The link between autism and bathing issues is something many parents of children of autism know all too well. Does your kid hate bath time? Are they overwhelmed by the sensations? Is it a never-ending battle to get them clean?
You’re not alone.
Does this sound like your child’s bath or shower routine (or lack thereof):
- Unable to get them to sit or stand in the tub
- Constant fighting and meltdowns
- Floor (and you) end up soaked
- Washing as quickly as possible just to get it over with
Bathing and showering can be emotionally taxing, for both you and your child. It can make them feel miserable, and you left feeling helpless. Not to mention, seeing your child in so much distress is a sad experience for any parent.
But it doesn’t have to be.
In fact, bath time could be a great opportunity to connect with your child when they are young, teach them important coping skills as they develop, and maintain a consistent routine when they are older.
The trick is getting there. Or should we say, getting in.
Here’s a glance at what we’ll cover below:
- What to Do If Your Autistic Child is Scared of the Bath
- 5 Tips to Make Bath Time More Enjoyable for Children with Autism
- Creating a Successful Bath Time Routine for Your Child with Autism
- How to Make Showering Easier for Autistic Children and Teenagers
But first, to better implement those solutions let’s take a look at the underlying problems of an autism bath time.
What Makes Autism Bath Time and Showering So Challenging?
Bath time can be stressful, confusing, upsetting, and a challenge for all parties involved. Not to mention the added concerns over safety.
It is very common for children with autism spectrum disorder (ASD) to react negatively to activities related to personal hygiene and cleaning. In those instances where a child is also diagnosed with sensory processing disorder (SPD) the issues are only exacerbated.
Consider brushing their teeth.
Overcoming tooth brushing struggles with autism is no small task. The weird smells, tastes, and feelings alone that come with brushing are enough to make the whole process off-putting. But whether the challenges are related to sensory issues, conceptualization hurdles, or difficulties staying on task, it is something parents and their children need to resolve, together.
Bathing and showering are no different.
The first step is being fully aware of the challenges you are facing.
Although bathing and showering is second nature to a lot of us, when we really think about it, there is a lot going on in that tub.
Your child with autism is very likely fully aware of all of them.
Which means there are so many things to consider from the child’s point of view that could make them dread bath time.
They can include:
- A fear of the water
- Distress over the water being too hot, cold, high, or low
- Aversion to air temperatures after getting out
- Disorientation from being in a small confined space
- Difficulties maintaining bodily control on slick, glossy surfaces
- Instability from stepping in and out of the tub
- Panic over the plughole and all the abnormal sights and sounds that occur once its unplugged
Making things even more frustrating is that sometimes kids have a great time in the bath, only the next time to hate it with extreme prejudice. Maybe a child will even grow out of an initial dislike of bathing, only for it to return a few years later or when puberty hits and the need for showering increases tenfold.
Enhancing the challenge even further is the inability to properly communicate. It can be especially tricky to calm, orientate, and guide your child through the process when they’re too worked up to listen or talk.
And once you get stressed, the challenges snowball from there.
So to say the least, bath time with autistic children can be a roller coaster.
Then there’s the added concern of sensory issues.
Special Sensory Issues to Consider During Bath Time
In addition to all those turbulent thoughts and fears above, there are the added complications of sensory processing issues faced by so many children with autism every single day. For instance, consider the sound of the water gushing into the tub - seeming to bounce off the tiles and the sink, echoing within the room with the potential to be overwhelming to a child with autism.
If your child also has a diagnosis of SPD, this could intensify bathing challenges in the following ways:
- Bright bathroom lights
- Mirrors reflecting illumination
- Rough textures of the washrag and towel against sensitive skin
- The feel of water on the skin, hair, or face
- The slippery slickness of the tub’s surface
- The smell of soap
- The slimy feel of shampoo
That’s a LOT of sensory input to process, especially when it occurs in a very short period of time.
It is little wonder bath time can turn into a terrifying situation for a child with autism.
The brains of autistic kids simply aren’t wired to be able to process all that information quickly enough, and the result is often feelings of fear or extreme distress. Their “flight or fight” responses may instinctively arise to protect themselves from these unpleasant sensory sensitivities.
This is when you’re likely to encounter resistance, tub meltdowns, and a total refusal to cooperate.
Every child is unique so it’s important to address bath time in the context of your kid’s fears, abilities, and concerns. Being scared of the bath is natural for a young child, but we want to do everything we can to assuage that fear before it becomes debilitating.
There are several things you can do to help your child with autism learn to navigate through bath time with a minimal amount of emotional trauma and upsetting experiences. Many of these we will go into more detail below, like changing the temperature of the water, offering distractions such as counting, toys, or favorite songs.
But perhaps the best way to overcome early signs of fear is to bathe or shower with your child.
Just the act of having you there in the tub with them can be a huge relief.
Start by sitting in the bath with them. Then slowly retreat, first by sitting on the edge of the tub with your feet in the water, and finally moving out entirely.
This is where we recommend starting in helping your child with autism overcome their fear of bathing.
Now let’s take the next steps.
5 Tips to Make Bath Time More Enjoyable for Children with Autism
Beyond just making bath time easier for autistic children (and yourself), there are several ways you can try to actually make it enjoyable.
Finding the right combination of tools and making sure you’re setting up the proper expectations for your child can eventually turn even bath time into a fun event, with much less stress involved for you and your little one.
1. Identify the Autistic Stressors of Bath Time
If you already know what upsets your child about bath time, that’s great!
Knowing is definitely half the battle here.
But if you’re not sure exactly what’s causing the distress, using trial and error may be your best approach. Before you do though, here are some common questions (and solutions) to verify what’s really going on.
- Does the bathing process take too long?
- Keep track of how long bathing is taking from one session to the next. Once you find that sweet spot, set a countdown timer to help the child know the end of bath time is coming soon.
- What is the ideal water temperature?
- Keep a thermometer nearby to test water temperature at every stage of bathing, during meltdowns and when things are calm. One study found that hot baths made autistic children more sociable and reduced repetitive behavior when lasting 30 minutes and with the water temperature at exactly 102 °F. A couple degrees below and the results were completely different. Most of the time, managing your autistic child’s behavior is not an exact science. But sometimes it can be.
- What is the ideal water level?
- Keep a ruler nearby to test water height. Once you find that ideal temperature and height you can prepare a bath with the best chance of success.
- Is it too cold to get out of the tub when your child is soaking wet?
- Make sure warm towels are ready for wrapping up in at the end of the bath. Electric towel warmers can work wonders, or put a towel in the dryer right before use.
- Does your child hate the feeling of being wet?
Be sure you've laid a change of clothes out ahead of time so post-bath time doesn't prolong the trauma.
- Who is in control of the washing?
- Sometimes, allowing your child to take a bit of control is enough to stop distress from building into a full-blown meltdown. So if you’re personally doing all the scrubbing, lathering, rinsing, and washing, see if your child responds differently if they handle the tasks themselves.
- Do they respond differently to a bath versus shower?
- You may be surprised to discover an autism shower routine works better for your child than a bath. For some children, a bath will work better. Don’t be afraid to try different things until you find a combination that works best for you and your child. Experimenting is key.
- What is their preferred towel and washing texture?
- For many children with autism, there are definite texture preferences. A washrag doesn’t have the same texture as a loofah or a sponge. The texture of towels can vary from one to another, and their texture can become an even bigger issue, depending on whether you gently towel dry your child or use a more vigorous rub.
- Are specific actions generating a worse response than others?
- Take note of cause and effects throughout bathing. For example, is hair washing a particularly volatile trigger? If so, breakdown all the variables in the process, from the type of soap being used to washing methods. Be aware that a child with sensory issues may also be dealing with gravitational insecurity, and leaning their head back to wash their hair can be highly upsetting.
- Are you calm and collected before and during bath time, or are you stressed and showing it with your words and actions?
- Looking at what usually happens before and after a meltdown, including what we say and do and how we say it, can sometimes help give us direction to see why the meltdowns keep happening (or getting worse) and what we can alter to improve the situation next time bath time rolls around.
Once you know the stressors that are causing the issues you can start eliminating them more easily. This might seem obvious but it’s really important to approach the entire process one step at a time.
This will make managing your child’s expectations and your response a lot easier.
2. Make Sure Your Child Feels Secure Throughout the Bath
The first step in making your child feel secure is feeling secure yourself.
Finding the right bath or shower routine can be a process. It involves trial and error, patience, and going slowly to find what works best for you and your child.
So make sure you’re in the right state of mind going in.
One way to make this easier is striving to etch out ample time for bathing. One of the quickest ways to get stressed is to feel rushed in what you’re doing.
The next step is finding ways to make them feel in control, secure, and protected with what’s happening. Here are a few examples:
- Issue: Your child negatively reacts to getting water or shampoo in their eyes
Response: Offer swim goggles or a foam or plastic visor to keep water and shampoo out
- Issue: Your child can’t stand being rinsed off
Response: Try letting them rinse themselves off using a hand-held shower hose
- Issue: Your child does not like water on their skin.
Response: Try using much less water in the tub, maybe only two inches to start.
- Issue: Your child has trouble with balance standing, getting in, and getting out of the tub
- Response: Attach a bath grab bar, traction mat, or safety railing to help with stability
Over time you will learn your child’s bathing preferences and improve the process. With enough attention, patience, and perseverance you’ll be amazed at the results.
Of course, we realize that’s easier said than done. But don’t give up! The most important thing you can do throughout this process is communicate with your child.
Each time you head into a bath battle, take a deep breath and ask yourself: Are you managing expectations and communicating as best you can?
Talk through the entire process with your child, before, during and after. Explain what you’ll be doing and in what order things will happen.
They’re likely to be less anxious when they know what to expect.
Many parents have found it helpful to have a list of each step in the autism bath time process. The same way you might create a visual schedule for daily routines, it’s also a really good idea to create a bath time-specific schedule or shower chart. This will help the child better understand where they are in the process and what’s coming up next.
3. Calm Your Child Before Bath Time
The calmer your child is going into bath time, the better chance of them remaining calm throughout.
If you find your child is overstimulated by bathing, consider having them do a little “heavy work” before the bath to help calm them down. This can mean going up and down the stairs or jumping on a mini-trampoline. Hugging your child, carrying boxes, walking pets, and yoga stretches are all good examples of proprioceptive input, commonly called “heavy work.”
Another way to offset the overstimulation of bath time is by moving it to earlier in the afternoon or evening, rather than bathing just before bedtime.
4. Make the Bathing Environment All About Your Child
Truth be told, those first three steps are more about getting your child with autism in the right mood — a neutral, accepting state. Once there, the window of opportunity is open to make the experience not just enjoyable, but something to look forward to.
Which is exactly what these next two tips are all about.
Because let’s face it, of all the rooms in our homes, bathrooms are one of the least exciting.
From teeth brushing to washing hands and bathing, there’s a lot of obligations going on in there for a child that are huge killjoys. So any little thing you can do to make the environment more enjoyable will make bathing more enjoyable.
Now, we’re not suggesting you turn your bathroom into a Chuck E. Cheese. But we’re also not suggesting you don’t turn your bathroom into a Chuck E. Cheese. (Because wouldn’t bath time be so much more enjoyable if it came with games, prizes, and pizza?)
Adding some kid-friendliness to your bathroom and bathing gear can go a long way.
Does your child love dinosaurs? Well, dinosaur the place up! Are they into ponies? We’re pretty sure a bathroom can never have enough ponies.
Here’s a slew of other fun bathroom design ideas for kids to inspire you.
Of course, it’s also important to consider the special needs of a child with autism when setting up the bathing environment.
If noises are bothersome to your child with autism…
Make sure there are plenty of towels, robes, rugs and other fabrics in the room. If necessary, spread extra towels or rugs on the floor. Bathrooms can act like echo chambers, and fabrics help absorb the sounds that may bounce off multiple hard surfaces.
You may also find it easier to prepare the bath ahead of time. Close the door while filling the tub, then turn the water off. Wait until the room is calm and quiet before bringing your child in to bathe.
If bright lights are troublesome to your child with autism…
Consider installing a dimmer switch, or turn off the bathroom light and only use a lamp or hallway light for illumination.
If certain smells overstimulate your child with autism…
It goes without saying bathrooms are one of the smelliest places in our homes. Try to make the room odor-free. Or use air fresheners.
You may find using essential oils in an aromatherapy diffuser helps create a more soothing, relaxing autism bath time experience as well. Include your child in the process by allowing them to choose their favorite scents.
Imagine creating a kid-friendly spa for your child.
Sounds ridiculous right?
Not when you’re in the throes of a tub tantrum.
5. Make Bath Time Fun
Last but certainly not least, if you want your child to enjoy taking baths make them fun!
You know what this means...
Toys! Toys! And more TOYS!
There is no shortage of waterproof dolls and action figures, wind-up toys designed for moving through sudsy water, special bath time crayons, or even just plain plastic cups and containers.
But even if you don’t want to turn your bathroom into a tiled toy box, there are plenty of other ways to make bath time less of a bore and more of game.
In fact, take that literally and turn your bath time into a game. Here are some great splish-splashing fun bathtub games and activities from Parents.com to get you started.
Create a Successful Bath Time Routine for Your Child with Autism
Okay, so now that you have gone ahead and put to good use all the tips above are you having the funnest bath time ever with your child? Has it just gone from something dreaded to the best part of your day? Do you now actually look forward to it?
But don’t be discouraged if the first thing you try doesn’t work miracles.
Experiment, talk to your child, and pay attention to their body language to find out what is working and what is not.
Crucially, don’t abandon a strategy just because it didn’t work the first time around. Try it a second time, even a third, or fourth time before looking into other options. Sometimes your child just needs the repetition in order to grasp the concept.
Because you can never underestimate the power of a good bath and shower routine.
Here’s a typical children’s bath routine:
- Plug drain
- Turn on the faucet tap
- Turn the faucet tap off (when it reaches predetermined level)
- Check bath water for comfortable temperature
- Get into the bathtub
- Wash hair with shampoo
- Rinse hair and shampoo with water
- Put soap on cloth or loofah
- Wash face
- Wash under arms
- Wash rest of body from top down
- Wash feet
- Rinse soap off with water
- Unplug drain and let water out of the tub
- Get out of the tub
- Use a towel to dry off
There are several visual schedules of this routine online to download but here’s an example:
What’s so nice about autism bath routines is that they break up bathing into distinct, easily grasped units. Take every little ‘win’ you’re able to accomplish and build on that. At first, a parent might have to do all the steps. But over time you can pass off one task at a time to your child until they can do all of them on their own.
Don’t let it upset you or derail all your optimism if there are setbacks. These are inevitable. Children with autism are all very different, and what works for one may or may not work for someone else, and it will take time to learn the entire routine.
How to Make Showering Easier for Autistic Children and Teenagers
An autism shower routine is not much different from a bath routine. However, there are some distinct differences to take into account.
Shawna Wingert, the owner of Different by Design Learning, shared a story about shower struggles she had to overcome as a mother of a young son reaching puberty.
Any parent of a child with developmental differences can probably relate.
Especially helpful is a list Shawna compiled of recommendations for helping kids with sensory sensitivities shower. Here they are:
- Change to a “rain” shower head. It will help ease the sensory overload of the shower water “feeling like needles.”
- Change to a “rain” shower head. This will cut down the noise of the water beating down considerably.
- Take a bath instead.
- Warm up the bathroom ahead of time to make the temperature changes less dramatic.
- Install a handheld shower nozzle. This allows our children to have a sense of control.
- Don’t worry so much about it. We have a cultural expectation that is very different from most places. Body spray and a quick wipe down will help.
- Dry shampoo works wonders.
- Dim the lights. Sometimes the lighting is half the sensory battle.
- Set a schedule and stick to it. The more it becomes a standard expectation, the easier it will be for both of you.
- Try different times of day. First thing in the morning or last thing at night can be the toughest times for our sensory systems.
- Buy lots of baby wipes and allow him to use them instead.
- Let it go. Many teenage boys fail to shower regularly. You have bigger fish to fry!
In addition to those we would also add:
- Try push button soap, shampoo, and conditioner dispensers on the shower wall or free-standing bottles with pumps. Label them by name and number them in order of use.
- Use a combination conditioner and shampoo to help speed up hair-washing time in the shower
- Attach an anti-fog plastic mirror (via suction cups) in the bathroom shower so a child can see themselves wash. Studies have shown the importance of mirror self-recognition behavior in autism development.
How Goally Helps Reduce Bath Time and Showering Stress
With the ability to set up routines and rewards in the myGoally app, it’s easy enough to include a bathing routine or a shower routine as well. Goally can help replace cumbersome, written visual schedules. During the bath, as in all other activities, Goally uses visual icon reminders as well as motivational noises throughout the activity to guide the child’s progress. Here’s an example:
You can set prompts in Goally to give your child with autism more ownership over their own bath time with less prompting needed from you, the parent. This cuts down greatly on the resistance many children tend to give parents who are trying to tell them what to do and when to do it.
Goally is able to reduce the amount of time it takes to complete a routine by keeping your child on task during bath time, when there are plenty of distractions and opportunities to procrastinate getting out of the tub, or getting properly clean. Goally is able to accomplish this without ever making your child feel rushed or anxious.
Goally can help you teach new skills to your child, including bath time skills. Complex tasks can be broken down into a series of steps your child can easily follow. You can also track how long bath time is taking every day over time and how often this routine is completed successfully.
When it comes to bath time, Goally is everyone’s friend!
Conclusion: Autism, Cleanliness and Good Hygiene
A lot of kids with autism dislike bathing. Many have an extreme aversion to them. A resistance to bath time is a challenge many parents face on a daily basis.
But we all know the importance of cleanliness, and introducing a good hygiene routine to autistic children.
Just remember, if your child is screaming and crying throughout bath time or showering, they’re not merely pitching a fit … they are in great distress.
In many cases, it’s a matter of sensory overload or over-stimulation.
In others, it has to do with specific fears or concerns.
As your child gets older, the need for proper hygiene becomes even more important. By starting early, when they’re younger, and making sure bath time is a pleasant part of their daily routine, you’re setting them up with good hygiene habits for life.
With a bit of planning and organization, bath time won’t always have to be a task that’s dreaded by both parent and child. The important thing is that you remain patient with yourself and your little one, and stay optimistic!
Ashley Lavoie is a mom of three and manages both child and adult ADHD and neonatal diabetes. She is advocating for awareness and loves writing and connecting with other families like hers.
Editor's note: This information is not meant to diagnose or treat and should not take the place of personal consultation, as needed, with a qualified healthcare provider and/or BCBA.