Cutting fingernails

my adult son has complex learning/physical disability and is on the autistic spectrum. He doesnt use words to communicate and has no understanding of makaton or pictorial prompts. He’s always disliked having his fingernails cut and it is a struggle (in every sense of the word) to keep hold of his hand when all he wants to do is pull away. When he lived at home it took us up to a week sometimes depending on how he felt at the time so we understand how difficult it is. He now lives in his own flat and has 24/7 support from a fairly consistent team, a couple of whom are very confident to cut his nails, however, if his regular staff are on leave or off sick then they don’t get cut. The reason given is that only a few staff have had training, (I believe it was a hair and beauty course at our local college) and some staff are fearful of “using restraint” Does the care provider have a duty of care to cut his nails, he can’t do it himself. He’s in his late 40’s and I don’t see him ever becoming tolerant of people holding his hand. Can the care providers own policy override his personal care needs and if they can, what are we expected to do? Can anyone help please?


Hi there,
would your son tolerate an emery board ? Introducing him to one would be much less dangerous than trying scissors and it could help him to have ownership of the whole nail cutting procedure. It may also enable him to be less anxious and possibly more engaged with no need to be restrained.

I think too often … it starts in childhood, but is still happening with adults … people think it’s something that HAS to be done ( like blood test for example) and there is an idea of just be firm and get it done.

In my experience this is absolutely the worst approach to take. It doesn’t have to be a struggle between your son pulling away and only those who now how to do his nails succeeding.

I have had years of experience of finding imaginative ways to deal with this issue. I find incremental approaches always work, but may take years.

I would suggest new staff interact with your son using the emery board as a tool for getting to know each other. Don’t even think of ‘doing’ his nails at first. Just let him hold, explore, chew on, throw away … whatever he wants. Then very gradually work towards nail maintenance.

All the best, another parent

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Hello and thank you for your response. Unfortunately my son reacts very badly to his nails being filed either by a metal file or emery board. Our latest method is to clip them in his bathroom after his shower on the same day he has his aromatherapy session at his day centre. He thoroughly enjoys the session and has begun to tolerate the back of his hands being stroked which is a huge step forward. She stops as soon as he shows signs of distress but he is letting her touch his hands a little bit longer each week and so when he gets home his team decided to continue the theme and devised a pamper evening. after tea they play a relaxation CD put on his sensory lights and aromatherapy diffuser to set the scene and so far they have had some success, just two nails to start with then three, I can hardly believe it after all these years. It now seems such an obvious thing to do but very often all we see is how difficult it is.
Best wishes

Oh that sounds brilliant. I am a huge believer in gradual incremental work. It sounds like this is working really well and is linked now to something pleasurable that he can look forward to … All the best.