Home Help for families Information & Advice Health & medical information Hemiplegia support For professionals Early years
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The information on this page is for professionals who work with young children in nurseries, playgroups and other early years settings. It focuses on hemiplegia, but much of it will apply to children with other complex needs.
“Soap box time, but if small people know that children like Aimee can attend nursery and school with them maybe their reactions will continue to be warm and we will have less restricting attitudes in our adults!” – says a parent of a three-year-old.
Early years workers may think they need to know about a wide range of conditions, and this may hold them back in feeling able to welcome and include all children. In fact, including disabled children is more of a case of extending ordinary good practice and recognising that all children have interests, ideas and aptitudes while supporting early years workers working with the more complex impairments.
In a successful inclusive nursery there is a positive attitude towards disabled children where staff support and encourage children to reach their potential. In order to achieve this staff need to:
Find out about hemiplegia and its symptoms.
At this age it is mainly their physical differences that distinguish children with hemiplegia from their classmates. But there are other difficulties known to be commonly associated with hemiplegia, which may or may not be apparent at this age. These include speech problems, visual perceptual problems, specific learning difficulties and emotional and behavioural problems.
For many children, these problems can be more frustrating and disabling than their physical difficulties. Obviously, the earlier they are identified and addressed, the better the chances of successful intervention, and nursery teachers are ideally placed to pick up early signs of potential problem areas.
Many everyday tasks, such as eating, dressing and going to the toilet are more difficult if you have only limited use of one hand. The children may need more help and take more time in these areas, and may need to have the tasks broken down into stages to help develop the necessary skills. For example:
At the same time, teachers and helpers should try to resist the temptation to do too much for the child: the aim should be to encourage independence.
Children with hemiplegia are just like all other children and simple solutions are often the most effective. Some people find it tempting to overprotect a disabled child. It is easy to make assumptions about capabilities. Children with hemiplegia are usually much more robust than we think!
The ideas here are only suggestions. Every child is unique, and you – working in partnership with parents and professionals – will find particular ways of dealing with these practicalities that work for that child!
These suggestions are about how you lift, carry, hold and position a child and learn to control any muscle stiffness or uncontrolled muscle movements. The best way to handle a baby or young child depends on age, type of hemiplegia and how the body is affected. Here are some suggestions, by no means exhaustive:
“People assume that if a child is disabled they want to spend all day in the same place – but disabled children have just the same aspirations – they want to see the changing world around them like everyone else. They just need physical help to get there!”- says a parent.
Some children with hemiplegia cannot suck and swallow and chew easily, so eating may be messy. It may also take longer but it is important to take time to ensure that the child has a healthy diet. A health visitor can advise, and a speech and language therapist can give specialist help and support if a child has difficulties when eating.
Trying to encourage children to be as two-handed as possible begins from the moment they start to feed themselves. It is important to reinforce this. Children need to be reminded to drink holding the beaker with both hands, and if eating with only one hand, to place the other hand flat on the table. A non-slip mat may help to anchor the plate.
Staff may be the first to encourage a child to feed himself or to make choices about food and drinks. There are special cups and pieces of cutlery that may be helpful. They may already be in use at home or parents might have brought them in, but a health visitor or occupational therapist will be able to advise.
Brushing teeth is particularly important when children have eating difficulties, since food can easily get stuck in their teeth and gums, and this can lead to tooth decay and gum disease. It may be worth checking the roof of the mouth if food has a tendency to become lodged there. Try to help the child brush his teeth after every meal and cut down on sugary food and drinks.
“It is a good idea to focus on low-tech aids that all children can use that don’t highlight differences – things like Velcro and rubber suction mats.” – says a parent.
Toilet training may be more difficult for a child with hemiplegia. For example, it may be hard for him to relax or use his muscles to empty his bowels. Continence can sometimes be a problem, too. A therapist or health visitor can give him help and support.
Getting dressed or changing clothes can sometimes be difficult for children with hemiplegia. It is likely that parents will already have discovered the practicalities of loose, comfortable clothing. Velcro and elastic can be easier to manage than buttons and zips. There are also specialist suppliers who design clothes with the needs of disabled children in mind.
See also our advice on dressing.
“Communication falls into the same category as food, drink and shelter – it is essential for life, and without it life becomes worthless.” Anne McDonald, campaigner.
Most of us who use the common form of communication ignore the many other methods of communicating, such as signs, symbols, behaviour, hand / eye-pointing, facial expression. This is called unaided communication. It does not involve any external materials or equipment, and is used by all of us unconsciously when speaking.
Disabled children are not always able to use the full range of unaided communication. They still express the same feelings, albeit in a modified manner, such as going into extension spasm with excitement. Aided communication is called augmentative communication and refers to techniques, symbols and strategies, often referred to as low-tech, that are needed to aid children with a communication need.
Augmentative and Alternative Communication (AAC) is a means of replacing spoken words by an individual. It can range from a movement or behaviour that is interpreted as meaningful, to the use of code agreed between people where items have specific meaning, i.e. language.
1Voice Communicating Together is run by parents for users of low-tech and electronic communication aids and it offers information and support.
Communication Matters is a charitable organisation which covers the whole of the UK.
I Can is a collaboration of three communication organisations. In particular it provides information on adapting the environment.
AbilityNet gives advice on using computers through assessments, workshops and courses. It also has an extensive list of communication aid assessment centre / services.
“Once I saw that Helen could play, I stopped seeing her as a syndrome, a problem, and saw her as a child with imagination, ideas and potential.” – says a parent.
All early years settings know that play is vital for all children. It is the way we explore the world about us and our place in it offering opportunities to relax, express feelings, experience success and failure, to learn about communication, our physical capacities – the list is endless.
Play allows parents and professionals to focus on the child’s abilities. It reinforces the positives and in doing so sends the message to all involved that the child is first and the impairment only part of their individual make-up. Parents have a key role in developing play opportunities since they are in position to bring in aids and adapted toys from home and have been working on ways to include their child.
“For the private nursery, I take in most of Arron’s equipment – chair, switch toys and other specific toys. Staff are creative and make mobiles, etc, but generally, he is included in most of the activities with use of his chair (Jenx whale) or the Bumbo [a make of chair]”. – says a parent of three-year-old at mainstream nursery and playgroup.
The child should:
In more formal activities the nursery worker or supporter should sit facing the child.
If the child is easily distracted, or may be showing signs of a visual perception problem:
Left to themselves, younger children with hemiplegia often tend to ignore their weak side and need to be reminded from time to time to bring it into their activities. Doing things like dressing or naming parts of the body in front of a mirror can help them be more aware of both sides of their body.
Sitting on the floor can be more of a problem for some children. Parents, carers and therapists should be able to advise on the best position for the child.
See our parent guide on holidays, play and leisure [PDF]
Early Years Alliance is a community pre-schools support and campaigning organisation. www.pre-school.org.uk
Bag Books is a charity that produces multi-sensory stories for people with learning disabilities.
Portage is a home visiting educational service for pre-school children with additional support needs and their families. Families have found Portage invaluable in supporting inclusion in early years settings.
A lot of the equipment needed by children with hemiplegia, such as chunky pencils and crayons, non-slip mats and left-handed scissors, is generally available in nursery and pre-school settings. Specialist equipment that might be useful includes magnetic boards or clipboards for anchoring paper (or use Blu-tack), an angled table top and a chair that supports the child in the correct forward-facing position.
Children with hemiplegia can join in all the usual games and activities that form part of nursery and pre-school, although things requiring two hands or balancing on one leg may be difficult for them. They may also need a little more space in group activities, so as not to feel crowded.
Pre-school activities designed to develop skills such as counting, letter recognition, matching and sequencing and co-ordination are particularly useful to children with hemiplegia, although they may need to have tasks broken down as well as some extra help.
Many children with hemiplegia have specific learning difficulties with reading, spelling or maths. These are not easy to identify at this stage, but it is worth looking out for warning signs such as difficulties with:
These are all indicators of possible visual spatial problems, and professional help should be sought.
To help children who have problems with puzzles, try using shapes to stick onto Velcro – e.g. parts of a face, car, house etc. that they can join together to make a whole.
To help children who have problems with spacing, use sticky labels to construct bar charts when recording their play activities or making pictures or charts
Some of the following are common in all children of nursery age, but in children with hemiplegia they may be markers for more serious difficulties later on:
Any of the above should of course be discussed with the parents or carers, and advice sought from any of the professionals working with the family or nursery/pre-school.
All children find starting nursery or reception class tiring, but children with hemiplegia find it more tiring than most, constantly needing to think about what they are doing and how they are going to do it.
By the time children with hemiplegia come to nursery or pre-school, their parents or carers will have been working closely with therapists to minimise their difficulties and develop self-help skills. If children are to build on these skills it is important that this be reinforced at nursery or pre-school. A partnership approach between parents and carers, therapists and teachers is the surest way to maximise the child’s abilities.