Stepping stones to independence – Dressing skills
by Sam Wade
Gaining valuable dressing skills is such an important part of self-care and independence skills. Independence in dressing usually takes years of practice. First steps are learning to undress before starting to learn to dress. Carers can introduce dressing as early as one year old when undressing and supporting the child to complete the final step in undressing such as pulling their arm out of their top. When the child is increasingly motivated to dress themselves, they will then attempt the more challenging task of learning to put on clothing.
Building on important gross motor and fine motor skills from an early age will support the development of dressing skills. Practicing dressing using a range of different clothes and playing with toys and books that involve using a range of fasteners with support from an adult can contribute in the development of vital skills that support independence in dressing.
Dressing involves a high level of performance skills:
• Active range of movement – To be able to move muscles voluntarily in order to move the trunk and arms and legs when dressing.
• Balance – To be able to maintain a balanced position for example when stepping through a leg into a pair of trousers.
• Motor planning – To be able to plan and order the activity of getting dressed. To think about what the child wants to do (ideation) to working out what they need to do (execution).
• Postural control – The ability to stabilise the trunk and neck to be able to coordinate limbs. For example, the child to be able to sit in the floor in an upright position so the child can put their shoes on.
• Vision – To be able to look and focus on the item of clothing.
• Perception – To demonstrate a have a level of perceptual awareness to be able to find an item of clothing in a drawer or busy cluttered cupboard.
• Sensory processing – Dressing involves sensory challenges. To be able to process different sensory input such as tactile input from different fabrics, knowing when an item of clothing is twisted or shoes are on the wrong feet. Movement processing challenges may impact a child being able to bend over when reaching for their feet or pulling their trousers up after toileting. Proprioception (body awareness) challenges may impact a child’s awareness of their own body and their body parts and where they are without looking at them including grading a movement to know the level of force required to push through their foot when putting on shoes. Auditory challenges may impact the ability to dress when trying to focus in a noisy, busy school changing room after a games lesson.
• Fine motor skills – Extrinsic muscle strength so that a child can reach for an item of clothing, grasp and release as needed. Using the larger muscles that originate in the forearm that control flexion and extension in the hand and broader hand movements such as a power grasp.
• Intrinsic muscle strength – using the smaller muscles in the hand and fingers to grade movement, shape the arches of the hand and enable precision movements, oppose thumb, make a pincer grasp. In hand manipulation skills are used to pick up an item of clothing and manipulating this within the hand to hold the end of an item of clothing such as a sock.
• Bilateral integration – Using both sides of the body together in a smooth coordinated movement when pulling on trousers using both hands or pulling both sides of a cardigan or coat together prior to zipping or buttoning. Using midline crossing skills when reaching across the midline with their dominant hand to reach for a shoe.
There is a typical development sequence for dressing skills that can be used as a helpful guideline:
| Typical Age | Developmental self dressing skill |
|---|---|
| 1 | • Holds out arms and feet to cooperate with dressing, pushing arms through pushes and legs through trousers. • Pulls off shoes and socks. • Begins to undress. |
| 2 | • Removes unfastened coat. • Removes shoes if laces untied. • Helps to pull down trousers. • Unbuttons a large button. • Pushes arms through a top once placed over head. |
| 3 | • Puts on a jumper with minimal assistance. • Undresses with minimal help. • Puts on shoes without fasteners (they maybe on the incorrect feet) • Zips and unzips jacket once Zip has been placed in fastener. • Needs assistance to remove jumper. • Independently pulls down simple trousers such as jogging bottoms, underwear, shorts. • Able to put on socks following support with orientation of heel. |
| 3.5 | • Able to pull open zip and separate fastener. • Unbuttons three or four buttons. • Dresses with supervision – may need support with orientating front and back • Undoes poppers. |
| 4 | • Able to zip up coat. • Removes jumper independently. • Puts on socks correctly • Identifies front and back of clothes. • Able to place socks on with correct orientation. • Puts on shoes, needs support to tie laces. |
| 5 | • Able to dress independently. • Able to tie and untie a knot. |
| 6 | • Able to tie a bow. |
Adapted from Klein, M.D. (1983) Pre-dressing skills. Tucson, AZ: Communication Skill Builders
The typical development sequence for dressing can be used as a guideline when supporting a child with their dressing skills, like other motor skills dressing skills can vary between children especially in the early years of childhood.
If a child continues to find dressing a challenge following practice, guidance and support an occupational therapy assessment may be helpful in identifying factors that may be impacting the child’s dressing skills. The occupational therapist can identify the necessary steps to support a child’s development and determine functional abilities, challenges and needs in their daily life. Occupational therapists can recommend a range of interventions that can support the child in achieving their goals.
