Toilet training a child is never going to be easy or straight-forward, and helping a child with special needs to gain the skills needed to gain bladder and bowel control can be very challenging for even the most patient parent. There are no short-cuts, easy methods or even a “one-size-fits-all” approach. Every child is different, and different approaches will work for different children, even those within the same family.
There really isn’t “a right way” to toilet train a disabled child. Disability impacts every child differently, and parents have to be sensitive, flexible, responsive and resourceful to find the best way to help their child with special needs understand and acquire the skills needed to successfully graduate out of nappies. Like many aspects of special needs parenting, this is one aspect where many families feel that they almost have to make it up as they go along, hoping that, through trial and error, they will stumble upon a way that works for their child.
It’s an issue that comes up time and time again, and parents often ask for advice. So last week I asked parents for their “Special Needs Toilet Training Top Tips” on The Special Parent’s Handbook Facebook Page. Dozens of suggestions flooded into the comments box, from parents who have been there and who have learnt the hard way, passing on all the things that had worked in their families.
So here goes – the top tips!
Before you start
Work out if you really think they’re ready. Are they staying dry sometimes for at least an hour or so? Do they understand simple instructions? Are they able to sit still for long enough?
Do you know any children of a similar age who have mastered it? Sometimes the “penny drops” with a child when they see someone of their own age do it. Is there anyone in your circle with a child who they could spend lots of time with and who can set an example?
Use a social story about going to the toilet, and start reading it with your child before starting toilet training.
Talk to your child’s school or nursery – explain what you’re doing and how your are approaching it, and get them to help and to do it in the same way as you’re doing it at home
Draft in as much other help as you can too – friends, family, carers – so that you don’t burn yourself out
Decide if you are going to use a potty or sit your child straight on the toilet and if possible, stick with it.
If they are going to be sitting on the toilet, make sure their feet are able to reach the ground, otherwise have a chair or a stool nearby for them to rest their feet on.
Be realistic
Expect it to take loads longer, and don’t worry if you have to stop trying for a few months.
It’s not a race, your child will do it when they are ready, and our children will often be significantly older than most before they are able to cope
Don’t rush things.
Don’t get fixated on an “ideal” age to have your child out of nappies. Every child is different, and their body matures at their own rate. If they have additional needs to contend with too, they may not be ready to be toilet-trained until much later than other children.
How do you do it?
Be consistent. Take your child to the toilet at frequent and regular intervals throughout the day, every day.
How often should you take your child to the toilet? It seems to vary – some families take their child every half an hour, others leave as long as two hours between visits. Be realistic about your own resources and what you can manage day in and day out for what may be several weeks or even longer.
Make sure they have plenty of fluids, but fluids are also in a range of things besides drinks – lollies, jelly, watermelon and other fruit.
Continuity can be very important. Buy identical potties or potty chairs and keep one in all the regular places they visit – school, nursery, grandma’s house etc, and have one that can go out and about with you too.
Notice signs that your child may be increasing their understanding of what they are expected to do, and praise them loads every time you feel that something has “clicked” with them.
Visual timetables can work really well.
Don’t make a big deal out of any aspect of toilet training
Have a potty in every room in the house.
Visuals can work really well to help a child understand the toileting routine
It can help to keep a toilet training diary. Write the times you take your child to the toilet, whether there were any positive results, as well as recording if their nappy was wet or soiled immediately prior to the toileting.
Make it a positive experience for your child
Make it fun to sit on the toilet.
Have a tray of toys with things like bubbles, balloons or whistles – anything that will encourage them to blow. Blowing helps to strengthen the muscles responsible for pushing out stools!
Always keep the toilet-sitting times short – never let them sit for more than 10 minutes.
Reward systems – but only for sitting on the toilet, never for actually using. Sitting on the toilet is something a child chooses to do, and therefore can merit a reward for good behaviour, whereas actually “going” on the toilet is often outside a child’s control, particularly in the early stages of toilet training.
Let your child take their favourite toy with them, even their ipad or similar device. You can put a chair in front of them for them to lean on the draw or keep their toys nearby.
Stay relaxed and happy – stress will only confuse your child and make it all much harder for everyone.
Give loads and loads and loads of praise and encouragement
Don’t beat yourself up, or get stressed over wanting your child out of nappies by a certain age. It will happen when it happens, we can’t force a child until they are ready.
General Tips
Notice signs that your child may be increasing their understanding of what they are expected to do, and praise them loads every time you feel that something has “clicked” with them.
Toilets can be frightening for a child – much more so than potties. A lot of children fear that they might fall down the toilet and get flushed away. Be particularly aware of their potential fears if they are non-verbal or have limited communication, because they will not be able to communicate those fears and to seek reassurance.
Some children like to sit backwards on a potty. So what?! It really doesn’t matter!
Some children can cope with passing urine into the toilet or potty, but can’t cope with bowel motions unless they are wearing nappies or pull-ups. If that’s the case, you can encourage them to sit on the toilet whilst in a nappy, so that they still get to make the association between bowel movements and toilets.
Be aware of how your child might be feeling about the whole toilet training process, particularly if they are non-verbal or poor communication skills.
- Take it at their pace, make everything as fun and as lighthearted as possible, and give masses of praise and encouragement
- If it’s not working, stop trying for a few weeks or months and start again.
- Don’t set them up to fail, or make them feel bad about themselves in any way.
- Don’t let it become a chore, or allow them to sit for too long.
- Count successes, not when it doesn’t happen. Successfully sitting on the potty or toilet is a success.
If boys don’t stand to pass urine, it really doesn’t matter, however old they are!
Try and “catch” the moment, look for any subtle signs that your child might be about to open their bowels and get them onto the toilet or potty quickly.
Some parents used a ping pong ball in the toilet for their sons to aim at – the balls don’t flush away and it makes it more fun and more likely that a boy will learn not to spill on the toilet seat. Other families have used a bulleye sticker on the inside back of the toilet bowl.
What if we’re just getting nowhere?
If it’s just not working and you’ve tried everything, and you think your child should be capable of learning how to use the toilet, look at other possible reasons why –
- Are they on any medications that may be affecting bladder or bowel control?
- Are they eating a healthy diet, with lots of fruit and vegetables for fibre?
- Are they drinking enough fluids?
- Could they be constipated? Constipation can lead to abdomenal pain, which could be having a detrimental effect on toilet-training
- Could they have another undiagnosed condition?
Does your child have a recurring pattern of loose stools followed by constipation so bad that they don’t open their bowels for several days, or in some cases, a week or two? This needs to be sorted out before attempting potty training. Ask your doctor to prescribe some medicine that may help get them into a more regular pattern.
Some children on the autistic spectrum also have gastroentrological problems. Again, ask your GP to rule out any medical conditions
Gluten intolerance or Coeliac Disease can cause bowel difficulties too, and there is a possible link to Autism. Discuss any concerns you may have with your GP.
Many children who have sensory processing disorders may have food issues too, and are prone to eat a very limited range of food, often only being able to tolerate dry food such as chicken nuggets, fish fingers or one specific type of sandwich with very little or no fruit and veg. These children may also be prone to constipation, which will make toilet training that much harder. Try to extend their diet, or talk to your GP about medication that may help bowel movements.
Some children, particularly those who have learning disabilities or autism, get very fixated with their “poo” and play with it or paint in all over walls and carpets. It’s very common, although very difficult to cope with. Try and approach it calmly, don’t make a big deal out of it, and give the impression that you’re taking it all in your stride. In virtually every case it’s a phase that will pass.
What medications is your child taking? It’s worth reading the contra-indications list in case your child is having a side-effect that might be having an impact on their ability to be toilet trained. For instance, some medications may increase urination frequency, which may mean that your child won’t be able to wait until the next scheduled toileting trip. Talk any of these issues over with your GP.
Just aim for dry days at the moment
Just aim for your child to be dry during the day. Night time control takes much longer; sometimes several years later.
Afterwards
Even when they seem to have “got it” they may still need reminders and prompting. Expect accidents long after they seem to be toilet trained.
Staying Dry Overnight – This comes later
For night dryness, sometimes all it takes is for a parent to wake the child and take them to the toilet just before the parent goes to bed. However, some children, particularly those on the autistic spectrum, have irregular sleeping patterns and if they wake up overnight they might not be able to get back to sleep. Work out what suits your child and your family best.
Staying dry overnight is something that often just happens all by itself as your child’s grows and matures. Sometimes it doesn’t, and if that happens, there are all sorts of products on the market that might help, such as bed-wetting alarms and monitors. Some parents have used them to great success, others have found that the alarms become a source of extreme anxiety in their child. Only you know your child and whether these might be a help or a hindrance.
There are also some great incontinence under sheets and similar products available which many families have found really helpful. See below for a list of products recommended by other parents.
Lastly – never ever give up hope. My son, Toby, is 21 and with complex disabilities including severe learning disabilities. He is also mostly non-verbal; although he has a very small handful of single words, uttering them is an extreme effort for him. We have tried and failed with toileting programmes throughout his life. Last week I got a phonecall from a really excited Care Worker. Toby had just pointed to the bathroom whilst saying a new single word for the first time – “Poo”. Eureka! And one very proud Mum.
Some books recommended by parents
Recommended waterproof bedlinen
Also, do you know about ERIC UK? They are the Children’s Continence Charity, and they have loads of information and help, and some great downloadable resources resources too.
Are you on Facebook? If so, have you seen The Special Parent’s Handbook Page? It’s full of the best information, advice and support for families of special needs children.
I also have another Facebook Page called Coke Floats & Chemo, to offer support, information, news and hope to anyone coping with cancer
Would you like to read my most recent post on the Coke Floats & Chemo Blog? It’s about why breast reconstruction after my mastectomy wasn’t for me.
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