A Must Read: Standing Changes for Anyone, yes, Anyone!

*Well, I guess to clarify anyone who can weight bear, even the tiniest amount.


JUST DO IT!!!! EVERYBODY WINS!!


To start off, I used to be a HUGE skeptic of standing changes. They seemed like more work, more time and more mess. And frankly, I didn't fully believe that any kid* could do it. I couldn't have been more wrong and after a few weeks of standing changes the entire team was all for it. And this was with older kids, so there was definitely more resistance and more barriers to change. And let's be honest most things are harder with bigger kids, so while its never too late (and always worth it!) to start toilet training or standing changes, it is definitely easier with smaller kids. Especially when going in public after they outgrow changing tables. Having a well-stocked diaper bag is essential for being in public since disposable diaper pads can be used to quickly contain a blowout or any mishaps-- plastic grocery bags are great for containing these dirty pads and everything else disposable.



But why standing changes:

1. Independence--Individuals will likely be very proud of themselves and feel more involved in their hygiene. They can slowly increase their participation in the change.


2. Dignity-- they are not a baby anymore so why should they be treated like one. Imagine how vulnerable it must feel to be half naked on a table lying down and you can't see what people are doing to you.


3. Easier on caregivers-- less lifting onto tables or the floor, easier to go out, less physically exhausting, less gross haha and you'll find yourself dreading it less.


4. Easier/possible changes in public places--isolation is a huge problem in the special needs community why let changes stand in your way ;)


5. Easier to find help. This is soo true as a previous caregiver I know that theres a huge shortage of quality caregivers so the reality is they have the freedom to choose their client. Lifting and changing big kids on changing tables can be the determining factor to go with a different client or can deter the caregiver to adventure out with your child.


6. Exercise and standing practice-- believe it or not, toileting may make up the bulk of your child's standing and walking during the day, especially at school or adult day care. This time really adds up and is great for adjusting positioning as well.


7. Less mess and quicker-- once you get the hang of it, you'll see how quick and easy this method is!


8. Much easier to toilet train after or in combination with! (I toilet trained a 20 yr old in a month after months of standing changes)


For ease, I'll break standing changes into 2 categories: able to stand independently or able to stand with assistance from a grab bar, toilet or surface and able to stand with assistance from others. Of course, there is lots of movement between these categories and thus it is important to adjust accordingly and to also aim for the maximum independence possible. Standing changes are also a great combo with toilet training and preparing to start toilet training. I will do another post on that.


Able to stand independently, with grab bar or walker/gait trainer (no pelvic support):

Even if your child can stand independently, you can either have them stand freely or hold/lean onto the counter, toilet (at home), grab bar or mobility aid (especially in handicap stalls). This is a game changer!! You just need enough space to reach around your child and to not make a mess by bumping into surfaces. Visual stories and wall aids are a great way to introduce the concept to your child including positive reinforcement and some sort of reward choice for after the change. Here is my example from toilet training, but you get the point.



If your child cannot stand for long periods of time you can have them lay their upper body on a surface (see the increased support resources from Rifton's blog)


Resources (these are targeted at infants but can be applied to all ages)

http://www.montessorinmotion.com/home/2018/7/30/standing-diaper-changes

https://www.montessorichild.com.au/blogs/news/17497868-standing-nappy-changes-why-how

https://montessoriishmom.com/2017/07/24/what-is-stand-up-diapering/


Able to stand with assistance from others:

Rifton has a super cool standing changing station that is ridiculously expensive, but can be emulated with other affordable equipment depending on individual needs. Any table that a good height can be used especially with a mat or pillow on it for comfort (we had a volunteer build a bunch of therapy table style tables that were small squares and had grab handles and easy strap attachment), toilets with the lid down if you have a small child, gait trainers, walkers and standers are great places to do standing changes if they permit enough room to change a diaper mess free! The surface can support the vast majority of the individual's weight or just a little depending on position.

Check out these resources and contact me if you


https://www.rifton.com/adaptive-mobility-blog/blog-posts/2017/december/toileting-skills-support-station

https://www.rifton.com/adaptive-mobility-blog/blog-posts/2017/march/toilet-initiative-special-needs-students


Support items (work in progress)

http://a.co/a4PV0DB


Share your experiences, successes, questions and concerns about standing changes below!


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