Motor skill difficulties

Below are some ideas for supporting children with learning cutlery skills, try different things to see what works for your child. You can also read ‘Daily living skills: Top tips for parents and carers’ which may be useful when thinking about the best approach.

Things to consider

How does your child sit?

• Can they reach the floor with their feet when sitting up to the table?
• Are they sitting at the right height in relation to the table surface?
• Are they well supported? Pull the chair close to the table, use a foot stool, small step or box to place their feet on

Have the right tools for the job

• A serrated knife is easier for cutting tougher foods, while a nonserrated knife is easier for spreading butter on bread.
• Cutlery designed for young children is often very blunt and makes cutting tougher foods more difficult.
• Use a heavier plate that doesn’t slip around. Non-slip mats can be useful (for example, silicone or dycem)
• Use the right sized cutlery. Cutlery with a chunky plastic handle is often easier to grip. Specialist cutlery like caring cutlery can be useful for some children.

• Hands should be pointing down towards the plate.
• Show your child how to point their index fingers down the knife and fork, using their “pointy fingers” to push down more strongly.
• Their other fingers need to stay wrapped tightly around the handle.

Try breaking the activity down into steps

1. First, get a good grip on the cutlery with it pointing upwards
2. Get your “pointy fingers” in the right place
3. “Stab” (push) with the fork
4. “Saw” with the knife (backwards and forwards motion, no tearing)

More ideas

• Practice using a knife and fork during fun activities, for example, play-doh or cookie dough, or their favourite food.
• Use a hand-over-hand technique by standing behind and placing your hands over theirs to guide while cutting. This allows your child to feel the movements needed for cutting.
• It is easier to practice cutting with soft foods, such as fish fingers, boiled potato, well-cooked vegetables. Cut round food (for example, potatoes or sausages) in half to stop them rolling around the plate.
• Gradually increase the amount of cutting they do. Allow extra time for practice. Make a deal with your child about the number of items they cut or how many times they try before you help them. This can be increased over time as they become more skilled and confident. Practice little and often.
• Many children need ongoing adult prompting to maintain their hand position and cutting technique, try asking questions about what they need to do, rather than giving instructions. Demonstrate how you use your knife and fork and make it obvious.
• Support your child to come up with a plan, how can they complete this task? What will help them remember? What comes next?
• Use a reward chart to record and praise their achievements at each step.

• Many children need ongoing adult prompting to maintain their routine.
• Help your child to come up with a plan that works for them. How can they complete this task? What will help them remember? What comes next?
• Break the task down in to small steps. Encourage your child to join in with very small parts of the routine, gradually increase how much they do.
• Use ‘chaining’ (see our introduction to getting dressed leaflet), if they struggle to start the task, you start things off and encourage them to do the final step. This also works if your child can start the task but struggles to complete all the steps, you take over.
• Use a reward chart to record and praise their achievements at each step.

Lots of ideas are given below. Try different things to see what works for your child. Read ‘Daily Living Skills: Top tips for parents and carers’ which may also be useful when thinking about the best approach.

Where do I start?

Environment and preparation

• Allow extra time. Think about what your child is doing before and after the activity, prepare them for a change of activity and what will happen afterwards, this can be motivating.
• What do you need now? (towel, clean clothes, toiletries).
• Can your child choose their own shower gel, soap, shampoo? (this can be motivating)
• What do you need afterwards? (for example, towel, deodorant, comb).
• Can your child get into the bath safely, can they sit comfortably and in a well-supported position?
• Consider using a step to help your child get in and out of the bath more easily.
• Consider a baby or toddler bath seat if your child is pre-school age.
• If your child is older and is not able to sit safely and independently in the bath, please consider whether an occupational therapy (OT) assessment would be useful for your child. You can find more information about how to refer to occupational therapy.

Washing

• Use a set routine: It is easier to remember what comes next, for example, wash the upper body, then lower body, or name body parts.
• Work from the top of your body downwards (or vice versa) each time: This acts as a memory prompt to wash everywhere.
• Use visual prompts to remind you and your child of the different tasks and the order
• Use a sponge, flannel or shower scrunchie: This makes it easier to lather and spread the shower gel or soap.
• Check: Does your child think they are clean? Have they washed and lathered everywhere? Have they rinsed well?

Hair washing

What steps are needed?

Try to keep techniques used consistent:

Wetting hair

• How long for?
• Could you use a timer?
• Do you need a jug to pour water on?

Getting the shampoo ready

• How much do you use?
• Could you use a measuring cup or spoon?
• How big should the blob of shampoo be?

Lathering shampoo

• How long for?
• Can the shampoo be applied in smaller blobs in different places (front and back)
• What kind of hand movements are needed to lather?
• Could you start at the front and work backwards, or vice versa?
• Can you use hand-over-hand to guide the movements?

Rinsing

• How can your hands help?
• How to rinse? Jug or shower?
• How long for?
• How to check hair is clean?

If your child does not like getting water in their face, remind them to:

• tip their head back
• close their eyes
• try a shower visor or shampoo guard

Drying

• Use a set drying routine, do things in the same order each time.
• Use hand-over-hand to demonstrate drying technique.
• Drying is often easier when sitting, for extra stability.
• Use a smaller towel (for example, hand towel) which is easier to hold and handle. Children can struggle to use bath sheets well.
• Wearing a towelling dressing gown is a great way to get dried.
• Encourage your child to think about how they know when they are properly dried.

What comes next?

Comb hair and get dressed. See our other leaflets for help with different tasks

This is an overview of general ideas that can help. Learning to dress is a complex skill which requires lots of regular practice and can take time. Encourage your child to do as much as they can for themselves.

Where do I start?

Environment and preparation

• Quiet room
• Have everything you need ready, including any visual prompts, for example, picture sequence
• Talk to your child about what you are going to do before you start
• Start with undressing, this is easier than dressing.
• Sit somewhere comfortable and stable where your child is supported, this makes it easier to think about the task in hand and not balancing.
• Put things in the same order and use the same techniques/routine each time.

Timing

• Go at your child’s pace
• Give lots of praise for practising skills even if they are not successful at completing the task straight away.
• Break it down and take things one step at a time, further information about the different aspects of dressing can be found below.
• Little and often can be better than spending a long time practicing one thing.
• Let your child do it themselves sometimes, they may do more when left alone.

Clothing

• Use loose fitting clothing with elastic waists, wide neck and arm holes.
• Ensure clothes are the right way round before starting.
• Talk about what you are doing as you are doing it, asking questions encourages independent problem solving.

Being aware

• Encourage your child to look at what you and they are doing.
• Encourage your child to look at themselves (maybe in a mirror) and decide if everything is right, if not, can they work out what is wrong themselves?

Techniques for learning dressing skills

Adapt the clothing

Could the items used for the task be more straightforward whilst your child is learning? For example, looser clothing, bigger buttons.

Change the environment

Could the environment or surroundings be changed to make the task easier?

• Quieter room
• No TV
• Reorganising where things are kept
• Can your child sit down to complete the task?

Grading

• Break the task into small steps and gradually involve your child more over time.
• It’s ok to start very small and provide some support.
• Encourage the next step in the task when they are ready.

Backward chaining

Here the adult begins the task, with the child only doing the last step. Gradually the adult does less as the child can do more for themselves. This way they always gets the reward of finishing the task, for example, you put the t-shirt over your child’s head and help them to get their arms through the holes. Your child then pulls down the t-shirt at the front and gets their reward!

Forward chaining

This is when the child starts the task (for example, putting the t-shirt over their head), and the adult helps with the later stages where more help is needed (for example, putting their arms through the sleeves). Your child needs to be motivated to begin the task themselves for this approach to work.

Visual prompts

• Using a sequence of photographs or symbols to support a dressing routine can be useful for some children.
• Encourage your child to look at the visual prompts at each step and consider what they need to do.

Problem solving approach

• Asking questions rather than instructing or telling encourages independent problem solving and supports the child to come up with their own strategies for dressing successfully.
• For children aged 6+ who have good communication, an “ask don’t tell” approach could be used to support independence in dressing skills.
• For example, ask your child:
  • what comes next?
  • what would help them remember?
  • is each step is complete? Encourage checking appearance/neatness and whether items look or feel right.

Hand over hand

This involves standing behind or next to the child and placing your hands over theirs. You can then physically assist them with gripping, pulling or completing the movements that the task requires, for example, pulling on socks.

Tops, jumpers, coats

Are clothes the right way round?

• Wear tops with a picture on the front. Point out the picture or ask them to find it.
• Put a coloured label on the back of the clothing. You may also want to remove other labels, for example, in the side seam of knickers. Encourage the child to find this to help them find the back.

Mark a key point to help

• Use stickers, permanent marker or a stitch of colourful thread to mark a key point on the item.
• Think about where will be easiest to spot the mark.
• Keep it consistent, mark all garments in the same place, in the same way.
• Ask questions: what’s on the front? Where is the tag?

Get a good grip

• Roll up the bottom, back edge of the clothing to give a good grip.
• Use hand over hand to help your child hold on to the right bit.
• Avoid slippery fabrics.

Can you find the arm and head holes?

• Lay clothes out flat in front of your child.
• Arms in first.
• Next, look and find the head hole.

Coats

• Choose a coat with a contrasting lining.
• Ensure coats are loose fitting, even when wearing jumpers or layers.
• Putting their nondominant arm into the coat first is helpful, their “best” arm is then still free to make the task easier.
• Put the hood on first, this means the coat sleeves are freely hanging and both hands are free.
• Drape the coat over the back of a chair with the lining facing outwards and sleeves hanging. Your child can then put each arm into the sleeves with their back to the chair.

Buttons

• Start practising with larger, flat buttons and move onto smaller ones.
• Practice with the garment on your child’s lap or on the table in front of them initially.
• Start practising with larger, flat buttons and move onto smaller ones.
• Use a “push and pull” method to fasten buttons.

• Is the button hole large enough for the button?
• Only undo the top 2 to 3 buttons when taking off a shirt and then pull it over the head, reducing the amount of fastening needed.
• Use Velcro instead of buttons, for example, on a shirt use Velcro and sew buttons onto the top flap.
• Leave the cuff buttons done up, or try sewing a button attached with elastic across the cuffs, this will stretch when the hand is pushed through.

Zips

• Test zips before buying for ease of use.
• Attach a key ring or tab to the zipper to help with gripping.
• Break the task into small steps: For example, pull the zipper down, slot the zip into the zipper, hold the bottom of your coat, pull it tight, pull the zipper up slowly.

Trousers, skirts, socks and shoes

Trousers, skirts and pants

• Get a good grip: Use hand over hand to help with hand placement and grasp, pulling up or pushing down clothing.
• Choose trousers or skirts with an elastic waist band if buttons and clasps are tricky.
• Encourage looking for leg and foot holes before starting, lay out the clothes flat.
• Are the clothes the right way round? Put a coloured label on the back of the clothing. Remove other labels, for example, in the side seam of pants. Use items with logos or pictures on the front.
• Use questions to prompt with self-checking, use a mirror if needed. This can be useful for tucking in shirts and making sure waistbands aren’t twisted.

Buttons and clasps

• Clasps and buttons on trousers and skirts can be difficult, especially as you can’t see clearly when fastening them. Practice with the item on your child’s lap or in front of them on the table.
• Make sure waistbands aren’t too tight, this makes fastening clothing much more difficult.
• Start practising with larger, flat buttons and move onto smaller ones.
• Use a “push and pull” method to fasten button.

Socks and tights

• Avoid tight fitting socks.
• Choose socks with different coloured toe and heel, as a prompt to help with getting toes and heel in the right place.
• Mark the back of the sock with colourful thread on the inside top edge.
• Roll down the top of the sock for ease of grip.
• Sew a loop on the back of the sock for your child to grip and pull up.
• Show your child how to hold the sock and support them to grip it with their thumbs inside and fingers outside, using hand-over-hand if needed.
• Use simple verbal cues such as “thumbs in, foot in, pull up”.
• Roll tights down and use hand over hand to support your child to hold them.
• Place their foot and toes in first, and pull up.

Shoes and shoe laces

• Use stickers or markers inside or on shoes to help with identifying the right feet.
• Flat laces are easier to tie. Ensure that the laces are long enough to comfortably tie a bow.
• Practice with two different coloured laces tied together and laced into one shoe. This helps when starting to cross the laces over.
• Practice with a shoe on the table in front of your child, or with it between their knees so it is easier to reach.
• Make a plan for shoelace tying by breaking the task down into very small steps and practicing each step.
• Can they think of a silly rhyme, story or poem to help remember the different steps and actions? Use their ideas!
• Alternatives to shoelaces include Velcro fastenings, elastic laces, springy-spiral laces, slip on shoes.

Early skills

Your child needs to be developmentally ready for toilet training

• Can they get onto the toilet and balance?
• Do they know what the toilet is for?
• Do they show awareness of being wet or soiled?
• Can they communicate their needs?
• Can they stay dry for an hour?

You may need child-friendly equipment, for example, potty, ringreducer for toilet seat, step up to toilet, big girl or big boy pants, easy access clothing.

Helpful strategies

• Use a reward system: It is essential that your child understands what is expected and that the reward is meaningful and motivating. You could use stickers or tokens or let them choose new pants. Give lots of praise and positive feedback and share successes with important adults.
• Visual cues: Let them see the contents of their nappy and help you empty it into the toilet. Show them that adults use the toilet too. A visual toileting sequence can also help their understanding.
• Grade the changes: Always change your child’s nappy in the bathroom, standing up if possible. Gradually introduce sitting on the potty or toilet with and then without clothing. Slowly increase the amount of time your child sits on the toilet, using toys for distraction.
• Routines: Prompt them to sit on the toilet at set times of the day. Keeping a record of the times they wet or soil will tell you the best times to prompt them to sit on the toilet.
• Speak to your GP if you have any medical concerns or need a referral for specialist support with toilet training.

To achieve independence with toileting, your child needs to manage their clothes, wipe or wash their bottom, flush the toilet and wash their hands without help or supervision.

Wiping top tips

Teaching to wipe

• Use a backward chaining approach: Wipe your child’s bottom and encourage them to do the final wipe. Ask them to check the toilet paper to make sure it is clean. Gradually reduce the number of wipes you help with until they are wiping and checking independently. Put your hand over your child’s hand to guide the direction and pressure they need to wipe. Gradually reduce your hand support but continue to supervise and give verbal prompts.
• Practise wiping at other times, for example, wiping their nose, helping to clean surfaces, and playing games, the wipe clean game can be a fun, motivating way to develop skills. Please see our website for a link to the game.

Too much or too little toilet paper

• Agree how many sheets your child will use and count them out together. Use a rhyme or a picture reminder.

Wiping in the wrong place

• Practise wiping when clean to avoid mess. Check they are reaching to the right place. Use hand over hand guidance if needed.

Difficulty tearing the paper

• Make sure they can comfortably reach the paper. Try using a box of tissues instead.

Difficulty scrunching or folding paper

• Demonstrate and practise how to fold, for example, in half and half again. Show your child how to hold the paper and protect their fingers.

Worried about getting messy

• Use good quality toilet paper or wet wipes (dispose of wet wipes in the bin to avoid blockages). Experiment with different folding techniques, and consider disposable gloves.

Common problems

Unstable on toilet

• A step for the feet can provide stability and good pelvic positioning.
• Try different positions for best stability and reach, for example, standing or squatting to wipe.

Forgets what to do or gets distracted

• Put a visual sequence on the bathroom wall to remind your child what to do next and keep them on track. Try to use questions, for example, ‘what do you need to do now?’

Accidents

• Give prompts at regular times, for example, morning, before bed, after meals. Encourage them to sit on the toilet whether or not they feel the need to go.
• Ensure they can manage their clothes. Adapt fastenings if needed.

Rushing

• Prompt your child to slow down and take the time to check they are clean. Explain that keeping clean prevents smells and sore skin. A social story may help them to understand the importance of toilet hygiene.

Poor motivation

• Set out expectations and encourage your child to participate as fully as possible, for example, adjusting clothing, flushing the toilet, and attempting to wipe.
• Reward independence and effort. You could use a sticker chart or token system tailored to your child’s interests.

Sensory issues

• Reduce sounds and smells by putting the lid down when flushing, using ear defenders, or putting pleasant smells on a tissue/in the room.
• Show your child how the toilet works and make it child friendly with a colourful toilet seat or putting food colouring in the cistern.

Smearing

• Try to unpick why it’s happening and address the problem.
  • Is there a medical reason such as constipation?
  • Does your child need to develop their wiping skills?
  • Do they enjoy the feeling or smell and need more opportunities for messy play?
  • Are they avoiding the feeling of the toilet paper or the cold seat?
  • Do they find the adult attention rewarding?
• Try to stop it happening in the first place. Keep your child’s hands busy with toys, or use all-in-one bodysuits to prevent access to their pants.

Aiming

• Check your child can reach the toilet easily. Use a step or encourage them to sit down. Stick-on urinals are available for younger boys.
• Check they are looking at what they are doing. Put a ping pong ball or a target sticker in the toilet bowl.

Using scissors involves a range of skills such as hand eye coordination, vision, attention, using both hands together, dexterity and strength. It takes time to learn and is an important skill for many arts and craft activities which are meaningful and fun!

Pre-scissor skills

• Encourage two handed activities. Start with hands doing the same thing together. Move onto hands doing different things at the same time, for example, using one hand to stabilise when opening jar lids and winding up toys. Then progress to activities such as threading, doing buttons, zips and using a knife and fork.
• Develop grasp and finger strength through play, for example, post boxes, wind up toys, tearing paper and finger puppets.
• Encourage squeeze and release hand movements, for example, using tongs and tweezers, pegs, pinching playdough
  and squirt bottles.
• Practise snipping straws, playdough, paper edges and making fringes out
  of card or toilet rolls.
• Practise pushing forwards after each snip by cutting along longer lines.

Scissor skills

• Choose the right scissors: Short blades, small oval holes, rounded ends for safety but make sure they are sharp enough to cut or they will cause frustration.
• It is important to use scissors designed for the dominant hand. Otherwise the blades block the line vision and create tension in the wrong direction. Cut in the right direction, right handers go anticlockwise around a circle and left handers clockwise.

Grasp

• Keep both thumbs on top when holding the paper and the scissors. As a reminder you could paint thumb nails, have a thumbs up sign, or put a sticker on the thumb hole.
• Ideally the thumb and middle finger are inserted in the holes with the index finger on the outside for stability.
• Sit in a good position, tuck in elbows or rest them on the table.
• Turn the paper not the scissors, keeping them straight and cutting away from the body.

Cutting

• Start by cutting along thick lines before gradually making the lines thinner. Draw roads or train tracks to keep within.
• Practise stopping accurately. Draw lines with pictures or stickers at the end to indicate where to stop.
• Use stickers or dots to break the line into sections and prompt turning the paper.
• Practise straight-lined shapes first, moving on to circles and then wavy lines. If the shape is on a large piece of paper, roughly trim the shape first to make it easier to hold.
• Start by cutting thin card before moving onto paper.
• Have a look at free online resources which suit your child’s interests.
• Have a good clean up routine!

Scissor types

Adapted scissors can help children who have a weak grip and poor control. A range of adapted scissors are available from Peta and other retailers. Shop around for cheaper prices!

Top tips

• Thumbs on top and elbows tucked in
• Turn the paper, not the scissors
• Cut away from the body
• Match the activity to ability
• Have fun.