For some children (and the carers who are teaching them), the transition from nappies to toileting can be a relatively easy one. But, for others, it can be a challenging and at times, a traumatic period of time. Delayed toileting can be a common problem, particularly for children who have additional needs. This tip sheet highlights some things to consider and some strategies that just might help your child to achieve this important milestone!
Physical: low muscle tone, over/under-active bladder, difficulty managing buttons, zips, or pulling pants up/down.
Environmental: the height of the toilet (are their feet supported), do they feel stable on the seat (does it wobble), is the toilet close to the main living area?
Sensory: Are they sensitive to the noise of the toilet flushing, exhaust fan or hand dryer? Do they recoil at the smell in the toilet? Do they feel uncomfortable with the temperature or process of undressing or the feel of the toilet seat? Are they insecure when seated (instability / fear of falling in)? Do they recognise the sensation of needing to urinate/defecate?
Emotional: do they have a fear of defecating due to a previous experience with constipation that may have been painful? Are they constantly ‘on the go’ and leave it too late?
Communication: are they able to communicate their toileting needs (either verbally, keyword sign or another communication method). Do they recognise or alert adults when they have gone. These are important developmental steps that support the success of toilet training.
Activities & Strategies
- Use a tracking sheet to monitor when your child typically tends to wee and poo – you may start to see a pattern.
- Schedule set times to sit on the toilet (for example on the hour or based on the tracking sheet). This can be made fun by having a basket of toys that are only used on the toilet. Put a Where’s Wally or find the hidden objects poster on the wall, read a special book, or play a special song. Blowing activities is also a great activity to do. Bubble Mountain is an activity that encourages engagement of the abdominal muscles. Add a drop or few of dishwashing detergent in a plastic bowl, jug or bucket of water and have the child blow through a straw or long piece of tubing to create a big mountain of bubbles!! You can make it extra fun by adding a drop of food colouring or glitter!
- Have a step stool set up ready to go and practice having your child using it to increase confidence. A smaller padded toilet seat with handles can also assist in increasing comfort and stability and a smaller hole can appear less daunting.
- Improve your child’s ability to do dressing tasks (i.e buttons/zips) outside of the bathroom environment to make it more fun. For example, use a dressing up box to practice pulling clothes up/down and have races to help with speed (particularly if urgency is an issue).
- If buttons are difficult, you can improve your child’s fine motor skills by practising activities that strengthen the muscles in the hands and fingers such as theraputty, peeling stickers and using tongs or pegs to pick up small items or alternatively avoid clothes with buttons and zips until your child has mastered toilet training.
- Encourage sensory messy play, such as playing with slime, drawing in shaving foam, finger painting, or water and sand play.
- A reward chart can also be used to help with toileting motivation!
- Children learn through play so role play with your child’s favourite soft toy. This can be a great way to address some of their concerns, particularly if they are of a more emotional nature.
- Consider the smell, sound, lighting and tactile experience in the toilet. What can you change to make it a more comfortable, and less daunting environment?
- Social stories and watching YouTube videos such as Tom’s Toilet Triumph can be a fantastic way to alleviate some of the concerns that the child may have. When creating a social story, ensure that it is simple, with pictures and that it highlights the steps and expected behaviour of the task.
- Visual supports can be a really effective way to help a child become more successful in a specific task. For example for toileting, the whole task can be broken down into “Pull pants down, Sit on toilet, Use paper to wipe, Pull pants up, Wash hands.”
If your child is experiencing difficulties with toileting, and you’re unsure if occupational therapy can help, contact with the team at Empowered Kids and we will be happy to have a chat with you.