Talking to kids about puberty and menstruation can be awkward. This anxiety can be multiplied for parents of children with cognitive disabilities, who may not be able to understand the changes happening to their bodies in the same way their peers do. However, there’s research emerging in this area that offers concrete tools and strategies for assisting young people with cognitive disabilities to understand and manage their menstrual health with as much dignity and independence as possible. Our goal in this article is to equip you, as caregivers, with tools to assist you and your child on this journey. Individualizing menstrual care is important, regardless of ability or disability, in promoting empowerment and dignity for menstruating persons. What works best for your child may change over time and will be impacted by their environment, personality, physical age, developmental age, and independence level.

Why Should I Teach My Child About Menstruation?

Menstrual education is a key aspect of increasing independence, empowerment, and dignity for menstruating persons, regardless of disability. If a child or teen does not have the skills to manage their personal hygiene and menstrual care, this may impact the social activities they’re able to participate in, and may promote feelings of shame (1). Teaching a child or teen safe and dignified practices allows them to carry out their menstrual care as independently as possible to promote health and reduce feelings of fear and stigma that may surround menstruation. Increasing menstrual independence for your child also reduces demands placed on you as you balance the competing requirements of daily life. 

When Should I Start Teaching My Child About Menstruation?

When to start menstrual education will vary for everyone, based on environment, physical age, and developmental age. Studies suggest it’s best to start teaching some skills young, to prepare your child for puberty and menstruation (2). We realize that initiating these conversations can be nerve-racking for caregivers. Still, many parents are pleasantly surprised at how well their disabled children handle the transition into puberty and menstruation (3). Starting early gives your child time to learn menstrual care skills so they’re more comfortable with them when they begin to get regular periods. It may take time to build these skills (sometimes years), but children who learn toileting skills can usually also learn menstrual care skills with a similar level of independence (4). 

What Should I Teach My Child About Menstruation? 

Once again, what you teach your child will be highly individualized. Consider their physical age, developmental age, and current level of independence when deciding what to prioritize teaching. You can also consult with their teachers, therapists, and medical professionals. In determining which skills to start with, we can break menstrual education into three categories: background education, concrete skills and abstract skills. 

Background Education:
Children and teens should be taught consent (5). Understanding consent is key to promoting safety and dignity for our kids. Use anatomically correct words to teach your child what areas of their body are private. Teach them what is appropriate in a public space versus a private space, such as a bathroom or bedroom. Give them the skills and permission to say “no” to things they aren’t comfortable with. 

Specific to menstruation, we should be teaching all menstruating persons that periods are a normal and healthy part of growing up, not something that should be scary or shameful. Children and teens should also be taught, to the extent possible and appropriate, the reproductive significance of having a period. 

Concrete Skills:
To achieve independence with menstrual care, children and teens should be taught to use the toilet and menstrual products, such as pads or period underwear. Most children who can learn toileting skills can also learn menstrual care skills to a similar level of independence (6). We should also teach children to communicate discomfort. People with learning disabilities are more likely to experience PMS symptoms than their non-disabled peers (7). For this reason, it’s important to ensure that your child can tell you when they’re in pain, and that caregivers (such as care staff and teachers) are aware of how they can assist the child with these needs. For non- or minimally-verbal children, communicating pain or discomfort may present as touching their stomach, withdrawing socially, or becoming agitated. Some methods to treat this discomfort can include applying a hot water bottle on the stomach, taking movement breaks, massage, and pain medication. Watch for signs of discomfort, and speak with a medical professional about the best ways to manage your child’s pre-menstrual and menstrual symptoms. 

Abstract Skills:
Many people with cognitive disabilities learn the practical skills of menstrual care, but struggle with the more abstract skills, such as understanding when they need to change their menstrual pad. We have some suggestions for this too! Your child can wear a watch with alarms set to vibrate at certain intervals to remind them to change their menstrual product. This is a more discreet and independent method of reminder them than a caregiver announcing “you need to go change your pad”. We also recommend they are supported in keeping a calendar to help predict when their period will start and end, and a diary for tracking their PMS symptoms. These could be physical calendars and diaries, or kept in a virtual calendar or smartphone app. 

Many parents and caregivers find it beneficial to create a Skills Hierarchy outlining “must have” skills and “nice-to-have” skills for their child’s menstrual care. For example, for a person to independently manage their menstrual care, they must be able to pull their pants up and down. We would consider this a “must have” skill, and would focus on mastering this before moving on to more complex skills. A “nice to have” skill may be the ability to independently identify when to change a menstrual product. While this skill is very helpful in creating independence, it could also be realistic for a caregiver to remind the person to go to the bathroom and change their menstrual product at regular intervals. Therefore, we consider this a “nice to have” skill, and would not prioritize it over “must have” skills. 

We recommend allowing your child to practice with multiple menstrual products over time. Just as non-disabled people appreciate having options during their period, so do people with disabilities. Allow them to practice using various types and brands of menstrual pads and period underwear to see what best suits their needs. Many people with sensory disorders find that period underwear are more comfortable than other products (8). They are also easy to use and require less frequent changes than disposable products, so they may be a good place to start. If appropriate, they could also try internal products such as tampons or menstrual cups.

How Do I Teach My Child Menstrual Care Skills?

There are many methods and resources available for teaching menstrual care to people who have cognitive disabilities. As always, emphasizing an individualized plan is key – you know your child best (9)! You can work with your child’s teachers or caregivers to create an Action Plan outlining a consistent routine for the child to follow. An action plan can ensure your child is practicing menstrual care skills similarly at home and at school. You can also give your child the opportunity to interact with others in a similar stage of life through social opportunities and support groups. People with intellectual disabilities have identified peer support as one of the most important aspects of learning menstrual care skills and becoming comfortable with their changing bodies (10). Ensuring your child has an opportunity to interact with others at a similar life stage is key to fostering their identity and reducing the stigma they may feel surrounding menstruation. 

Social Stories can help teach our children and teens about periods, why they happen, and how we manage them. A social story is a short description of a specific situation that explains what is expected of a person and why. It uses simple words and can include pictures if this is helpful to your child. We can also use chaining and visual strips to teach specific skills. Chaining breaks down a task into several smaller steps. For example, we could chain the process of applying a menstrual pad:

• Pull your pants and underwear down around your ankles
• Sit on the toilet
• Open the menstrual pad
• Remove the plastic from the back of the pad
• Place the pad onto your underwear so that the sticky side is against the underwear
• Place the plastic in the garbage
• Pull up your underwear and pants
• Wash your hands

A visual strip uses a similar process of breaking down steps and adds simple pictures as cues for the steps. You could make your own visual strips using photos in your home, and leave this in the bathroom for your child to follow. 

Some children also benefit from the ability to practice menstrual care skills, such as applying a menstrual pad, when they do not have their period and/or on anatomically correct dolls. This creates a positive and play-focused learning environment for them.

Teaching your child menstrual care skills may seem daunting. However, it’s a rewarding and important task with potential to increase your child’s quality of life.