Top Tips for Intimate Care - children with Complex Needs, Limited/No Communication and SEND

• Read the child’s Intimate Care Plan, Healthcare Plan, behaviour plan and communication profile;
• Understand their:
  • Medical conditions;
  • Mobility needs;
  • Sensory sensitivities;
  • Triggers and calming strategies;
  • Communication style (verbal, non-verbal, Augmentative Alternate Communication (AAC), gestures, eye gaze, objects of reference).
• Only staff who know the child well should deliver intimate care wherever possible.

For children with no or limited speech:

• Use their communication aids (Picture Exchange Communication Systems (PECs), symbol boards, eye-gaze, switches, signs, objects);
• Use consistent language and gestures;
• Work slowly and give processing time;
• Watch for non-verbal cues of distress, consent, refusal, or pain;
• Avoid sudden movements or changes in routine.

Even if a child cannot communicate verbally, they can still indicate consent, choice, and discomfort.

Older children and teenagers may be particularly self-conscious:

• Ensure full privacy while maintaining safeguarding visibility;
• Offer towels, robes, or dignity sheets when appropriate;
• Use gender-appropriate staff if this is the child’s preference;
• Never discuss the child’s needs in front of others or in corridors/ communal areas;
• Avoid infantilising language; speak to them as their age, not their developmental level.

Support the child to do as much as possible independently:

• Offer step-by-step prompts;
• Break tasks down into manageable parts;
• Use visual prompts (e.g., first/then cards, visual checklists);
• Celebrate successes, even small ones;
• Do not rush, supporting independence may take time.

Older children and young people may be larger or heavier which can impact on intimate care delivery procedures. Staff must:

• Never lift manually unless specifically trained and authorised;
• Use hoists, slings, adjustable beds, or other equipment exactly as trained;
• Work as a pair where the plan requires it;
• Maintain good posture, avoid twisting, and follow the manual handling plan;
• Report all equipment faults immediately.

Children with limited communication often show discomfort differently. Watch for:

• Withdrawal or freezing;
• Pushing away, tension, stiffening;
• Facial grimacing or flinching;
• Unusual vocalisations or silence;
• Increased movement, agitation, or self-soothing behaviours;
• Sudden changes in breathing or colour

Report anything unusual or unexplained as a matter of urgency to the DSL and SENDCO.

Many children with complex needs rely on routine:

• Use the same staff where possible;
• Warn the child before each step (‘In a moment, I will help you stand up’);
• Use countdowns (e.g., ‘1-2-3 lift’);
• Keep noise low and lighting appropriate;
• Introduce changes gradually and with preparation.

• Older children may feel embarrassed; respond with sensitivity;
• Avoid comments about bodily appearance;
• Always work at the child’s pace;
• Reassure them, but avoid unnecessary touching or invasion of space.

• Always follow the plan for one or two staff;
• Communicate clearly with your colleague during hoisting or transfers;
• Share key information in brief handovers;
• Ask for support if behaviour, size, or medical needs make care unsafe with one adult.

• Have all equipment ready before the child arrives;
• Ensure the space is clean, warm, and organised;
• Check hoists, slings, belts, beds, grab rails, and hygiene supplies;
• Avoid leaving the child unattended at any point;
• Do not lock doors.

Older children may have strong preferences. Consider:

• Gender of staff;
• Clothing preferences;
• Sensory sensitivities to touch, textures, smells, or temperature;
• Cultural or religious boundaries.

• Wear appropriate PPE;
• Use gloves/aprons safely and dispose of waste correctly;
• Clean equipment thoroughly;
• Store continence products securely;
• Keep a calm, clean, dignified environment.

Document intimate care immediately:

• Time and date;
• Staff present;
• What support was given;
• Any marks, injuries, unusual behaviour;
• Any child responses or distress;
• Concerns about equipment or safety.

For non-verbal pupils, even small changes must be documented.

• Report immediately to the DSL if:
• You notice unexplained marks or injuries;
• A child shows fear or distress around a specific adult;
• Something feels unsafe or 'not right';
• A child’s behaviour changes in a concerning way.

• Stay calm and child-centred;
• Keep hands visible and movements clear;
• Never use your phone or personal device in care areas;
• Never be alone with a child against policy;
• Never carry out intimate care when feeling rushed or unsupported.

• Use correct posture and equipment;
• Tell a manager if you feel unsafe or physically strained;
• Debrief with colleagues or leaders after challenging incidents;
• Never be alone with a child against policy;
• Do not work beyond your training or capability.