Equipment - where to start

In the article Back to basics, as featured in Disability, Pregnancy & Parenthood international, Issue 37, January 2002, five disabled mothers with back conditions talked about their parenting experiences. Most of them had visited either The Back Store or their local Independent Living Centre, hoping to find useful parenting equipment. Although they had seen various chairs, beds and stair lifts, all were very disappointed not to find any equipment specifically for disabled parents.

When looking for baby care equipment it is a case of trailing around major stores, looking through catalogues or at websites to see which commercial baby products might be appropriate. Often it is worth talking to an independent retailer who may be very knowledgeable about products on the market or about getting items built or adapted.

Practical information sheets, produced by DPPi, on choosing cots and beds, nappy changing and bathing your child, list a number of useful products. Below are some features, which disabled parents may wish to consider, when choosing a particular product.

Prams and buggies

There are hundreds of prams and buggies on the market. Styles and features frequently change from year to year. Features to consider include:

  • Intended use - indoor, outdoor or multi-use, for example, a travel system that includes a car seat. When the car seat is on the pushchair it will bring the baby higher but you may need to consider whether you could lift the car seat in/out of the car and other features of the remaining buggy (see below). If you have difficulty carrying your baby from room to room consider using an buggy indoors or a carrying chair on wheels to move your baby from a to b.
  • Height and style of handle - whether it is height adjustable.
  • Ease of use of brake.
  • Manoeuvrability and suspension.
  • Weight/bulk when pushed and when folded.
  • Ease of folding.
  • Seat height and depth.

Changing area

Height is probably the most important feature to consider and will depend on whether you intend to stand or sit to change your baby. Alternatively, you may consider something adjustable. Underneath access may be important, especially if you intend to sit to change your baby. Other points to consider are:

  • How you can prevent a child rolling off.
  • Whether you want a bath incorporated and how this will be filled/ emptied.
  • Whether there is space for changing equipment such as nappies, wipes and a change of clothes.
  • Whether you want to be able to move the changing area and lock its wheels.

If possible arrange a changing area next to the cot to cut down on carrying distances. Make the area interesting with mobiles, music and activity toys to distract attention from the nappy changing task.

High chairs

Adjustable height chairs are designed for adjustment before the child gets in. We are not aware of any that can be adjusted with the child seated. There is better access if the tray can swing right out of the way or be removed completely. A larger tray will give more room to play and make spillage onto the floor less likely. Look for an easy wipe surface. Some styles of legs allow closer access to the chair. We understand that highchairs are not supplied with wheels in the UK, but check with manufacturers, or perhaps an occupational therapist could fit them.

Cots

Consider side access and mattress height. Also, how easy it is to scoop the baby onto your lap? A raised cot with a gate opening side provides good access, avoids reaching over a cot side and will enable you to roll and lift your baby from a convenient and comfortable height. This type of cot will also enable you to sit to use the cot as a changing/washing/play area as well as for sleeping. Commercial cots are available, although they are very expensive. REMAP is an organisation in the UK to approach for adaptations to standard equipment (see details below). A heavy mattress may make changing the bed even more difficult. Check with your health care professional for the latest advice on mattress safety. Larger cots can probably be used for longer. Although cots can be adapted to shorten the legs, raising them may affect the stability of the cot and compromise the child’s safety, unless the depth of the cot is also altered.

Finding solutions

Choosing appropriate baby care equipment may not be enough. Parents with a back condition may also need to find alternative ways of doing baby care tasks. Developing different techniques will not only help make the best use of a piece of equipment but will also reduce back strain. Alternative baby care techniques may include finding ways of encouraging a child to cooperate. The techniques of ‘cueing-up’ and rolling from side to side (described in box) are examples of how the baby can be involved in nappy changing. Parents may find having assistance with certain tasks is necessary.

It is important to look at the layout of the area where you care for your baby. Establish the best working height-for you and then adjust working surfaces accordingly. Community occupational therapists can provide raisers for tables, chairs and beds and offer other advice.

If you are experiencing difficulty carrying your baby up and down the stairs it is often best for someone else to do this, leaving you to manage your baby downstairs during the day. Keep everything you need to care for the baby downstairs for daytime use. Some parents find it possible to negotiate the stairs on their bottom whilst carrying their baby in a sling.

Some parents, if they cannot lift at all, find it easier to manage their baby on the floor rather than trying to lift from one area to another. Consider arranging a cot mattress in the corner of a room for daytime naps rather than trying to lift your baby into a pram or upstairs to the cot. As your baby/child becomes more mobile and requires a higher level of supervision, a stair-gate/barrier placed across a doorway or a playpen will improve safety in one room, for example, when you need to answer the door.

To avoid lifting, low chairs are often preferable to high chairs as your child can be encouraged to climb and sit independently. Provide cushions or stepping stools at different heights to encourage climbing rather than the child being lifted onto a sofa, your lap or toilet. Appropriate clothing, for example, dungarees or a handling belt can be worn to hold on to, and to encourage a child to climb.

Occasionally, parents who are not able to lift at all, have used a hoist to lift a baby from a to b. It may seem like a sledgehammer to crack a nut, but if a parent prefers to be independent, it can be a solution. Again, layout is important, as space is needed for the hoist and an adapted cot is necessary to give easy access to the baby. A carrying chair fitted to a trolley has been used to hoist the baby into and then to push him around in. A high chair mounted on wheels has also been used to push an older child from room to room. If you are considering any of these options, it is best to seek professional advice to ensure both your own and your baby’s safety.

Try to work within your pain levels and activity tolerance, and do not be afraid to ask for help. To take risks when lifting may exacerbate pain or place you at risk of secondary injury. There may be particular tasks that are impossible. One of these is likely to be lifting in and out of a standard bath, as the lift is from a low level and at a distance. For safe lifting, your baby should be as close to your body as possible. Do not try to conform to old traditions. Your child will come to no harm if he or she does not get a bath every day as long as they are washed. It may be better left until someone else is around to help.

Baby care techniques

Some ideas from Adaptive Baby Equipment: Guidelines, Prototypes and Resources by Through the Looking Glass, California, USA.

1. Break down the task - to save energy and make transferring and transporting a baby less demanding, break the task down into small parts and pause between each part.

2. Get the baby to cooperate - cue the baby that a change of position or lift is about to occur. This can be done by saying the baby’s name or counting ‘1,2,3’ or by touching the baby to get her attention, then positioning her as a cue. This prepares the baby and gives her time to get ready for the lift or position change. For example, babies can be taught to lift their bottoms during nappy changing. The parents cues the baby by gently tapping her bottom and saying ‘up, up, bottom up’. Over time the baby learns to anticipate the cue and assists by lifting up her bottom. As a baby gets older she can be encouraged to get into a sitting then standing position before you pick her up.

3. Rolling the baby from side to side instead of lifting him to place a nappy can reduce the lifting demands on the parent.

4. Slide down transfer — to transfer a child aged six months or older onto the floor, sit with the child on your lap, then encourage the child to turn onto his stomach and slide down feet first over your knees to the floor.

Other resources

REMAP designs, manufacturers and supplies equipment to disabled people, free of charge, where no commercial equipment is available or suitable. Website: www.remap.org.uk

DPPi information sheets on Choosing Cots and Beds, Bathing, and Nappy Changing and Dressing are available from the www.dppi.org.uk, free to disabled parents.

With thanks to Judi Rogers, Occupational Therapist, Through the Looking Glass, California, USA, and Val Fitzgerald and Susan Stuart-Jervis, Occupational Therapists, UK.

First published in Disability, Pregnancy & Parenthood international, Issue 37, January 2002.

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