Guidance for Teachers delivering RSE to CYP with
 Physical Needs
This guidance is designed to support teachers to deliver bespoke Relationships and Sex Education (RSE) to children and young people with additional physical and often, medical needs. If done well, RSE enhances self-esteem, it can be life changing, increasing the quality of life now and in the future! 
It is crucial to remember that every child is an individual, and this guidance should be adapted to meet their specific needs, abilities, and developmental stage, ensuring compliance with the legal framework.

Statutory Entitlement: 
All CYP, regardless of their needs or abilities, have a statutory entitlement to a comprehensive RSE curriculum. This is an important aspect of their personal development, health, and wellbeing.
DfE RSE Guidance (2025):
Pupils with special educational needs and disabilities (SEND) 
75. Teaching should be developed to ensure these subjects are accessible for pupils with SEND and prepare pupils for adulthood,14 as set out in the SEND code of practice: 0 to 25 years. This applies to both mainstream and special schools. 

14 “Preparing for adulthood” outcomes are set out at section 7.38 of the SEND code of practice: 0 to 25 years. 
76. Schools should be aware that pupils with SEND may be more vulnerable than their peers to harmful sexual behaviour, sexual abuse, exploitation and violence, bullying and 
other issues. RSHE can be particularly important for these pupils, particularly those with social, emotional and mental health needs or learning disabilities. 

Parental support:

It can challenge parents to realise that their children are becoming adults with adult feelings. It is important that the whole school approach to RSE, including extra information on the bespoke RSE offer for CYP with Physical Needs is shared with parents:
•	An explanation of ‘this is what we teach and how we teach it’. 
•	 Safety; ‘this part of their education is fundamental to keeping them safe’. 
The following guidance has been produced with reference to the training delivered by Helen Dunman. For more information on this specific training course see:
The Sex Factor course for teachers | Chailey Heritage Foundation

Reasons to adapt – the challenges faced by CYP with Physical Needs 
There may be children and young people (CYP) in your school with severe physical disability, they may have some or no movement, they may be wheelchair users and AAC users e.g. talking mats or using Makaton. They may have medical equipment attached to their bodies such as a port, a stoma or feeding tubes and they may have additional sensory needs. These CYP are dealing with such a lot already, regarding their physical function, it is essential that they are supported to receive a RSE curriculum that works for them. The RSE curriculum can be broadly defined as: understanding my body, puberty, relationship types and keeping safe, with that in mind, consider the following:
•	CYP with physical needs may be emotionally younger, both developmentally and due to their lack of opportunities for independence, their reliance on adult support for self-care.

•	CYP with physical needs may have never seen their own naked body – they may have everything done to them lying down with no mirror. Imagine if you hadn’t seen your own or anyone else’s naked body. •	

How can you support CYP to understand what is happening with a period when they wear incontinence pads and receive intimate care? They may never have had experience of changing towel or have seen their blood. Precocious puberty is defined as early onset puberty – below age 8 for girls and below age 9 for boys. This could occur with or without additional physical needs and highlights the need for an individual and responsive approach to teaching RSE.

•	How can you support CYP with physical needs to understand the difference between safe interaction and unsafe interaction when intimate care is a normal, daily experience?

Considerations- See Resource bank for resources to support these ideas 
1. Communication and Language
You need to be prepared to answer CYP’s questions about Sex and Relationships. It is important that we lay the ground rules down when they are young: YES you can have a relationship if you want. People used to say that disabled people didn’t have sexual feelings – how much of that outdated belief remains in the community?
Explicit and Concrete Language:
Avoid euphemisms. Use clear, explicit, and medically correct language for body parts and bodily functions. This is particularly important for children who may struggle with abstract concepts.
Use of social stories
Social stories can be an effective way to introduce complex social situations, like puberty, personal boundaries, or relationships, in a simple and predictable narrative format. Social Stories are short, sensory and all enjoy a story. It can be scaled up or down depending on learning needs. With a social story, there is already a structure and a script. You don’t have to worry about what language to use, how much detail to go into. It can be repeated easily. Using a social story can increase staff confidence.
Social stories can be used to teach content including: puberty; keeping safe and relationships including dating; the difference between friendship and a crush; body changes; intimate care; good secrets/bad secrets, LGBTQ issues and more.
Alternative Communication: 
Be prepared to use a variety of communication methods, including signing (e.g. Makaton), communication boards, and assistive technology, to ensure all pupils can participate and express themselves. You need to ensure that students using AAC have the correct symbols to communicate their needs and questions.

2. Visual Aids: 
Use a wide range of visual resources, such as images, symbols (e.g.PECS), and objects. Anatomically correct dolls can be helpful for teaching about body parts and personal hygiene. See resource bank for adapted dolls that reflect specific medical and physical needs.
Use of anatomically correct dolls
CYP with Physical Needs have a very fragmented view of their bodies. Dolls are visual and they also they enable a member of staff to talk about sensitive things in the 3rd person, for example: masturbation, erections, wet dreams and periods. 
Abusive touch can be clearly demonstrated using a doll. 
Anatomically correct dolls are available: teenage ones for puberty, children’s ones for pre puberty. This enables CYP with Physical Needs, a multi-sensory approach to learning.
It is important there is a distinct difference between the doll and a person. It is a doll, not a real person. A doll must not be personalised. It is important not to give them names outside of the social story, use ‘it’ rather than he/she outside of the stories. Differentiate between real life and the doll; it can be explained that the doll can be undressed because it is not a real person. Use an introductory statement when beginning the story such as ‘In this story, the doll is going to be called ‘Ibraheem/Sarah’. 
Use of a Drama Circle 
The drama circle is a space created on which to ‘tell/perform’ the social story. It can be made using a cloth laid out on the floor, around which the CYP and member(s) of staff are gathered. Outside of the drama circle, you are just the teacher, but inside the drama circle, something different happens.
The drama circle creates a safe space and a physical barrier to something different. It separates the social story from ‘normal’. Staff need to practise using the drama circle and embed the rules around its use. 
Within the drama circle, emotions can be explored, for example, CYP can gain a more complex understanding of emotions beyond happy, sad, angry e.g. frustrated, disappointed.
A mirror being present in hygiene rooms
A powerful visual aid is the presence of a horizontal mirror alongside changing tables. A mirror that enables a CYP to see their own body enhances their ability to learn in context. Staff give a commentary on what they are doing for the young person and this becomes education in context, using appropriate language and empowering the student. Quality RSE can start at age 3-4, when children see their bodies in the mirror.

3. Personal Care and Puberty:
For girls with physical disabilities, menstruation can be a particularly challenging topic. Practical, step-by-step guidance on managing periods, using adapted resources, and involving parents is essential. Similarly, for boys, a focus on shaving, hygiene, and nocturnal emissions is important. Occupational Therapist involvement may be sought for support with developing independence skills for changing pads, wiping etc
Normalise Changes:
For pupils who require assistance with personal care, it is crucial to normalise the physical and emotional changes of puberty. Staff should provide this support in a way that respects the child's dignity and privacy. The CYP should be at the heart of deciding how the care is to be provided, giving them as many choices about who/how/where as possible.
Privacy and Boundaries:
Explicitly teach the concepts of public and private parts of the body, appropriate touch, and the right to say "no." Body autonomy and consent is a fundamental safeguarding measure.
Consider the learning opportunities that might currently be missed during daily intimate care procedures. Intimate care should be a very important part of RSE. Throughout the day, there is a chance to learn about the body. In best practice, intimate care is linked with RSE and safeguarding. Staff can provide a running commentary about what they are doing and why. Making the most of that time can be a core part of learning about RSE for children and young people (CYP)

3. Relationships and Sexuality
RSE should focus on a broad range of relationships, including friendships, family relationships, and professional relationships with carers and health workers. CYP with physical/medical needs often have professionals seeing and touching areas of their body usually covered whilst intimate care is provided. It is important that the CYP understands the difference between appropriate and inappropriate in terms of the people providing the care, how/where/when it is given. The goal is to build skills for all relationships, not just intimate ones. CYP may have to manage medical needs in their future relationships. 
Consent: 
Teaching about consent is a cornerstone of RSE. It should be introduced early and in a simple way, such as "my body, my choice" and the right to say "stop." This can be taught through everyday activities as early as sharing toys or choosing a snack for younger children. Self-advocacy is an important skill for CYP with Physical Disability, particularly as they often rely on others for help and may not be well practiced in maintaining their boundaries or voicing their opinion.
Understanding Emotions: 
Many children with additional needs may struggle to recognise and express their own emotions and understand the emotions of others. Use visual aids like emotion cards and stories to help them develop emotional literacy. Positive self-image and body confidence can be particularly challenging for CYP with physical/medical needs. Exploring their own relationship with self and body is very important in overcoming some of their negative beliefs about their attractiveness, their right to enjoy all that relationships of all types bring.

4.Online Safety: 
Address online safety in a way that is relevant to pupils' experiences. CYP with physical/medical needs can be more at risk of social isolation and use the internet to overcome loneliness. They may like to be anonymous, inhabit another persona to hide their additional needs and the dangers associated with false identities are to be explored.

Example of a CYP, their needs and possible adaptations to RSE: 
Sarah 13-year-old with cerebral palsy who uses a wheelchair and has limited fine motor skills. She requires assistance with all aspects of personal care. 
Needs: Sarah is starting to menstruate, which is causing her anxiety. She is worried about managing it at school and feels embarrassed. 
RSE Adaptation:
Sarah is offered the opportunity to talk to a trusted person in school, about how she can be supported to manage her periods; the products that are available to make managing them easier, for example, choice of pads or period pants; and how the procedure for changing a pad, if necessary, would be done.
Adapted Plan: A step-by-step visual guide is created, with symbols and pictures, showing Sarah the process of changing a sanitary pad. If involved, an occupational therapist, parent or school nurse works with Sarah to find a method that is comfortable and dignified for her, and they practice in a safe environment. 
Communication: Sarah is given a communication card that she can use to discreetly signal to a trusted staff member when she needs to go to the toilet. This gives her a sense of control and independence. 
Dignity: The staff who assist Sarah are given specific guidance on maintaining her privacy and dignity during personal care. 
Please see links found below and at the end of the Resource Bank for general guidance on intimate care:
Intimate Care Guidance 
Fitting and removing pads - weight bearing and non weight bearing2022.pdf
Next Steps:
Review your current RSE offer and identify which learners might benefit from tailored sessions. Look at the resources in the bank at the end of this guidance to see which ones are best for supporting your learners.