Practical parenting

		“Techniques and equipment offer simple solutions for one-handed parenting”
Occupational therapists, Nelly Stanbury, of the Oxford Centre for Enablement, UK, and Sheeley Garrett, of the Community Neuro Rehabilitation Team, Hackney, London, UK, write about practical childcare ideas that may be useful for parents who use one hand

Preparation

The Posture Independence and Mobility Service at the Oxford Centre for Enablement offers support to parents with disabilities early in pregnancy.

Parents can work with an occupational therapist and try out baby care activities with a life size doll, enabling them to gain experience and confidence.

One-handed parenting

There are various reasons why a parent will only be able to use one hand and the condition may affect them in other ways. They may have had a stroke and have hemiplegia, and their mobility and balance may be affected. Alternatively, someone with a congenital arm amputation will have incorporated the asymmetric use of their arms and body in all their activities from birth, and may need little or indeed no specialised equipment or support with parenting.

Some one-handed parents, just like many other disabled parents, may initially have concerns about lifting and carrying, holding and feeding, nappy changing, dressing and bathing their baby.

Lifting and carrying

Our Centre has developed a specially made sling of strong material with terry towelling lining and two handles that can be used for very short distances (please see picture in left-hand panel). The baby can be rolled to his side, the sling can then be positioned underneath him and he can be rolled back onto the sling.

For longer distances, and if the parent has good balance, a Prémaxx Baby-Bag baby carrier, as featured in DPPi Journal, issue 42, is worth trying.

Holding and feeding

When bottlefeeding, the baby can be positioned on the bed, slightly propped up on a cushion and can then be fed while the parent sits alongside or opposite.

When sitting on a chair to bottlefeed, it is a good idea to have a pillow on the side of the affected arm to lift and support the arm, if possible. The baby can then be positioned, by lifting the baby with the sling onto a beanbag or soft cushion on the parent's lap. His head can be supported and raised by the mother's arm, while she holds the bottle with her non-affected arm.

Breastfeeding can be done lying on the bed after some practice to find the best position. Changing over to feed the baby on the breast on the non-affected side can be a little more involved if the mother is sitting in a chair: the support of a midwife who has experience of mothers who breastfeed twins may be useful in this situation.

Nappy changing and dressing

If balance or lack of stamina is an issue, parents may find it easier to sit down, while they dress the baby or change their nappy on a changing mat on a table or working surface. An alternative is to dress or change on a bed or on the floor, as long as they are able to get up again easily and are able to lift the baby safely onto a higher surface.

To change a nappy, the baby can be rolled on their side, kept in this position with a rolled up towel and the nappy can then be removed. Putting on a nappy can also be done by rolling from side to side.

Bathing

Bathing involves multi-tasking: lifting and carrying, filling the bath, keeping the baby safe when in the water, dealing with a slippery baby, drying the baby and emptying the bath.

A mesh sling can be used to lift the baby into the bath, and the parent can kneel by the bath, or sit down if stability and stamina are an issue. There are various baby support and bath floating aids available. It is of course not necessary to bath the baby every day.

Simple solutions

Techniques and equipment offer simple solutions for one-handed parenting. It also helps to prepare well for all baby care activities and to take things step by step.

Nelly Stanbury

Practicalities

I am an occupational therapist working in a community rehabilitation team.

I first met John in February. He had a stroke in June 2003 when his wife was pregnant with their first child. June was six months old when I first met him. His wife had recently started work, which required John to manage June's hands-on care. The stroke had particularly affected his left arm; he had some limited movement in his shoulder and elbow but none in his hand.

John was able to pick June up but was holding onto and pulling on her shoulder. We practised an alternative technique: sitting June up first and then putting his right arm round her back, hip and leg to pick her up.

Nappy changing was a bit trickier! John managed to undress June and take the old nappy off but lifting a baby's legs while cleaning their bottom can be difficult at first using one hand! Putting on a clean nappy and dressing June was also quite difficult. He used an aid called `Eazy Feet' _ a piece of stretchy material which gently holds the baby's ankles together _ featured in DPPi journal, issue 24. Once in place John could lift June's legs up using the forearm of his left arm, leaving the right hand free to clean her. We discussed different types of baby clothes which were looser and without too many fastenings. Now, after some practice, he is regularly changing June's nappy with relative ease.

Shelley Garrett

Finding an occupational therapist

Occupational therapists (OTs) in the UK work in a range of settings. The criteria for access to statutory services may differ between areas, as do the available resources and the OT's role.

Social services OTs assess clients for aids, equipment and adaptations either within the framework of a comprehensive community care assessment or in response to specific identifiable needs. Such equipment typically includes personal, domestic, environmental and safety aids. Examples of adaptations are ramps, rails, lifts and level access showers. A client can self-refer for this service.

Community rehabilitation teams focus mainly on helping with a client's rehabilitation. This usually entails practising everyday tasks, or teaching compensatory techniques to manage tasks, such as dressing, cooking or childcare. They may also assess a client's need for small pieces of equipment. Referral is via your general practitioner or another professional.

Specialist services. Depending on their impairment, some parents may be referred to a specialist team such as a community neuro rehabilitation team. This may be funded privately or by the National Health Service.

Independent living centres. There are 49 centres in major cities where OTs may advise, demonstrate and trial day-to-day living equipment.

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