Self-Care & Daily Living

What are self-care and daily living skills?
Simply stated, self-care and daily living skills involve the ability to care for one’s own needs, thereby facilitating independent living across a range of contexts, such as the school, home, and community. The following functions are commonly included within this skill set: self-feeding, drinking, dressing, bathing, grooming (i.e., tooth brushing, combing hair, nail trimming), and toileting. Other important self-care and daily living skills are proper sleep hygiene, participation in leisure and play activities, social communication, and safety awareness.

Many other skill areas are involved in self-care and daily living skills. These include but are not limited to the following:

• Sequencing: The ability to arrange thoughts, information, and actions in an effective order. For example, first socks, then shoes.
• Fine motor skills (involve the small muscles of the fingers and hand): Required for manipulation of buttons, unscrewing a toothpaste cap, and holding an eating utensil.
• Gross motor skills (involve the large muscles of the arms, legs, and trunk): Required for balance while inserting one leg into a pant hole, postural stability while seated on the toilet, and strength for carrying a school backpack.
• Sensory processing: Must understand where one’s body is in space to allow for dressing, be able to tolerate the feeling of water on the skin during bathing, and have the ability to attend to spoken or visual instructions regarding hand washing.
• Praxis: The ability to mentally generate and then physically execute a motor plan to achieve a desired result. For example, tying shoelaces is a complex task requiring the use of motor planning skills to first understand and then efficiently carry out the many steps involved.
• Bilateral coordination: The use of both sides of the body in an organized and coordinated manner. This is required when threading a belt through a loop, using one hand to hold a toothbrush and the other to squeeze toothpaste, and using one hand to stabilize a bowl and the other to stir.
• Social and language skills: Required for communicating one’s needs and interacting with others (i.e., telling a parent or teacher about need to use the restroom).
• Visual perceptual skills: The ability to cognitively understand what one sees with his or her eyes. Required for locating a sock from within a pile of laundry and matching a pair of shoes.
• Visual motor skills: The ability to integrate visual input with motor output for achievement of coordinated movements. This is required for obtaining food with an eating utensil and bringing cup to mouth.

So, why is this important?
Self-care and daily living skills are important because they enable a child to achieve maximal independence and success in their everyday life, which can in turn instill a sense of confidence and self-efficacy. Furthermore, self-care and daily living skills offer children an early methodology for practicing many of the foundational skills that will facilitate favorable outcomes across academic, community, and social contexts. For example, self-care tasks allow children to develop fine motor skills through the manipulation of fasteners such as zippers, Velcro, and snaps. Additionally, when participating in daily self-care tasks, children are able to practice sequencing skills (i.e., deciding which clothing item to put on first) and motor planning skills (e.g., formulating and carrying out a motor action to open a lunch container). Self-care and daily living tasks also incorporate gross motor, visual motor, and bilateral coordination skills. Developing this foundation translates into other skill areas, such as forming letters and numbers, understanding how to use scissors to cut paper, and participating in functional play tasks with peers (i.e., pushing Legos together to form structures).

What are some signs of challenges in this area?
Signs that a child may be experiencing challenges with this skill area may include the following:

• Relying on others to perform self-care tasks such as putting on socks and shoes
• Difficulties with toilet training
• Lack of motivation to develop independence
• Difficulties copying and learning from others, including peers
• Moving slow during morning routine
• Challenges with following instructions at home and at school

How can OT help?
Occupational therapists can assist children in developing self-care and daily living skills through the use of evidence-based interventions designed to promote independence and participation in everyday tasks. Occupational therapy services are intended to be fun and engaging while also aiding a child in achieving maximal success. For example, a child may be taught the sequence of shoe tying with a silly song or may practice buttoning a vest on a favorite stuffed animal. Interventions also involve strengthening the skill foundations underlying self-care, including fine, visual, and gross motor; bilateral coordination; sequencing; and more (i.e., strengthen visual motor skills required for self-feeding through practice of stringing large beads).

Lastly, a child’s progress and success is maximized when strategies are provided that enable carryover across other contexts. Thus, interventions frequently include family and caregiver training. For example, an occupational therapist may educate a parent in techniques for simplification of a complex self-care task such as brushing teeth, or provide a visual aid depicting the steps of hand washing (i.e., first soap, then water). Overall, the goal of occupational therapy is to equip a child and his or her family with the tools and resources necessary for achievement of success, independence, and participation in all areas of life.