In the previous article, “Is My Child Ready for Toilet Training? (Part 1)”, SPD’s occupational therapist, Jahzeel Ann Adan Eleazar, introduced toilet training and some common barriers that affect it. In the second part of this series, Jahzeel shares some tips to help make toilet training easier for your child.

Preparation before embarking on toilet training

• Toileting journal: Displays children’s toileting pattern such as timing for bowel and bladder movements, fluid and food intake etc.

• Environment: Create a calm, relaxing, and structured environment that encourages toileting independence.

• Toileting sequence: Instead of viewing toileting as a single event, approach it as a sequence/series of tasks.

• Visuals: Use visual supports, if needed.

• Rewards: Prepare rewards that are meaningful for children. It should be concrete and highly motivating. Keep praising or rewarding children every step of the way.

Strategies for toilet training

• Get the right seat: Some children are disturbed by the size and feel of a large toilet seat. Bring children to the store and help them pick out a potty chair or a cushioned seat that fits onto an adult toilet seat. Make sure your child feels safe and comfortable. It will also be helpful to provide a foot stool to ensure optimal sitting position. You can speak to your child’s therapist for toilet seat recommendations.

• Put on loose clothing: General rules are to keep your child in loose, easy-to-remove clothing, and allow plenty of time to practise dressing and undressing first. Sensations from tight clothing may interfere with the sensation of needing to use the toilet. Clothes without buttons or zippers are recommended so the child do not need to deal with fastening them while trying to get settled on the potty.

• Reduce the fear: Assess the environment to identify triggers which are keeping the child from feeling safe in the bathroom. Common triggers include loud noise, strong smells, cold toilet seat, or a cramped bathroom. For children who are frightened of the sound of flushing, get them to pour water instead of flushing the toilet. Do not force children to stay in the toilet when you flush. Another option is to put down the seat cover to reduce the sound of flushing. Some children may also be afraid of hand dryers. In this case, allow children to dry their hands using paper towels or handkerchief. Sometimes, it is also good to check whether the child had any prior unpleasant experience that may interfere with the toileting training.

• Optimal sitting position: Guide your child in adopting the optimal sitting position by getting them to:

1. Sit with their knees higher than their hips.  Use a foot stool or other flat, stable object, if necessary
2. Lean forward and put elbows on knees
3. Relax and bulge out stomach
4. Straighten spine

• Increase awareness: Help the child be more aware of toileting by:

1. Doing all the nappy changes in the bathroom, so they begin to associate this room with urinating and defecating.
2. Showing them that their stool goes from the nappy into the toilet, before flushing. Explain what you are doing at every step to reinforce the toileting steps e.g. “Stool goes into the toilet bowl, then next we close the toilet seat and we press this button to flush.”
3. Setting up a routine to encourage your child to use the toilet at stipulated times.
4. Some children prefer to defecate after a diaper change as they feel more comfortable doing it in clean diapers. Don’t feel upset. You can try taking the dirty diaper off and throwing away the stool in the diaper, into the toilet bowl. This may help your child understand that you want the stool in the potty. This can help to increase their awareness.

Other strategies

• Language and Communication Strategies

1. Provide children with the language to describe what they are feeling e.g. telling them: “I feel like I want to poo/pee” or “I need to go to the toilet”.
2. Give children the mechanisms and opportunities to communicate internal sensations by using visual prompts or pictures.

• Mindfulness Activities: Engaging children in activities such as yoga and meditation can further enhance their awareness of their own body.

Things to note

• Make toilet training a pleasant and positive experience.
• Setbacks are to be expected and should not be regarded as a failure or regression. Setbacks may occur when your child feels too much pressure.
• Make sure to coordinate your toilet training plans with others who may be with your child like their grandparents, childcare staff or teachers. It is important that they know how you want your child to be trained so that the child receives the same message during the times when you are not present. Source
• Postpone toilet training on these occasions:
  • An upcoming or recent move
  • The arrival of a new sibling
  • A change in childcare arrangements
  • Switching from a crib to a bed
  • A death, major illness, or other disruptions in normal family life

Resources

Toilet Training Guidelines: Parents—The Role of the Parents in Toilet Training Pediatrics June 1999, 103 (Supplement 3) 1362-1363;

Guide to Toilet Training (Copyright © 2003 American Academy of Pediatrics)

https://pediatrics.aappublications.org/content/pediatrics/103/Supplement_3/1362.full.pdf

http://theinspiredtreehouse.com/what-is-interoception/

https://www.continence.org.au/information-incontinence-english/poor-bowel-control?id=533

https://pediatrics.aappublications.org/content/pediatrics/103/Supplement_3/1353.full.pdf

https://www.hopkinsmedicine.org/health/wellness-and-prevention/toilettraining#:~:text=Toilet%20training%20is%20teaching%20your,and%20at%20the%20appropriate%20times.

https://childdevelopment.com.au/areas-of-concern/self-care/toileting/

https://www.camhsnorthderbyshire.nhs.uk/learning-disabilities-toileting-and-asd

Dunn, A., McGarry, M. (2017). 12 Elimination Patterns. In; Burns, C., Dunn, A., Brady, M., Barber Star, N., Blosser, C., Garzon, D. (Eds). Pediatric Primary Care (6th Ed.). Elsevier. St. Louis Missouri