SELF-CARE

Children with spina bifida should be encouraged to acquire independence in age-appropriate activities of daily living (ADLs) at an early age. Fine, gross, and visual motor skills are rarely significant enough to account for delays in ADLs. Despite adequate intelli­gence and upper extremity function, delays in ADLs are often appreciated. Family members should be instructed to proceed with age-appropriate expecta­tions. If there are continuing problems and extensive lower extremity paralysis, an occupational therapy consultation is necessary; this should include educa­tion of the child and the parents (74).