Q An eight-year-old who was in foster care for most of his life is absolutely terrified of water. He was just returned to his mother and it seems he was never introduced to washing. His mother tried to bathe him starting with only one inch of water in the tub and added some bubble bath and toys, but he would only stand in the water. Each time water from the washcloth would touch him, he would jerk and scream. We think he is just freaked out by the concept of cleaning, because this is something he's never done. What can we do to get him clean for school and how do we introduce him to bathing without him being so terrified?
When a child is struggling with tasks of daily hygiene it can be very hard. Sometimes they also face bullying and trouble in school as well as impairment at home. Seeking out a qualified provider like a behavioral therapist who can create a formal hygiene plan is going to be important for this family. They may also want to consult with an occupational therapist to determine if this child has any sensory needs that require support.
For now, beginning with small exposures to water and bathing — what we call “graduated exposure” — is a good place to start. This can even mean just talking about bathing and personal hygiene. For example, any time his mother is washing her hands or taking a bath or shower she might mention it — just let it be a common thing that they talk about. They can also read books about taking baths or use something called “social stories,” which are very simple stories that help children get more comfortable with things they find challenging. Using a social story specifically geared towards why we bathe and the steps of taking a bath to make it more familiar.
Practicing exposure through everyday situations can also help. For example, when his mom is washing dishes or preparing food for dinner she might say, “My hands are in the suds. It feels wet and cold. What does it feel like for you?” Or they can practice on other things in the house, like giving the dogs a bath. So she’s creating a context for him to get used to the water in a way that is very low pressure — it’s not about getting him bathed in that moment.
When it comes to being clean and appropriate to go to school, getting creative and starting with things like wipes can help. So can acknowledging some body autonomy by asking for permission to do things and starting small. Maybe his mom can say, “Can we start with a high five first?” when she has a wet washcloth on her hand. She isn’t trying to surprise or scare him, which could make washing become more difficult. Or she might ask, “Do you want to wash your right arm or your left arm first?” Or, “Do you want to use bubble bath tonight or not?” Giving him the opportunity to make decisions, such as picking between the bath or shower, or choosing his bathing toys and the towel he can use to dry off will make the washing feel less forced. Since he’s older he might also appreciate having the washcloth and getting the opportunity to do it himself.
His mom can also try pairing washing with things he likes, such as a favorite activity or tv show, to motivate him. She could say, “First we’re going to wash your arms, then we’re going to wipe your legs, and then we’re going to be able to watch your show.”