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“Use both hands”: Helping toddlers learn self-help skills

“I have to quit teaching and take care of my mom,” Liz tells the child care director. “When Mom gets out of the rehab hospital next week, she’ll need someone to care for her.”
“I’m sorry to hear that,” the director says. “We hate to lose you. Maybe you can come back in a few weeks or a few months?”
“I don’t know,” says Liz. “When Mom turned 85, I started helping her out with cooking and cleaning. But now with this broken hip and memory loss, she needs help with everything—eating, bathing, dressing, using the toilet….”
She pauses, staring out the window. “Funny, isn’t it? These are the very things I teach toddlers how to do.”

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In early childhood education, we call them self-help skills. In elder care, we call them activities of daily living. They are the ordinary tasks of everyday life.
Their ordinariness makes them no less important. As the example above indicates, the loss of self-care skills in an aging relative can affect jobs, family life, and finances, not to mention the elder person’s privacy and self-esteem.
When seen from this perspective, self-help skills in toddlers assume great significance. A child’s acquisition of these skills can affect jobs, family life, and finances. In addition, these skills play a huge role in the social-emotional development phase that psychiatrist Erik Erikson called autonomy versus shame and doubt. The goal is that by about age 3, children are well on their way to autonomy, confident and pleased with their newly developed abilities.
What’s more, we adults expect these skills to conform to health and cultural standards. Yes, children will learn to feed themselves, but we want them to know how to use a fork and spoon and use these utensils with the appropriate foods. Yes, children will learn how to eliminate body wastes, but we want them to know how to wipe themselves and wash their hands afterward.
In early care and education, helping toddlers learn self-help skills is more a matter of opportunity than curriculum. The opportunities occur largely in daily routines and transitions. Toddlers learn to use spoons, for example, during snack and mealtime. They learn to wash their hands before eating and after diapering or toileting.

Use a developmental approach
Between 18 months and 3 years, children are developing physical skills that enable them to learn self-care tasks. They progress through gross motor skills —walking, running, climbing, hopping, and jumping—and move toward fine motor skills, such as scooping up food with a spoon and buttoning a button. They need some degree of physical coordination to be able to pull down their pants to use the toilet.
Toddlers are also developing language and cognitive skills. Children need to know the meaning of arm and sleeve to learn how to put on a jacket, for example. They need memory skills to turn on both faucets part way make the water warm and not too hot or too cold.
Because toddlers are still acquiring these physical and mental skills, safety is a primary concern. Take precautions in setting up the toddler room and supervise carefully. By observing and getting to know individual children, teachers know when and how to offer help. Jeremy needs someone to hold the bottom of the zipper while he pulls it up, but Kayla insists on doing it herself.
In caring for children with limited physical or mental abilities, consult with the child’s parents and Early Childhood Intervention team. For a child with cerebral palsy, for example, the ECI team may suggest seating the child in a specially designed chair to help with body balance while eating.
In all interactions with children, use positive guidance. Instead of saying “Don’t spill it,” for example, say, “Use both hands to hold the pitcher.” In no circumstances do adults shame a child. Whether a child spills milk or has a toileting accident, the teacher treats the incident matter-of-factly. Likewise, adults never punish children by withholding food or keeping them in soiled diapers.

Tips for teaching
Self-help skills for toddlers fall into four main categories: washing, eating, dressing, and toileting.

Washing
Hand washing. Make it a habit for children to wash hands before eating and after diapering, toileting, or nose wiping. Make sure soap, paper towels, and a trash can are within a child’s reach. Provide sinks at a height that children can reach comfortably, or a sturdy step stool that children can stand on.
Spend the first few days teaching children which faucets are hot and cold. Demonstrate how to turn on both faucets part way to make the water warm. Show how to test the water with one finger before putting both hands in the running water. Supervise children as they wash their hands and offer help to make sure they are doing it correctly.
Safety note: Adjust the water heater temperature to below 120 degrees F. so it won’t scald children.
Tooth brushing. Introduce tooth brushing, but don’t expect children to do it independently until they are about 4 years old. Provide soft-bristled, child-sized toothbrushes and, if possible, children’s toothpaste. Help children squeeze a small amount of toothpaste on their brushes.
Show children how to spit out the toothpaste and rinse their mouths with water. Be aware that some children will need time and practice to learn how to spit out effectively.
Nose blowing. Teach this skill when children have a runny nose. At first, you might hold up a mirror so the child can see how the nose looks with drainage coming out. Offer a tissue and let the child wipe, while looking in the mirror. Encourage the child to blow gently—not too hard—and wipe the nose. Make sure the child tosses the tissue in the trash. Keep tissues within easy reach.

Eating
Weaning from the bottle or breast. If children are not weaned by 18 months, encourage parents to begin. Check to make sure children are sleeping through the night, and that parents will follow the same feeding schedule on weekends that you use on weekdays.
Generally weaning starts with the child’s least favorite feeding time, such as afternoon snack, and ends with the child’s most favorite feeding time, which is usually before bedtime. Substitute a drink from a cup at the targeted time. Do this for at least a week before targeting the next feeding time, which gives children time to adjust.
Eating family-style. Family-style eating, though messy and often challenging, helps children develop language and social skills in addition to feeding skills. Younger toddlers may sit in highchairs or booster seats at an adult-sized table. Make sure children’s elbows are at table height. A child-sized table and chairs allow children to seat themselves and assist with setting the table. Provide a child-sized spoon, a plate or bowl, cup, and paper napkin for each child.
Always begin by having children wash their hands. Then have them take a seat at the table, where the cook has placed serving bowls of food and small pitchers of water and milk. Start a conversation about the food, naming each item and commenting on such things as color and texture. Over time, you can talk about the place settings, activities the children are doing at school, or news about their families.
Pass one bowl at a time. Hold the bowl while each child takes a serving. At first, you may need to help the child grasp the serving spoon, scoop up a small serving, and transfer it to the plate.
For pouring, instruct one child to use both hands to hold a cup firmly to the table. A second child uses both hands to hold the pitcher and gently pours the milk into the cup—but only about halfway.
Remember that toddlers are growing more slowly than they did as infants and probably will have smaller appetites. Never force children to “eat one more bite” or clear their plates. If you offer dessert, make it a nutritious part of the meal. Don’t offer it as a reward for eating everything on their plates.
End by having children assist with cleanup, which may require three trips. First, children empty their cups and stack them in a designated place. Second, they scrape any remaining food from their plates into the compost container and stack the plates. Third, they put napkins in the trash.
As children move to toileting or napping, you clean off the table with a diluted bleach solution and sweep the floor.
Eating with a spoon. Offer at least one finger food while children are learning to eat with a spoon. You can help feed the child with another spoon or fork. Encourage children to chew foods slowly and eat with their mouths closed. By about age 2 1/2, they can begin spearing food with a fork.
Drinking from a cup. Typically, children are introduced to “tippy” or “sippy” cups when they begin eating solid foods, about 8 or 9 months of age. These cups have a lid with drinking slit or spout to prevent spillage, and some have a straw and handles. Use tippy cups only at snack and mealtime; don’t let children walk around with one.
When moving to a cup without handles, encourage children to hold it with two hands and fill it only halfway.
Drinking through a straw. When children are learning to suck the liquid, they may release it before it gets all the way to the top. If so, you can cut the straw in half.
Safety note. Don’t give small foods that can cause choking. These include nuts, seeds, raisins, and other dried fruits. Cook hard foods such as meat and vegetables and cut them into small pieces. Cut grapes into quarters, and avoid serving chewey foods like hot dogs and peanut butter.

Dressing
Pulling off clothes is typically easier than putting them on. By about 18 months, many children can pull off caps, socks, and shoes (unlaced). About age 2, they can begin learning to put on clothing—jackets and mittens before outdoor play and shoes after nap.
Dress-up clothing can provide practice in zipping large zippers, buttoning large buttons, snapping snaps, and buckling buckles. Older toddlers may enjoy practicing with fastener boards, either homemade or commercial.
Safety note: Make sure buttons, snaps, and other fasteners are secure. They can be a choking hazard.
Encourage parents to dress toddlers in T-shirts, pants with elastic waists, and shoes with Velcro fasteners. (They won’t learn to tie shoes laces until they are 5 or 6 years old.) Ask parents to provide a change of clothes because many activities are messy.
As part of routines, remind children to put away their jackets in their cubbies after arrival, and hang paint aprons on hooks after painting. Keeping the room tidy is an important self-help skill.
Safety note: Don’t let children share hats, brushes, and combs to prevent the spread of lice.

Toileting
Learning to use the toilet can take a long time. Many children will continue needing help until age 4 or 5. Parents’ cooperation is essential. Avoid starting during times of change or stress, such as having a new baby at home, weaning from the bottle, and changing teachers.
The key to learning this skill as quickly and with as little stress as possible is a child’s readiness. The child must be physically ready; that is, the bladder must have grown large enough to allow fewer urinations (compared to an infant’s 12 times a day). The child must also have developed control of sphincter muscles that hold and release urine and feces.
Children will show other signs of readiness when they:
have a predictable pattern each day;
understand and use words such as potty, pee, and poopoo;
can pull their pants down;
can wash their hands; and
indicate discomfort with soiled pants.
Ideally children have already learned toileting words from conversations during diapering as infants. Extend these conversations by showing the child that you drop the poopoo from the diaper into the toilet, and let the child press the flush handle.
Beginning about 15 months, offer casual opportunities to learn about the toilet. Tell stories and read books about going to the potty. Afterward, you might provide a clean potty (never before used) and a doll that can sit on it.
Introduce toddlers to the bathroom. Point out the potty chairs or child-sized toilets, and answer children’s questions about them. Invite children to sit on a potty with their clothes on to ease potential fears.
If you’ve noted a child’s elimination pattern, you may be able to anticipate bowel movements. Encourage the child to sit on the potty with diaper and pants off at the expected time, but no longer than about 10 minutes.
Expect accidents to happen, and treat them matter-of-factly. “Oh, an accident. Let’s change your pants.” Offer praise and encouragement for trying.
When children are successful, express approval but avoid over-praising or giving rewards. Ideally they will want to learn toileting to feel good about themselves, not to earn prizes. Show them how to pull out an appropriate amount of toilet paper and wipe. Instruct girls to wipe from front to back.
When the child has had about a dozen successful attempts, begin using training pants. Ask parents to use cloth training pants rather than paper or plastic ones. Disposable training pants are still diapers to a child. Children who can go for a few days without an accident can begin wearing underwear.

Moving toward autonomy
Children continue developing self-help skills as they move through the early years and adolescence. They learn to bathe themselves, wash their clothes, use a telephone, prepare meals, ride a bicycle, and drive a car.
The foundation for self-care tasks is laid during the toddler years. Our role as caregivers is to provide a safe environment and the guidance to help them begin learning to do things for themselves.