Children with cerebral palsy have abnormal movements and muscle tone that make it challenging for parents to pull apart the thighs in order to change a diaper. Muscle tone refers to the amount of resistance felt when bending a joint such as the hips or knees. Children with cerebral palsy may have muscles that are
• Overly stiff (hypertonic or spastic)
• Loose (hypotonic) or
• Athetoid (characterized by involuntary movements)
The athetoid child may kick a lot, but it should not be too difficult to change a diaper while the child is on her back. The hypotonic child's limbs are excessively easy to move and should also not present a challenge to dress or undress. However, changing the child with spasticity can be difficult because
• there is resistance to movement
• lying on her back promotes abnormal reflexes
• the child may assume an abnormal posture such as "scissoring" the legs (knees turn inward)
How to Relax, Stretch and Position Your Child
Step 1
Relaxing the Child
It is important to help your hypertonic child to be as relaxed as possible before changing her diaper. Speak to your child slowly in a calm voice; soothing background music may be helpful. Sit in a chair with the child straddling your thigh (if she is small enough). This position opens up her hips and relaxes the muscles. Slow movements such as the following also help to decrease spasticity:
• Place your child on her side with her hips and knees bent and a small rolled up towel between her knees. Support her head and shoulders as you roll her onto her back, keeping her hips and knees bent; then gently rock the knees from side to side. A small rolled-up towel under her head will help prevent back arching.
• Slowly rock a baby in a cradle or in your arms.
• Place a baby inside a small blanket with two people holding opposite ends and slowly swing the baby.
• An older child can be relaxed by rocking her while over a large therapy ball (on her belly).
Step 2
Positioning the Child on a Changing Table or Floor
Provide a small rolled-up towel to place under the child's head. Position her with her hips and knees bent and head curled forward as much as possible before placing her on the table. If you are changing a baby, try to have her touch her toes or better yet taste them. Babies typically play with their toes and put them in their mouths between 6 and 9 months of age.
Step 3
Provide Gentle Stretching
If it is still difficult to open your child's legs in order to change the diaper, place a small pillow between the knees and gently rock the legs (with knees bent) from side to side. Children with increased muscle tone benefit from daily stretching, and diaper changing is a great time to do it. Relax, talk and sing to your child.
Step 4
Preparing to Pick Up the Child
Never pick up a child with cerebral palsy by pulling on her hands. It is best to provide support at the head, shoulders and hips when picking the child up. Help your child to keep her hips and knees bent while carrying her positioned on her side or straddling your hip. Avoid carrying or positioning a child with hips and legs extended (straight) because that position promotes spasticity.
References
- "Handling the Young Cerebral Palsied Child at Home", Nancie R. Finnie;1975.
- "Teaching Motor Skills to Children With Cerebral Palsy and Similar Movement Disorders", Sieglinde Martin, 2006.
