The issue
Along with learning to feed and dress oneself, becoming toilet trained is an important step in personal independence. Socially, it opens up opportunities for interacting with others and taking part in a wider range of activities. In addition, there are practical benefits for parents and caregivers, including time and financial savings connected with nappy changing and the cost of related supplies.
Toilet training can be more challenging for children with SEND because:
- parents and carers of children with developmental delays cannot rely on the typical timelines for guidance about toilet training - instead, they must continue to watch for signs of readiness, even after the toddler years
- children with delays often have difficulties with language, both in understanding spoken directions and in verbally expressing their toileting needs
- where children have difficulty with change in their routines, they may be resistent to the steps involved in toilet training, such as taking away their nappy or sitting on the toilet for several minutes at a time
- children may also have a high activity level, be anxious in new situations and have difficulty feeling when they need to go, or have sensory sensitivities - for example, they may overreact to the sound of loud flushing, the sight of the flourescent lights, the feel of the toilet seat, or the smells associated with bathrooms
All these issues may combine to make toilet training a challenge - but it can be done.
Is my child ready?
Beginning toilet training too soon may make the process more frustrating for both you and your child. However, if your child is around three years or older, look for some of the following signs of readiness:
- notices when their nappy or clothing is wet or soiled
- shows interest in self-care like dressing, hand-washing and toileting
- shows interest in other people's toileting behaviour
- completely empties bladder when having a wee and stays dry about two hours at a time
- has bowel movements that follow a regular and predictable pattern
- has the balance to sit on the toilet for two to five minutes
- follows a few simple directions like "sit down"
- indicates the need to go to bathroom through facial expressions, postures, gestures, pictures or words
Even if your child is not yet showing all these signs, there are parts of the toilet training process you can begin to help prepare your child.
Am I ready?
Since you will be guiding this process, you need to be ready to begin. This means that toilet training is a high priority for you, and that you have adequate time to commit to it. It also means that the other people in your child's life - family members, babysitters, pre-school providers, are ready to help.
Toilet training will go more smoothly if all the people caring for your child use the same approach.
What can I do to prepare?
Before beginning toilet training, it may be helpful to keep a 'toileting diary' for up to two weeks that will capture information about the timing of your child's urination or bowel movements each day. This will provide you with clues about the appropriate times to take your child to the toilet. Depending on your family's comfort level, you may want to provide opportunities for your child to observe another person using the toilet to model undressing, sitting on the toilet, wiping, washing hands and so on.
Select the specific words you will use consistently (for example, pee and poop). Choose words you will feel comfortable hearing your child use in public when he or she is older. During this preparation phase, set up the environment to promote success. This may include purchasing a potty chair or adapted seat for the regular toilet, removing distractions, purchasing pants.
How do I begin?
- keep a toileting diary - this will hopefully give you good information about the best times to take your child to the toilet
For example, if the diary indicates that the child is consistently dry at 9.30am, but consistently wet at 10am, a good time to have the child sit on the toilet is right before 10am
- develop a visual schedule - this may decrease language demands and promote understanding of each step of the process
For example, you can present your child with a sequence of drawings or pictures depicting the specific steps: enter bathroom, pull down pants, sit on potty, wipe, flush, pull up pants, wash and dry hands - you can use these pictures to help
- if your child is in the early stages of toilet training, you may have to begin by scheduling trips to the bathroom that only involve certain steps of this process, like being in the bathroom or sitting on the toilet for a few seconds - deciding where to start will depend on how comfortable and compliant your child is with these first steps of the toileting process
Other helpful strategies
- increase liquids and high fibre foods to increase the chances of 'catching' your child when they need to go to the bathroom
- make the bathroom a positive place (music, soft lighting, pleasant scents etc.) and decrease things about the bathroom that may be seen as negative or anxiety provoking for your child
- decrease discomfort or fear of sitting on toilet by providing foot rests for stabilisation and a toilet seat insert
- plan clothing for ease of undressing
- assemble a basket of favourite toys for your child to use while sitting on toilet
- use a timer to increase length of time sitting on toilet
- create a 'now and next' board to communicate to your child the reward he/she will receive for going to the toilet - for example, 'First sit, then bubbles' - as a reward
- remember to provide rewards for the behaviours you want your child to do during the toileting process
- use social stories to describe each step of the process through a simple story format
- create a picture card for your child to communicate the need to use the bathroom, if your child is nonverbal or has a hard time using his/her verbal abilities in stressful situations. Here is an example you could use of a toilet visual.
Setbacks?
It is common for all children to experience setbacks in toilet training, particularly when they go through transitions or other stressful experiences; you may therefore need to repeat some of the earlier steps of toilet training to get back on track.
