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Beds & bedding.

Children spend many hours in their bedrooms, awake and asleep. Knowledge of a child's abilities, along with necessary adaptations, can enhance the enjoyment of everyday bedroom activities.

Positioning. For children who are likely to remain in one position during sleep because they are unable to move about easily and/or have difficulty in controlling the position of their body parts while in a lying position, the position in which the child sleeps (e. g., the legs raised) may need to be modified. The specific bodily support provided via proper positioning can aid such bodily functions as circulation and elimination, reduce the likelihood of deformities and prevent pressure sores. A properly positioned child can also control his or her movements better because there is reduced muscle stiffness.

Positioning is also important for some children with special health needs to facilitate breathing or digesting during sleep and prevent medical complications.

With the clinical team, parents can discuss the pros and cons of lying on the stomach (called prone position), on the back (supine) or on one side or the other. They can also review whether the child's head, legs or other body parts should be propped up or tilted down via the use of mattress raisers or wedges.

When a child tends to keep his head turned to one side, parents can ask whether it is helpful to try to change this tendency by requiring the child to turn his head to enjoy certain activities. Or, when a child cannot reposition himself, parents need to find out how often it will be necessary to reposition him or her.

For children who must remain in a bed for extended time periods, it is always important to find ways to move the child to where the action is: to the kitchen, playroom, living room or outdoors.

Beds. While cribs rarely need to be adapted initially, once a child can move about in the crib various padded "bumpers" or guards around the crib are helpful to prevent injury. For an older child, some padding for the "bars" may be necessary As a child develops, a junior bed, with a removable head, foot boards and sides, can provide protection from falling. Bedguards can be padded with cloth or foam to prevent injury.

For the child in a crib, a mobile and some crib toys can provide important stimulation. Young children also enjoy photographs of parents, siblings and pets near their beds. These familiar pictures create a pleasant atmosphere and provide "company" on lonely nights. As interests and tastes change, older youngsters will be eager to decorate accordingly and are likely to add pictures of other "heroes" and "heroines."

Accessibility of beds. It is easier for adults to dress and care for a child in bed when the bed is raised. A raised bed may also be better when a lift is used to transfer the child out of bed because the base or other parts of most lifts require some space between the floor and the bed.

Wooden blocks under the legs raise standard beds, while manually adjustable or electrically adjustable beds provide ways to alter the height and position of certain sections of the bed. However, when a bed is raised, it makes it more difficult for a child to get in and out and can increase the risk of falling. An electrical lifting device under the springs can make it possible to raise the bed for the convenience of parents as well as lower it when the child is climbing in and out. An ADL ladder or an over the head trapeze bar, fastened t the bed, can help a child to pull himself up.

Most children can use an ordinary bed when the mattress or the bedding and sleeping surface is appropriately adapted. For some children with complicated needs, hospital beds, which are moveable and adjustable for height as well as for elevating or lowering a child's head or feet, may be needed. Water beds or other special mattresses can help to relieve pressure as well as to prevent sores.

It is difficult to get out of most water beds. However, an accessible water bed can be designed which provides compartments and lids for storage as well as a transfer and dressing surface.

Mattresses and sleeping surfaces. A mattress should facilitate an even distribution of a child's weight while being comfortable. Most therapists suggest a mattress that is neither too hard nor too soft. For safety in getting in and out of bed, the edges of the mattress need to be firm; bedboards may help firm up the mattress.

Various types of mattresses, (air mattress, water flotation mattress, dry flotation mattress and others) and sleeping surfaces (pads of different materials, pillows and inserts) can be used in meeting individual needs for comfort, to facilitate movement and for the prevention of pressure sores. Since there are many different types of materials available, parents can review the options with the clinical team and, if possible, test specific items before purchasing them.

Meeting other needs. Other devices can be helpful to meet individual needs. For example, for a child whose feet and legs get cold easily, bed warmers provide heat. If the touch of a sheet or blanket is irritating, a folding blanket cradle can keep the blanket off the sensitive area. A sheepskin cover can be placed on top of the bed sheet to provide air circulation and cushioning; bed underpads promote both hygiene and the preservation of the mattress.

An intercom enables parents to hear sounds from the child's bedroom while they are in another room. A child with a hearing impairment can use an alarm clock which flashes on and off or vibrates the bed. For reading or playing in bed, a folding back rest makes sitting up more comfortable and provides firm support for the head and neck. A foam elevating arm tray can be inserted into some back rests to provide a comfortable, raised position for the arm and hand. A page turner can help children who cannot turn pages. For writing in bed, a lap cushion provides a firm surface to write on.

For any child with limited mobility, the items they need should be within their reach. Over the bed tables or night stands act as convenient storage areas and can provide accessibility to toys or tissues; or bed pockets fastened to the bed can hold magazines and books.

All children will enjoy having some say in the choice of furniture and decorations, as well as with the arrangement of items in the room in which they will spend many hours, awake and asleep. A child's bedroom - carefully, comfortably, and cheerfully furnished - can become a personal haven, a hideaway and a place for rest.

PRESSURE SORES: Also called decubitical ulcers or bedsores, they can be a serious problem for individuals who sit or lie in one position for long periods of time. By remaining in one position, circulation to the skin is decreased, making the skin surface more vulnerable. When the skin breaks open, serious infections can occur which can spread throughout the body and effect bones as well as skin. Pressure sores are most likely to occur in areas where bones are near the surface of the skin and in areas that support weight. Parents need to watch for the beginning signs of pressure sores (redness, blisters, or scabs) so they can take appropriate action quickly.
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Author:Klein, Stanley D.; Schleifer, Maxwell J.
Publication:The Exceptional Parent
Date:Jan 1, 1990
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