Dressing Skills
Independence in dressing usually takes 4 years of practice ( Case-Smith 2001). It is easy to forget the complexity of dressing activities and therefore it is also easy to get frustrated and overwhelmed when our kids or students are moving slowly, missing items, and especially when we are trying to get out the door on time. Occupational therapists know that kids’ ability to dress themselves plays a big part in relieving family stress and improving family routines. This is true whether a child has disability or not.
Key points:
Children learn to undress before they learn to dress.
Dressing tasks require fine and gross motor coordination, body awareness, bilateral coordination, right/left discrimination, postural stability, motor planning, organization, decision making, and more!
Improved independence equals improved confidence.
Backward chaining, the practice of putting the garment on the child and allowing the child to complete the action, is a great learning and teaching strategy (more on this below).
Kids can have challenges with dressing skills for a number of reasons.
Dressing skills and abilities follow a developmental sequence.
Typical Development of Dressing Skills.
1 year:
Cooperative. Holds out arms and feet.
Pulls off shoes and socks.
Pushes arms and legs through garments.
2 years
Removes unfastened jackets.
Purposefully removes shoes (if untied).
Helps with “ pull down” garments (pants and underwear).
Finds arm hole in pull-over shirts.
2 1/2 years
Removes“ pull down” garnet with elastic waste.
Puts on front-button type shirt or coat.
Unbuttons large button (s).
Tries to put on socks.
3 years
Puts on t-shirt ( over the head garment), with some assistance.
Puts on shoes ( no fasteners, may be wrong feet).
Puts on socks (difficulty turning the heel).
Independent with pull down garments.
Zips and unzips with help to place on track.
3 1/2 years
Finds the front of clothing.
Does up a front snap.
Unzips a jacket and separates the zipper
Puts on mittens.
Puts on boots.
Dress with supervision (exception of fasteners). Needs verbal guidance.
4 years:
Removes pull over shirt without help.
Zips jacket.
Puts socks on correctly.
Identifies front and back of clothing.
Puts on shoes
5 years:
Dresses alone.
Ties and unties knots.
6 years:
Ties bow and shoelaces
Self-Dressing Skills: Case-Smith ( 2001)
One of the most useful learning strategies for dressing skills is a strategy called: backward chaining.
The following is a fantastic summary and illustration of backward chaining. It was originally read in “ Your Child’s Dressing Workbook” (Turner, Lammi, Friesen, Phelan,. 2001).
Imagine that you are running a race. This event has no rules, just a finish line and a starter. In this race you want to guarantee your success. You want to win. What would and could you do?
Likely you would decide to start the race right next to the finish line. Then as soon as the starter said “go” you would be first to cross the finish line. This would ensure you are successful and met your goal.
Backward chaining is a strategy that views the teaching of a skill much like the race you just imagined yourself running. Now consider your child is the runner, and putting on a piece of clothing is the finish line. The best way to ensure your child is successful is to be right next to the finish line, in other words put the child near the completion of the task. As soon as the race begins the child only has a short distance to go before reaching the finish and experiencing success.
Break the skill down ( an OT can help with this, it is more complex than we often imagine) and start at the last step. You begin by practically doing the entire task for your child, requiring them to only do a little. Overtime you will do less and less, moving the “starting line” a little further away from the finish line each time.
Remember:
If you are putting on pants, the last step is “ stand and pull the pants to the waist.” Pull pants to knees, or put one leg in the hole are other steps and should not be where we start.
If you are putting on a zippered jacket, “ Finish the zipper” is the last part. Arms in and line up the zipper are other steps and not where we should start.
For school aged children completing arrival and departure routines can be stressful and challenging.
These strategies are meant to set the child up for success.
Try to find clothes for school that are easy for child to put on independently and quickly ( e.g pull on jeans, shoes with elastic laces or velcro)
Lay the child’s clothes out in the order they are to be put on. Ask them, what do you want to put on first? Usually they have a great idea and a plan that works for them. After all, you can put your socks on first or you could put them on last.
Explain and describe how you get dressed. Verbalize your plan. Tell the child what might get in the way, or what steps are hard.
Practice other two handed activities to help strengthen button and zipper tasks ( e.g. cutting, sealing a ziplock bag)
Allow extra time for dressing. Start early and in a quiet non cluttered environment to minimize distractions.
To help with planning use visual schedules or checklists to help remember all the steps of a dressing task and to evaluate the effort ( eg. Did you put your water bottle in your bag?)
Here are a few ideas for working specific dressing skills.
BUTTONS:
Begin buttoning practice with large buttons and big holes. Developmentally a child should be able to put 3 big buttons into the holes by age 4.
Have the child push buttons, coins, poker chips into a container, through a hole cut in a plastic lid. Also practice doing this with the lid in an upright/vertical position.
Demonstrate while standing behind the child. Remember mens and women’s shirts have buttons on the opposite side. Keep this in mind when practicing.
Insert the button through the hole and have the child pinch the button on the other side and pull it through (back-ward chaining)
Play with costumes and routinely play dress up.
ZIPPERS:
Work on starting a zipper after the child has mastered pulling up a zipper.
Try attaching a key chain to the zipper to provide a larger object to grasp when pulling.
Use large zippers to start.
Use backward chaining methods.
Practice jobs where the hand have two different jobs. For example mixing a bowl of cookie batter. One hand holds the bowl the other stirs.
SNAPS:
Practice pushing activities using the thumb and first two fingers such as pinching putty, popping bubble wrap, pinching clothes pins.
Show the child that both parts of the snap need to be lined up directly overtop of each other.
Practice at times of low stress during the day ( not running to and from the bathroom)
HAT:
Practice in front of a mirror so child can see self.
Model. Put your hat on your head and take it off, give it to the child to try.
Provide a variety of hats to try. Ball hat, cowboy hat, toque, etc.
Dress up time and lots of imagination play.
SOCKS:
Start with larger socks and work your way to ones that fit child.
Start with sock that has no heel to be oriented.
Back-ward chaining.
Connect with Path
If dressing skills continue to be a challenge, getting out the door a hassle and a negative part of the day or managing routines are hard, please reach out. An occupational therapist can help you change the demands of the task, modify the environment, provide skill building ideas, help you see the strengths in your established routines and offer guidance.
References:
Case-Smith, J. (2001). Occupational Therapy for Children. (4th ed.) Mosby.
Turner, L., Lammi, B., Friesen, K., Phelan, N. 2001. ( 2021, February 8). Your Child’s Dressing Workbook. CanChild Center for Childhood Disability Research. https://www.canchild.ca/en/resources/305-dressing-work-book.