Adaptive clothing can make a great difference to families with a child or relative with special needs. The right type of clothing or underwear can make the day to day care of someone with special needs easier and less stressful for carers. It can also improve the comfort and well-being of the user. The right type of clothing can make coping with incontinence less challenging while clothing designed with those with sensitive skin or sensory issues in mind can really help improve their physical comfort. Some people may need clothing adapted for wheelchair users or those with limited movement, while other may need garments which allow access for a feeding tube. There are different clothing solutions for a range of specific needs.
Clothing to help with incontinence (underwear)
For families and carers who have a child or relative with special needs, coping with incontinence can be a major part of their daily routine. There are many clothing solutions which can make these daily tasks more manageable.
Bodysuits/vests with poppers - most of these under garments are styled to fit over the body and fasten with poppers between the legs. You can find versions with a vest top, short or long sleeves – in various stretch or jersey type fabrics. Some styles incorporate an opening to accommodate a feeding tube, while others have poppers across the body to allow for easy dressing. They can range in size from small child up into adult sizes. The advantage of having bodysuits with a popper opening are;
• Bodysuits with poppers between the legs, at the gusset, allow easy access when pad/nappy changing is required.
• Versions which have back, side or cross body openings are helpful for those who need help dressing as well as those who are tube fed. The garments are easier for carers to change, keeping unnecessary movement to a minimum.
• They can keep the nappy or pad in place, both during the day and at night time.
• The vests can help conceal the nappy and avoid embarrassment or unwanted attention, can be worn under regular clothing.
• Can prevent a person undressing at inappropriate times and places.
• The vests are comfortable and help to keep the person warm.
• Provide a comfortable and practical solution if a child or adult has a feeding tube.
• As it takes longer and is harder for the wearer to access their nappy, the vests can help with incidents of ‘smearing’.
It is worth thinking about the style which is most suited to the person who is going to wear the garment. If they have a sensory condition associated with autism for example, what kind of fabric would be most comfortable? Some children and adults may prefer the closer fitting feel of bodysuits with lycra in the fabric while others may feel more comfortable in a softer, looser jersey. In addition, there are bodysuit versions which incorporate a little short leg with poppers between the legs which may be practical for others.
When thinking about purchasing a bodysuit vest it may be worth while trying out one or two different styles to start with before committing to buying a larger quantity. This way the underwear can be tested to see which suits the wearer best. It will also allow you to see which size you need. We always advise that you take good measurements before ordering, it will help you and the supplier decide what would be the best size for you. Again it might be a good idea to buy one first to check the sizing before ordering more.
Unitards - The unitard is an all in one garment which does not have a poppers between the legs. Ideal if the wearer has worked out how to undo poppers. The wearer would step in through the neck opening and pull the garment up over their body. Some styles have short legs and no sleeves while others come with a long leg. Usually made of a stretch fabric containing lycra, they are designed to be close fitting. For those on the Autistic spectrum or with sensory issues the closer fitting garments provide compression across the body which can help with proprioception (a person’s sense of body awareness) As these undergarments do not have a popper opening they are harder for hands to get at the nappy or pad underneath: the long leg versions are particularly effective and can help minimise incidents of smearing. As the unitards are harder to remove they can also help with those who might undress at the wrong time or in public. They can be worn under normal clothes as under wear or at night time to help prevent the wearer accessing their pad or nappy.
Stretch shorts - these shorts tend to have a longer leg and are usually made in a stretchy lycra fabric. They can help keep a pad or nappy in place, discourage the wearer from putting their hands in nappy and as help prevent the wearer undressing. The shorts can be worn under trousers or a skirt.
All-in-one pyjamas - these all in one pyjamas come in zip back or zip front versions. The pyjamas can be found in jersey or fleece fabrics. Some styles have integral feet attached, while others have zips at the front which allow the suit to be opened from the front and down the legs to allow for the easy changing of pads and nappies. Back zip pyjamas can help stop the wearer undressing at night or taking off their nappy. These all in one sleep suits can keep the wearer warm at night, especially if they are inclined to kick off their bed clothes.
Made to measure underwear and sleepwear - For many families made to measure garments can provide a more tailored fit. This can include back fastening garments which prevent undressing and accessing nappies or pads or underwear that full opens up to allow changing. The advantage of made to measure garments is that allowances can be made for the wearers unique shape and amendments made to include changes such as an opening for a feeding tube. Made to measure garments are available in a range of styles and can be made either in cotton jersey or micro fleece, white and various colours are available. With made to measure garments you would need to co-ordinate closely with the seamstress team working on your order, they will need accurate measurements and details of your specific requirements. Be aware that made to measure garments are bespoke and returns may not be accepted unless the garment is faulty. They may also cost more than ready made products and it is likely that you would need to allow more time for your item to made up and sent. If you are considering made to measure, it may be an idea to have one made first to check the fit and to see if the garment works for you before ordering more.
Therapeutic, Sensory and Seamless Clothing
Many people with special needs and other conditions can experience sensitivity and sensory issues that make wearing normal clothing uncomfortable and distressing. This can include those with a Sensory Processing Disorder, Autism, ADHD as well as those with skin conditions such as Eczema and Psoriasis. For these people, soft natural fabrics and seamless clothing can be very helpful.
There are suppliers of underwear and garments that can help people with skin sensitivity. They tend to use soft breathable natural fibres such as organic cotton, bamboo, silk or viscose. The fabrics tend to be knitted jersey which will conform well to the body shape – often they come in seamless styles. The fabrics may also be medical quality or anti – bacterial which are designed to be used with salves and skin creams to protect and treat the skin. Some of the clothing is designed to help night time scratching, such as nightwear that incorporates mittens.
There are a wide range of undergarment styles and items available, including vests, leggings, shorts, socks, caps and gloves. You can find clothing suitable for adults and children, including small babies.
Skinnies – supply soft, seamless skin wear such as vests, leggings, shorts, socks, caps, gloves etc. Ideal for use with salves and creams and to protect sensitive skin. Socks suitable for diabetics. Available in Adult, Children’s and Baby sizes. May be available on prescription.
https://www.skinniesuk.com
DermaSilk - DermaSilk Therapeutic Clothing is made of a special, knitted medical grade silk, capable of absorbing moisture without causing irritation to the skin. Special knitted construction allows the free movement of air through the fabric; this allows the skin to breathe more easily. Designed to help a range of skin conditions, suitable for sensitive skin. Range of underwear garments for children, men and women.
http://www.dermasilk.co.uk
Eczemaclothing.com – range of garments for adults and children in soft natural cottons, especially organic cotton. Range includes gloves, nightwear with integrated mitts to prevent night time scratching, vests and fleeces. Also a range of children’s school uniform.
http://www.eczemaclothing.com
Clothing – Outerwear, Wheelchair adapted, Back Opening
Some families and carers need adapted outerwear clothing for their child or relative. This can include clothing designed for ease of dressing, including fastenings at the back or sides and garments designed for those in wheelchairs or with severe physical disabilities. There are suppliers who provide ready to wear items while others offer a bespoke or alteration service. The advantage of a bespoke service is that the clothing can be made to fit any size, shape or proportion and the openings/fastenings tailor made for the wearers needs - however the made to measure option may be more expensive and you would have to wait longer for the garments to be made up. There are ranges of ready-made products which may suit however.
Wheelchair Covers – Outerwear - You can find different sorts of covers designed for wheelchairs which can be brought ready-made. These are available in child and adult sizes. Think about what sort of cover you may need;
- Does it need to be waterproof?
- Do you want it to be lined for extra warmth?
- Do you want one that is easily folded, can be popped on and off quickly, stored in a bag for when you need it?
- What sort of opening do you need for easy access?
- How mobile is the user? Some users may have more mobility and want to get out of their wheelchair on occasion, they may need a cover that can be taken on and off with ease.
Capes - These garment have no sleeves and can come with or without a hood. They are designed to be easy to pull over the head and drape over the body and wheelchair They are usually waterproof but unlined. The advantage is that they will fold away in a bag until needed, ideal for rainy days. If the weather is cold the wearer would need warm clothes underneath, however as they do not have sleeves the wearer may feel a bit restricted and it could be harder for them to self- propel in their wheelchair. Some capes are longer than others, so check the length to see if the cape is designed to cover the knees or the whole leg.
Wheelchair covers with sleeves - Similar to the capes in that they are intended to cover the body in rainy weather but they incorporate sleeves - ideal if the user needs their hands free and wants to propel their own chair. Again check the style for length to see if it suits your needs.
Waist high wheelchair covers - There are a range of covers which are designed to come up to the waist and cover the legs while the user is in their wheelchair. These can be lined or unlined and are usually waterproof. Some fit over the user’s legs, pop under the footplate and attach to the wheel chair at the waist. Others are made to fit into the wheelchair so that the user can be lowered into or sit into the cover, which is then zipped up around them: these sorts of cover are usually fleece lined so that the user’s body is encased and protected all round from the elements. This style is great in bad weather and for those whose lack of mobility or have a condition which makes them feel the cold. You would need to check if the opening allows the user to get in and out of the chair easily, some have a central zip, while others may have a zip at each side.
Clothing adapted for use in a wheelchair - Clothing adapted for use in a wheelchair include, trousers, tops fleeces, ponchos, capes and jackets. Many items can be brought ready-made, although there are manufacturers who make and adapt clothing for those with a disability.
Trousers - Trousers which have been cut and styled for sitting in a wheelchair – usually higher at the back and lower at the front, may have elasticated waistband, a drop front for easy access and a longer leg to cover the ankles while the wearer is seated.
Ponchos/capes - Usually made in a warm fleece fabric these items of clothing are often designed to be dropped easily on over the head and to drape over the body while seated. Others may have front or back openings. Some are sleeveless while other incorporate sleeves. These loose fitting garments keep the wearer warm and drop on over the user’s other clothes easily. Can be worn under a waterproof cape for added protection. Capes and ponchos are good garments for those who experience stiffness in the limbs or difficulty raising their arms to dress.
Jackets - These have different adjustments to accommodate sitting in a wheelchair such as a raised back and longer front to cover the knees, others may have a higher front so that the jacket does not bunch up at the waist when the user is seated. Can include a back opening so that the jacket can be put on from the front without the user having to be raised.
Able2Wear – supply adapted clothing for wheelchair and non wheelchair users.
http://www.able2wear.co.uk
Clothing Solutions – Make bespoke garments and undertake alterations. Clothing Solutions is a registered charity no. 1120118, and offers information, advice and a garment production/alteration service. They can offer solutions to most clothing and dressing issues whether concerning, shape, size, proportion, access and fastenings, fabric technology and care. Contact them for advice and how to order.
http://www.clothingsolutions.org.uk
School Uniform
Often as a child grows it can be difficult to find school uniform to fit. For example, trousers with a fully elasticated waist are often much easier for a child with special needs to manage but often these become unavailable in larger sizes. Similarly, a child at school may be expected to be able to dress themselves but find normal fastenings such as buttons difficult and time consuming. If a child has sensory issues or sensitive skin, the fabrics of clothing found in many shops can be uncomfortable and hard for them to wear.
Many people with special needs will bite or chew, especially those on the Autistic spectrum. There may be a range of reasons for this such as frustration, stress, anxiety, the desire to communicate or the need for sensory stimulation. By chewing or biting a person may find comfort in stimulating their senses, as these activities provide a sensory input to the proprioceptive system. It can also be a reaction to sensory overload.
Chewing and biting can often be seen in the sucking of clothing, particularly at the cuffs and necks of garments as well as the chewing of fingers and other inedible objects. This form of self- stimulating behaviour is often referred to as ‘stimming’. Chewing aids are one way of safely redirecting this behaviour by changing the object on which the person chews to a safer alternative. They can also help strengthen muscles in the mouth and encourage the chewing skills needed for eating and speech. An occupational or speech and language therapist can advise you on the best products and solutions for you.
There is range of chewing aids available, some of the benefits can be seen below;
• As an oral fidget aid for sensory seekers craving stimulation and proprioceptive input
• As a safe alternative to chewing on hands, knuckles, cuffs and sleeves, shirts, pencils, etc.
• As an alternative to tooth-grinding or thumb-sucking
• To practice biting/chewing safely by using a safe chewing aid, thus avoiding the risk of choking on inappropriate objects.
• To build oral strength and control
• Can help with the urge to chew for individuals who are tube fed
• Chewing aids are usually made of non-toxic medical grade material for added safety.
Please note: Some biting and chewing behaviour can be severe enough that the person may be harming themselves physically and damaging the tissues of their arms, hands and fingers. Every individual’s experiences and behaviour will be different so in instances of severe biting it may be best that professional advice is sought. Be aware that biting and chewing may also be related to physical discomfort, pain in the mouth or another medical issue. If you suspect this may be the case please seek specialist medical or dental advice.
Types of Chewing Aid
Chew Bangles, oral aids worn on the wrist - Usually made of high grade and resilient material such as medical grade silicone or Therma Elastic Polymer these chewing aids are designed to be worn at the wrist. They are ideal for those who have a tendency to chew on cuffs and wrists. There is range of styles on the market – some have textured surfaces for added sensory stimulation, they may be stretchy or come in a variety of colours and shapes. They can be worn singly or in groups. Be aware that the firmness of the material used varies and some may be more suitable for a strong bite than others. It is best to check with the manufacturer or supplier as well as your OT if you have any queries as to what would be best for you. It is also a good idea to check the product and wash it regularly. Even the strongest material will eventually show signs of wear, especially if the user has a strong bite, so if the bangle becomes damaged it should always be replaced.
Chew Pendants, Necklaces - not everybody gets on with wearing a bangle on the wrist some people may find wearing a chewing aid around the neck more comfortable to use. The pendant should be suspended from a cord or lanyard with a quick release clasp. These should always be used with adult supervision and are not suitable for children under 36 months as the cord can constitute a choking hazard. There are different styles and colours to choose from, some have variable levels of hardness while others are textured and ridged for an added extra sensory experience. Please check the pendant regularly and replace if it shows signs of wear.
Chewing Aids - there are many other different types of chewing aid such as the Chewy tubes, Super Chews, P’s and Q’s, Chew buddies and Ark Grabber. They are tactile and designed to be comfortable to hold in the hand and mouth - some have grip like ‘handles’ for example. They come in a range of different levels of hardness while others have textured or ridged surfaces for added oral stimulation. An OT should be able to advise you on the most suitable product. It may be that if your child has a particularly strong bite they will need a tougher chewing aid made from a more resistant material. Again you would need to check the chewing aid regularly and replace it if it becomes damaged.
Neckerchiefs with chewing aid attached - there are some bibs and neckerchiefs available that incorporate a chewing aid at the tip. These means that the neckerchief/bib acts as a dribble bib as well as a chewing aid. The chewie is less likely to be lost as it is part of the neckerchief, however these items may not be suitable for those with a very strong bite.
Please note: all chewing aids should be used with adult supervision and should be replaced once they show signs of wear. Please inspect the chewing aid regularly and wash with warm soapy water.
Information and links regarding challenging behaviours, such as biting and chewing can be found at;
National Autism Society Website:
http://www.autism.org.uk/challengingbehaviour
Challenging Foundation Foundation:
http://www.challengingbehaviour.org.uk/
Enquiries about incontinence and products that can help families and carers are some of the most common questions that we receive at Fledglings. We are often asked about products that can help alleviate some of the stress and work associated with night time bed wetting. There are a range of products which are designed to help protect the bedding and mattress from wetting: you would need to assess your needs so that you can choose products suitable for you. An OT or Health professional should be able to advise you if needed.
Mattress Protectors/Pads - these absorbent pads are designed to used over a mattress and on top of the fitted sheet to protect the area of the bed most vulnerable to wetting. They are ideal as they can be quickly changed in the middle of the night without having to resort to changing the whole bed. There are disposable versions available but in the long term these can be costly, so a washable and reusable pad or protector may well be better value in the long run. (Disposables however, can be good for travelling and holidays) The reusable protectors usually have a waterproof backing and a softer absorbent upper layer. Some styles come with wings or flaps which can be tucked around and under the mattress to keep it in place (e.g. the Brolly Sheet).
Chair Pads - these work in a similar way to the mattress protector but they are smaller so that they will fit into a chair or wheelchair. They have a waterproof backing, protect the chair and upholstery from leaks, are washable and can be swapped over easily when needed.
Waterproof sheets, Duvet and Pillow Protectors - in order to protect the bed and bedding from staining and urine, there are a variety of products that can be used. Some have a waterproof PVC backing, others are made in breathable polyurethane or Tencel type fabrics. They are all designed to keep the mattress, duvet or pillows underneath clean. It is a good idea to check if the product is suitable for heavy or only light wetting before you buy - as well as the size you need.
Mattress Protectors - designed to fit over the mattress to protect it from soiling and wetting. Some are designed to slip over like a fitted sheet, others encapsulate the whole mattress and have a zip opening. For heavy soiling however a waterproof mattress may well be a better long term solution.
Waterproof Mattresses - in cases of very heavy soiling and wetting a complete waterproof hospital style mattress can be a more economical solution in the long run. Made from a foam which allows the body to mould into the mattress, these have a completely waterproof cover. They come with concealed zips and allow the free flow of air for comfort. The mattresses can be wiped down and dried easily which makes them ideal for night time. As a child moves into adulthood a waterproof mattress can often be a better solution as the wetting increases in volume.
Waterproof Duvets and Pillows - waterproof pillows and duvets have a waterproof cover which can be wiped down with a damp sponge or cloth and then wiped dry. Usually made of a soft polyurethane they are designed to be breathable as well as waterproof. For comfort these should be covered with a washable duvet cover or pillowcase. These are excellent when wetting or soiling is heavy and are ideal for using at night time. When the duvet or pillow gets wet the outer covers can be changed quickly while the duvet or pillow below can be wiped clean and dried quickly. This means laundry can be kept to a manageable level as the duvet and pillows do not need to be constantly washed – saving wear and tear on the washing machine and time on drying.
Waterproof Changing Mats - changing mats are ideal for changing a person either at home or when they are out and about. Folding versions are particularly good for days out.
Please note the use of bleach and harsh cleaning products is not recommended on these products.
