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The following tips and advice, developed with the help of Gunilla Tibbelin from the Child and Adolescent Habilitation Services Center in Lund, Sweden, will get you started.
Children who have suffered damage to their spinal cord may have reduced motor function and sensitivity. If so, you will have to adapt the environment and catheterisation equipment to your child's condition. Sit steadily and securely. Your child's hands should be free so that they can assist. Allow enough time to complete the procedure, so that time pressure will not force your child to give up. The routine should be clear to the child, as well as his/her delegated task. Remember that Mum and Dad should also be able to work in a comfortable position! Practice makes perfect, and it does get easier.
As a parent, you need a certain amount of patience to use a catheter on a child (especially when that child is 2-4 years old with a strong will of their own). If your child feels that catheterisation is very boring, a television in the bathroom might help distract them during the procedure.Teaching a child to empty their bladder using a catheter takes time. Encourage your child to participate in bladder emptying as soon as possible. Be calm and methodical and do it on your child's terms. With a little training and patience, it soon becomes a natural part of your everyday lives.
It's easier to empty the bladder if your child is sitting upright than if he/she is lying down. If your child has not yet learned to sit upright, use a pillow or a similar object to support their back. As soon as your child can sit upright on their own, he/she can follow the emptying procedure and maybe even participate more actively. In the same manner as you would teach your child to hold their own toothbrush and see how it feels, you can let your child hold a catheter while you empty his/her bladder. This can be a way of trying to build an understanding of how catheterising becomes a part of the daily toilet routine.
When your child is 1-2 years old, it is time, as for all children, to start sitting on the pottie or toilet. Take advantage of your child's natural curiosity. Let them fetch the catheter, open the catheter bag or maybe even pull the catheter out after they’re finished.
When your child is pre-school age, you can start teaching them self-catheterisation more actively. Use a doll to show them how a catheter is used. Sit down and draw pictures together, and explain how urine leaves the bladder. Having a doll with a "pee-pee" hole, where your child can practice inserting a catheter, increases your child's nimbleness in handling a slippery catheter. When it is time to empty the bladder, let your child try to find their urethra and insert the catheter by themselves. Even when your child has learned to insert a catheter, it is important that you help them make sure that the bladder has been emptied properly and correctly. Catheterisation becomes natural for your child if he/she is allowed to participate from as early an age as possible. This contributes to their self-esteem and to greater independence later on in life. By the time your child begins school, it will help if he/she can empty their bladder with a catheter on their own.
It's important that your child learns that emptying his/her bladder is a private matter, which should be done in the toilet. You should therefore start catheterising your child in the bathroom as soon as possible. When your child begins school, ask the school if they can put an extra cabinet in one of the toilet stalls. This cabinet can be used to store catheters and other equipment.
It helps if you can find tricks that help your child remember when it's time to catheterise. Try not to nag, as it can have the opposite effect intended. It's important to adapt the scheduled times for emptying your child's bladder to his/her daily lifestyle. Maybe it can be done in connection with other activities, for example meals and snacks. Many children use their mobile phones as reminders. At school, schedule catheterisation to fit in with your child's curriculum. The schedule should always be easily accessible. Let them take responsibility for emptying their bladder as much as possible. It’s important to remember that assistants who remind your child every time they need to empty their bladder can sometimes be counterproductive — kids can become reliant on the reminders, which can slow development of confidence in their own ability.
It will be challenging at times. But seeing your child learn to trust their ability makes it all worthwhile. For your child, knowing that he/she can go to the toilet by themselves, can go to a friend's house after school, a sleepover or even camping and always feel independent is a strength. It also builds your child's self-esteem and self-confidence.
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