Tag Archives: nail trimming and ASD

Why Cutting Nails Is Such a Challenge for Autistic and Sensory Kids

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Most children resist nail trimming.  But kids on the autism spectrum, kids with sensory sensitivity, and children with significant language delays can turn this simple grooming task into an epic contest of wills.

There are some good reasons why cutting your child’s nails can be so difficult for them to handle.  If you can identify the “why”, you can adapt the experience to help a child handle this grooming task.  Even if your child doesn’t immediately calm down, you may be calmer and more compassionate when they squirm.  And a calmer parent can inspire calmness in their child.

BTW, even though some of my links are to previous posts with the word “toddler”, these techniques work equally well for older kids with ASD or with SPD.  In fact, they work well with any child who is upset or demanding during grooming, haircuts, etc.

 

Here are some good reasons why your child is so distressed:

  • Most typically-developing young children do not enjoy nail trimming.  They don’t see the need for it, and they really don’t like leaving a fun activity to do a not-fun activity.  A child with ASD or SPD may not be so unlike their sibling or cousin.
  • Typical kids put up with nail care because they have the following abilities:  they understand your explanation, they tolerate the frustration of sitting passively, and they tolerate the awkwardness of having their finger held by another person and don’t mind the pressure applied to each nail.  In addition, they do not see the nail as an essential part of themselves, and they do not fear that you will injure them by accident.  If your child still doesn’t yet have some of these skills, then you are going to have problems when you want to trim your child’s nails.
  • Children with ASD,SPD, global developmental delay, or significant language delays do not have most or all of the above skills.  Sometimes they have only one or two. They may genuinely find your touch irritating, and they often have very little frustration tolerance for the things that they do not want to do or struggle to understand.
  • Nail trimming is usually an occasional event, not a daily part of a familiar routine.  Parents of children who fight nail trimming often leave this task until it is unavoidable,  Rare events are almost always seen as unwelcome or even threatening.

There are some things that parents can do to make nail trimming less aggravating:

  • Build your child’s frustration tolerance for other small events and annoyances with Patience Stretching, Dr. Harvey Karp’s wonderful technique from Happiest Toddler on the Block.  I wrote a post on this technique, Stretch Your Toddler’s Patience, Starting Today!, and it gives you some insight into the how and why of this simple strategy.
  • Use Dr. Karp’s “toddler-ese” language and Fast Food Rule techniques when you get some push back; see  Taming Toddler Tantrums Using Sympathetic Reframing.  Simplifying what you say, and empathizing but not agreeing with a toddler who balks at nail trimming can reduce the resistance.  Children will then understand that you get their point of view: they don’t want to do this.  Most kids are well aware that they will be asked to do things they do not want to do.  Diaper changes, clothing changes, tooth brushing (see my series of toothbrushing posts for specifics on that subject.)  Just hearing that you know they don’t like it is sometimes enough to help them allow you to trim their nails.  They feel heard.  Most kids will not assume that you understand them by reading your tone and body language alone, and ASD kids struggle with this more than the average child.  You are giving them information about your mindset that they cannot understand unless you spell it out in this manner.
  • Don’t go wild when they are compliant.  I know you are excited to see progress.  Keep most of it to yourself.  Sensitive kids need some finessing when it comes to praise.  Here’s how to handle it so it doesn’t backfire on you: Sensitive Child? Be Careful How You Deliver Praise
  • Choose a comfortable position for both of you.  Some kids really like beanbag chairs as they feel cradled while the chairs also supporting them.   All that deep pressure helps them stay calmer and they can’t squirm as much.  Some prefer to be lying down, and some want to be watching Paw Patrol.  I don’t know that using distraction is such a terrible idea.  You might even sweeten the deal with a special DVD like home movies that feature them!
  • Use good technique and equipment.  There are nail cutters that protect children’s fingers better than the standard clippers you buy for yourself.  Clippers that are easy for you to hols steady are essential.  Buy them today!
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Hammacher Schlemmer sells these well-designed clippers.  Expensive…but worth it!

 

  • Make it clear why their nails need attention.  One of my clients had a great idea to show her child that his nails were too long:  she asked him to run his nails along his own upper thigh and see if they were “scratchy”.  Scratchy nails need to be trimmed.
  • Try a little hand massage.  Nothing too hard, but never ever use light, flighty touch.  Light touch is always stimulating to the nervous system, and light moving touch is even more stimulating.  Don’t add fuel to the fire.  Use firm grasp that doesn’t roam on-and-off their hand during nail trimming.  If you don’t believe me that light touch is irritating, imagine getting a massage of flighty fingers running up and down your back. Can you feel that?  It is alerting, and a bit annoying, right?  Certainly more stimulating than relaxing.  Well, when you hold a child’s fingers loosely, and then grasp/release their hand over and over….their brain perceives it as light touch. Oops.  I use my skills as a licensed massage therapist with my OT skills to create a calming pattern of hand and finger massage either prior to or after nail grooming.  Usually after, as I can use lotion then (lotion before trimming creates slippery hands for both of you!)
  • Pair the experience of nail trimming with something your child enjoys.  You could try offering a healthy but tasty snack right after nail trimming.  Read a beloved book after nail trimming.  Something that they like and can look forward to.  My trick: have it visible but out of reach, so that an upset child who is more literal and less likely to understand your words will see evidence of the positive experience he will have immediately after nail trimming.  You might be surprised that even though your child is calm enough to speak, his response to nail trimming is so much better with the visual cue of the actual treat.
  • Some children need to do nail filing before they can tolerate trimming.  Daily filing can be less scary and still keep things well groomed.  This really works!  Once filing is well tolerated, you may be able to move to clipping.  If not, a calm child that can handle filing every other day is a lot happier than a squirming, screaming child who learns to fear your grooming routines.  i like the foam filing rectangles rather than the emery boards.  If a child suddenly becomes agitated, I am not as worried about accidental eye injuries.
  • I will use a distraction such as a video on a tablet at times while I do nail filing/cutting and massage.  It’s not a bribe.  Really,  I try to pick really short videos and definitely move back and forth between letting them watch and bringing their attention to their hands.  I directly discuss a child’s nails and hands with them, naming the fingers and talking about whether their nails are smooth or bumpy.  Why?  Zoning out totally doesn’t reduce overall anxiety over time, but being able to toggle back and forth between targets of attention is active use of the frontal lobes, the ones that can stay calm and think things out….!
  • Try to do a small trim on a weekly basis (or even every other day) so that it can be expected and part of a routine.  Familiarity really helps all of us.  That is why tax time can be stressful.  It only comes once a year.  And here in the U.S., we are about to enter into the least happy time of the year!  So make nail trimming part of a routine and it could be less of a surprise.

Remember to be patient with yourself as well. The challenges of parenting a child with sensory sensitivity and modulation issues can really affect how you see the world.  It is important to acknowledge how you feel, as well as how your child feels.  If you feel angry or hopeless, talk to your partner, a friend or a counselor that can help you maintain your focus and positivity about caring for your child.

Are you doing your CPSE or CSE meeting online due to COVID-19?  Read CPSE or CSE Review Without a Re-Eval Because of COVID-19? Here’s What You Need To Ask For

Thinking that you need some ideas on how to manage isolating at home with your special needs child?

 Visit my website Tranquil babies and go to the bookings section.  Scroll down the list and buy a consultation session!  They are listed as toddler or baby sessions, but anyone can buy a session and use it for any age!

You get to ask me questions, I will help you review the toys you have at home and give you suggestions for new toys and activities you can use to build REAL skills during this unprecedented time we are enduring.

 

Need more information to make daily life easier when you are raising a young hypermobile child?

I wrote an e-book just for you!  The JointSmart Child:  Living and Thriving With Hypermobility Volume One: The Early Years gives you strategies on carrying, positioning in a chair, dressing, grooming, bedtime and even how to communicate better with your family, teachers, and even doctors!

Knowing how to help your child develop independence and safety awareness isn’t intuitive; parents deserve skilled guidance.  This book is filled with practical information and insights from my 25 years as a pediatric occupational therapist.  It is time that parents know all the tricks and techniques that therapists use to find good equipment and select the right strategies for success.  Parents need to feel empowered…today!

It is available on Amazon as a read-only download, and on Your Therapy Source as a printable and clickable download.  Your Therapy Source also sells both of my books (see below) bundled for an amazing deal!

  My e-book, The Practical Guide To Toilet Training Your Child With Low Muscle Tone, also helps children with sensory processing issues and ASD make faster progress with potty training.  

Read  The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! to learn more about how the pre-training strategies in The Practical Guide will help your child speed up potty training at any age, and why understanding how low tone impacts your child’s sensory, motor, and social skills will make a huge difference for both of you.  To purchase my e-book, visit Your Therapy Source or Amazon .

 

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