With families spending so much time at home, during the COVID-19 health situation, every day starts to look the same! It’s hard to imagine what goals you can be working toward in such strange times - figuring out what day of the week it is seems like a challenge in itself!

How about toilet training? Spending so much time at home presents a good opportunity to work on toileting. When a child has a disability toilet training can present its own unique challenges and getting started can feel like a big step. It’s ok to feel overwhelmed. The best starting point is usually your allied health professionals and medical team. Below are a few of the common questions we receive from families and responses from our team.

Can my child be toilet trained and how long will it take?

Whilst there are certain medical conditions or disabilities which may result in toileting being unachievable, this is not a blanket rule for all disabilities. It was previously thought that those with complex movement disorders or postural support needs couldn’t use the toilet and that those with intellectual disabilities were unable to learn this skill. This resulted the ongoing use of continence aids.

The process for toilet training is different for every child.  It could take days for some children and weeks, months or years for others. Some children will learn to consciously and actively control their bowel and bladder and for others it will be a matter of ‘toilet timing’ (regularly sitting on the toilet resulting in learned physical responses). Your health team will be able to help you work out the best method for your child.

Toileting is not an issue of convenience. It is not even just an issue of health (although it does minimise the risk of skin breakdown and urinary tract infections). It is an issue of dignity for children and young adults with a disability.

Why is toileting such a big skill? Isn’t it one of the most automatic and universal things we do?

It may not seem like it but using the toilet is a complex skill. It relies on multiple biological and developmental factors, including:

• Motor skills – involved in movement to and accessing the toilet, as well as adjusting clothing, wiping, flushing the toilet and washing hands.
• Social skills – influence how children understand the appropriateness of toileting time and place.
• Communication – the capacity of a child to express needs around toileting as well as to receive explanation /
• Cognition – toileting requires sustained attention to the task and completion of a sequence.
• Sensory issues – some children find the toileting experience a sensory overload.

I’m keen to get started. What do I need to know?

A good place to start is to give your Occupational Therapist a call. Or if you’re seeing your preferred medical professional in the near future, they may have some tricks and tips too.  Medically, your child will need to be clear of constipation prior to starting toilet training.

Some general tips include:

• Set realistic goals! Independent toileting is not the only goal. Each step toward independent toileting is a goal. The goal may be to develop a positive toileting association. The goal may be to establish timed toileting.
• Healthy lifestyle habits such as increased fibre in diet, plenty of water throughout the day and exercise help to prevent constipation.
• Establish a communication method that is clear, simple, positive and works for you and your child. Use consistent language to talk about ‘wees’ and ‘poos’ and a ‘need to go’.
• Use correct anatomical terms for genitals (this is protective for children long term).
• Support your child to do as much as they can for themselves. It may be pulling one side of their pants up or even actively looking and watching you. Being an active part of the process is critical.
• Collect observations about your child’s toileting pattern (your OT can help with this).

Can you give me a specific approach to toilet training?

To explore your child’s toileting behaviour and start to establish positive toilet associations you can begin by sitting your child on the toilet at regular intervals such as upon waking, 20-30 minutes after each meal (highlighting natural toileting urges) and before bed. Don’t force them. Don’t expect anything to happen. If they become distressed praise them for trying and try again later. If your child develops a toileting habit from this, hooray! If not, give us a call. Developing an individualised approach is best done in consultation with your Occupational Therapist and we’d be pleased to help!

Equipment required to support the toilet training process can include:

• Seating - appropriately sized child seat, insert or commode chair. For many children with a developmental delay it is easiest to use the toilet to begin with to avoid the transition from potty to toilet.
• Footing – use a secure stool or footrest.
• Clothing – that is easy to remove or adapted clothing if regular hoisting is required.
• Environment – an inviting, non-aversive room with limited distractions. Remember in different environments outcomes may vary. A child who can usually verbalise and ask for ‘toilet’ may not do this in a busy shopping centre as they are experiencing sensory overload.
• Aids – visual and communication aids can help.

This is still really difficult. What other things can I try?

We’ve encountered all sorts of toileting “tips and hacks” over the years which are worth a try! Here are a few:

• Gentle music playing in the room can help if the sound of the water is distressing.
• Squash the toilet roll to make it an oval shape and this will stop it rolling off all the paper
• Let them watch you. The more children see other family members using the toilet the more motivated they will be. Let them help you flush when you’ve finished to remove fear.
• Set a timer so toilet time has a predictable end.
• Clean your child as soon as they are wet or soiled to highlight the feeling of being dry.
• Have a toileting toy box of books/toys that is only able to be played with after toileting.
• Utilise a ‘transition’ object for toileting. When you are wanting your child to sit on the toilet for a period of time, hand them an object to signify this. This may be a picture card of a toilet or an empty toilet roll.
• Make a tape line on the wall for how long to make the piece of toilet paper.
• Provide control in any way possible. Perhaps they can select the reward (“will we put gold stars or red stars on our chart today?” or “after toilet time would you like to read a book or play a game?”)

Good luck and happy toileting! If you need support we’re here to help, toileting is an ideal skill to review via telehealth.