The development of a child’s self-care skills is critical in the developmental process of children, especially between the ages of 1-8 years. Self-care skills include dressing/undressing, self-feeding, toileting, and grooming tasks (e.g., hand washing, tooth brushing, bathing, etc.).
Improving your child’s self-care skills can benefit him by developing his motor, visual-motor, sequencing, attention, and organizational skills, as well as confidence. Increasing your child’s skills will also benefit you and other members of your family by providing more time to complete other tasks.
Factors Influencing Skill Development
There are several factors that may influence your child’s participation in self-care tasks. Biomechanical issues (e.g., muscle tone, strength, range of motion, etc.) can influence a child’s ability to participate in self-care. For example, a child with decreased strength may have difficulty pulling socks on and off. A child with restricted range of motion may not be able to lift his arms to brush his hair.
Sensory processing can also affect a child’s ability to engage in self-care tasks. A child with tactile defensiveness may have difficulty tolerating various textures, which can affect his ability to dress, bathe, wash his hands, or brush his teeth. A child with motor planning issues may have issues maneuvering his body to dress independently.
In addition, interest and confidence in one’s ability can influence a child’s involvement in self-care tasks. As a result, it is important to initially make the tasks as fun and simple as possible. Then as the child becomes more independent, the task’s demands can increase. For example, dressing (including fasteners) may start with a doll during play and as the child demonstrates increased independence, those skills can be transferred to self dressing/undressing.
Lastly, opportunity is an important component. To adequately develop skills, children should be given frequent opportunities to practice the skills. Often parents complete many self-care tasks for their children due to time constraints, cultural influences, or other factors. By taking one self-care task at a time or a single part of that task to focus on, parents can readily provide more opportunities until the skill is achieved. For example, if a parent chooses to target dressing, it may be better to try it at night after bath time, instead of attempting it in the morning when everyone else is trying to get ready for the day. Then as the child becomes more independent, dressing can transfer over to mornings, freeing parents to complete other activities. Dressing can also be broken up into parts. A parent can choose to focus on dressing by first working with their child on removing and pulling up his pants after every diaper change or toileting.
Please refer to the following chart for developmental milestones for self-care skills.
Developmental Progression of Self-Care Skills
It is important to remember that all children develop skills differently. Some may accomplish many of the skills listed before the reported age, while others may demonstrate the skills several months after the indicated age. The sequence listed here is meant only to be a guide.
Progression of Self-Care Skills
Age: 1 1/2 years
- Cooperates with dressing by holding out his arms and legs.
- Finger feeds small pieces of food and begins to drink from sippy cup.
- Indicates discomfort when wet or soiled, has regular bowel movements, and will sit on toilet supervised.
Age: 2 1/2 years
- Removes unfastened coats and shirts, socks, shoes, and pulled down pants; unbuttons large buttons.
- Able to spoon feed, drinks from a straw, and begins to drink from an open cup independently.
- Toilet regulated by an adult and may need help getting on the toilet.
- Washes hands and brushes teeth with assistance.
Age: 3 1/2 years
- Dresses with assistance to orient clothing; pulls down pants independently; unzips separating zippers; buttons large buttons; uses snaps on the front of clothing; unbuckles shoes or belts.
- Begins to stab food with fork.
- Goes to the bathroom independently, but may need assistance to wipe and fasten clothing.
- Washes hands independently and begins to wash his face.
Age: 4 1/2 years
- Undresses independently; orients clothes; laces shoes; buckles shoes and belts; puts belts through loops; zips separating zippers.
- Washes face and brushes teeth independently; begins to comb and brush hair; bathes with assistance.
Age: 5 years
- Dresses unsupervised and learns to tie and untie knots.
- Begins using a knife to cut food.
- Completely independent with toileting.
- Combs and brushes hair independently.
Age: 8 years
- Bathes independently.
Also see our more comprehensive checklist of additional self-help milestones for ages 8 months to 7 years.
Now that typical development is understood, we will concentrate on general and task-specific strategies to improve your child’s continued independence.
Visual schedules can be used for many self-care tasks (e.g., dressing, toileting, hand washing, tooth brushing, bathing). Visual schedules are actual pictures, icons, or words depicting a daily schedule or steps for an individual task. Schedules can be very specific or general.
Chaining is another method that can be used with numerous self-care tasks. There are two types of chaining: forward and backward. In forward chaining, a task is taught step by step, by starting with the first step. For example, with hand washing, a child can first be taught to turn on the water, then wet her hands, get soap, and so on. In backward chaining, a task is taught by starting with the last step and working backwards. This method is often useful to provide immediate success, since the child completes the final step and the task is accomplished. Backward chaining can also be used for hand washing. For example, a child can first be taught to rub her hands on a towel, then rinse the soap from her hands, rub the soap on her hands, and so on.
Dressing/Undressing Using over-sized clothing or clothes with large openings (e.g., V-necks, boat necks) can help a child learn to dress and undress. Also, shorts and bathing suit bottoms are easier to put on than pants. Visual cues are often useful to help children orient their clothing (e.g., teaching a child to look for their tag or marking their clothes can help them orient back/front, socks with a different color toe and heel can help children orient them). Socks are often tricky for children to put on and take off, so starting with tube socks can make the task easier. Also, there are two methods for removing socks. Most children attempt to remove their socks by pulling at the toe. This method is often difficult for tight socks. An alternative method is the thumb hook method, in which the child puts her thumb in the sock at the heel and pulls it off. Clothing fasteners are another complicated aspect of dressing. First, use large fasteners on clothing that the child is not wearing. Then as the child becomes more independent, decrease the size of the fasteners and try them while the child is wearing the clothing.
Tooth Brushing One of the biggest issues with teaching children to brush their teeth is getting them to brush longer. There are now toothbrushes on the market that light up and represent the amount of time children are supposed to brush. In addition, using a vibrating brush can increase cleaning, without any additional effort from the child. Another strategy is to have a structured method for tooth brushing each time the task is done. For example, start with the bottom right side for five strokes, then the bottom left side for five strokes, and so forth.
Bathing Using a bath mitten instead of a washcloth can make bathing simpler. Also, using a hand towel to dry is often easier to control than a large dry towel. Foam or liquid soap is fun alternative to bar soap, which can also simplify bathing.
These are just a few suggestions for increasing your child’s independence with self-care. Remember children love play, so start teaching self-care skills in play first and then infuse them into self-care routines. Your child will be more confident and more willing to participate.