Toilet training any child is frustrating. The number of light up musical potties, DVDs devoted to the task, and sticker charts available for purchase indicate parents’ desperation for success. Toilet training a child with a disability can be a whole new ballgame, and depending on the disability, it requires patience, endurance, and creativity. In our case, it even involved a custom toilet specific to my son’s size made with love by Grandpa!
Are they ready?
Experts agree that for any child to begin toilet training, they need to appear ready. In the United States, most parents train their child between the ages of eighteen months and three years of age, for children with disabilities, this can be later.
According to Maria Wheeler, M.Ed., a child may be ready if the child acts differently when they are wet or soiled, appear interested in bathroom related tasks, or expresses interest when seeing other people involved in activities related to toileting. Of course, there are physiological factors to consider as well. These include whether the child can stay dry for periods of time during wakefulness and naps. If your child is unable to stay dry for more than one or two hours at a time, consider restricting drinks and food intake to meals and designated snack times. If your child is showing signs of readiness, consider the following:
Physical issues
If not, an occupational therapist is a great resource. For children with sensory issues, the toilet itself may cause anxiety or fear. Some children don’t like the sensation of sitting on the toilet, whether it’s too high, too hard, or for reasons we may never know! The choices of musical light up potties is almost shocking, and there are a variety of lids you can place directly onto your home toilet.
For kids that don’t like having their feet off the ground, purchasing a wide step stool for your child’s feet, or installing handrails might help. In my son’s case, he opted for none of the above. He was too tall for the light up potties, but was anxious about our home toilet. Luckily his grandfather is a wood worker, and we took specific measurements to make sure the height, width, and depth were perfectly suited for him. Consider looking at a medical supply company for options as well.
Communicate the plan
When you, your pediatrician, behavioral therapist, occupational therapist, special and regular education teacher, speech teacher, the Easter Bunny, and whoever else you have working with your family determines it is time to begin toilet training, it’s important to remember that every child is unique, and that any program you choose to use may require tweaking. Sharing the toilet training plan with the therapy team is a good idea so training can continue in different environments. Some families put toilet training objectives on the Individualized Education Plan at school. While trial and error is a part of this game, so is consistency. Determine the best path based on your child and stay with that plan until there is a specific reason for making a change.
Create a habit
It starts with learning your child’s voiding schedule, including determining the approximate time of their bladder or bowel movements. Marking this data on a chart will help see patterns you may otherwise not notice. Noting fluid and food intake on this chart may be helpful too. The goal is to determine when they need to use the bathroom and get them on the toilet before their need to go.
When we initially started getting my son acquainted with sitting on the potty and becoming comfortable, we brought in his favorite video game or a special book to read. Once he no longer seemed upset about sitting on the potty, I assumed if he just sat there long enough, something would come out. We were quickly told by his therapist to cease that practice, as he needed to know the toilet had a purpose, and it wasn’t an extension of the playroom.
Knowing that he only moved his bowels at night, I’d place my exhausted little boy on the toilet and rub his back. Once he even fell asleep while sitting on the potty-my legs and back ached while I held him on top. I was so excited (perhaps delirious with exhaustion!), thinking all that needed to happen was for him to “accidentally” sleep-poop on the toilet, and he’d realize how easy it was! That dream soon vanished when he woke up minutes later, crying about the ‘needles’ he had in his legs from sitting on the toilet for so long.
Instead, experts like Ms. Wright encourage sitting for moments at a time, allowing the child to get up to stretch and returning to the potty until voiding occurs.
Consider the disability
In addition to behavioral therapy, children with various disabilities may need extra help and practice with other bathroom related behaviors, including undressing, wiping, and washing hands. In cases like this, an occupational therapist can offer suggestions such as hand-over-hand guided practice as well as games to develop motor skills.
Night Training
Once daytime training is successful, nighttime training can begin. For some of us, this might be more challenging, as crossing this hurdle can mean sacrificing precious sleep!
For children who usually get out of bed regularly or wake up often, use this time to enforce using the bathroom. It is also important to teach your child to use the bathroom immediately upon waking each day.
Maria Wheeler, M.Ed., is author of the book “Toilet Training for Individuals with Autism and Related Disorders” is available for purchase.
Diana Browning Wright, M.S., L.E.P., is an Educational/Behavioral Consultant, Psychologist, and Trainer. Her work can be found at www.dianabrowningwright.com.