Being toilet trained is an important milestone. For a child, it’s a step towards independence. For parents, not having to change nappies anymore or buy them is great — they’re expensive!
It also takes patience and positivity. Some children may be hypersensitive. Others may have poor interoception: that is, being able to sense what’s happening in their body, like if they are hungry or tired or need to go to the toilet.
Many neurological processes happen to let a person know it’s time to go to the toilet. For urination, the bladder fills and stretches so there is a sense of fullness. Muscles tighten to hold on… and after a point, we know it is time to go. If a child has a neurological delay, neurological processes may also be delayed.
So how will you know if your child is ready to start training?
Skills needed for toilet training
Consider whether your child can do or is ready to learn the following:
- Motor skills
- Getting to the toilet/potty safely
- Getting on and off the toilet safely
- Balancing and staying in a comfortable seated position on the toilet
- Reaching behind and wiping their bottom, flushing the toilet, pulling pants up
- Accessing the basin and taps to wash and dry hands
- Attention span
- Remaining seated on the toilet for two to three minutes or standing until they need to release
- Remembering to follow all the steps in the correct order to complete the toileting process
- Expressing their need to go to the toilet or clean up after an accident
- Understanding the instructions associated with going to the toilet and the purpose
- Social skills
- Recognising appropriate places and times to go to the toilet
Child’s signs of readiness
Also, look for these signs that show a child is ready for toilet training:
- Staying dry for long periods of time during the day
- Releasing large amounts of urine at once and a regular, predictable bowel pattern
- They’re indicating to you that they are wet or dirty
- Showing interest in the toilet and wanting to be more independent
Training can take time, so it’s also essential for parents to feel ready. Is it the right time for you to start? Significant events like moving house or having another baby can be disruptive and stressful. See parent readiness checklist below.
Timing and clothing
Summer may be a good time to start toilet training. Children can wear less clothing layers, which makes the process easier. Clothes during the early stages must be easy to take off.
- Toileting pants that are slightly absorbent and help transition from nappies to underwear
- Wearing underpants and then nappies
These will help increase awareness of feeling wet and needing to be changed. Nappies absorb everything, so there’s no wet sensation for the child.
Elasticised pants or shorts so children can master pulling pants up and down. Buttons and zippers can make this difficult and discourage them from participating.
Chronic constipation can have a significant impact on toilet training. It can be a painful and scary experience when children are on the toilet. The memory of it could make them want to stay with the security of using nappies.
Constipation can be due to dietary difficulties, such as a lack of fibre in children’s diets. Always talk to a paediatrician or GP to ensure there are no underlying health issues. For children with additional needs, it can be beneficial to discuss your intention to start toilet training with your GP or Paediatrician and ask them for their medical opinion about whether this is appropriate.
Toilet awareness and environment
The first step is introducing a toilet or potty to raise awareness. If your child’s nappy changing routine is happening in another room like the living room or bedroom, gradually move it to the bathroom to familiarise them with the bathroom environment and what happens there.
Safety is important. For older children, make sure that they can quickly and easily access the toilet, balance themselves and be comfortable. There are various toileting aids and equipment to help in this area. Talk with an Occupational Therapist for further advice or information.
For hypersensitive children, the toileting area needs to feel safe and relaxing. Think about sensory aspects that may scare and stop them from participating; it can be a trial and error process.
Here are some ideas that may make it feel more safe and comfortable:
- Background music that your child likes
- A box in the bathroom with favourite toys
- Dimmable lights, a coloured lamp or light shade
- Stickers on the toilet, wall posters around the bathroom
- Carpet/rug over tiles and a padded toilet seat if they don’t like the cold
- Soft toilet paper or wet or wipes for children sensitive to roughness
- A warning or countdown before flushing
- Time and no pressure! Never underestimate the impact of having plenty of time so neither you or the child feels rushed/pressured.
How can a child communicate a need to go to the toilet, and how do you explain the steps involved? Consistency of words across environments is important. If he or she can use words like “wee” or “poo,” that’s great.
Other signs might be holding the crotch area or squirming. If you can recognise that your child is needing to go to the toilet, rather than asking “do you need to go to the toilet?”, it’s better to take the lead, to help them learn to understand what they are feeling. Get into the habit of saying: “It looks like you need to go to the toilet; let’s go to the toilet.”
Having some visuals in your pocket or on a lanyard (for example an image of a nappy) to combine with words like “you’ve got a dirty nappy, it’s time to change your nappy” can be very powerful.
A visual schedule or social story that models every step of the process and pointing to them is another useful tool. Explore whether your child responds to drawings, or photos of siblings or family members (if they’re ok with getting involved). Showing a schedule to young children can be a helpful lead-up to the toilet training years as well.
Videos can be an excellent tool as well. They explain the process, make it playful, and children love copying what they see. Some children, however, may keep on wanting to ‘play.’ It’s important to explain that they can stop and come back to the toilet when they need to.
Key Word Signing can also be another effective medium. Often children will have their own gesture, go with what’s natural for them.
Using iPads or mobile devices
When working on staying seated on the toilet, it can be tempting to use an iPad or similar. However, the child’s focus is on watching, not learning to sit.
iPads can be useful as a reward. For example, reward one minute on the iPad if your child sits without distraction for one minute. Gradually extend the sitting time up to two or three minutes maximum.
Some toileting tips
- Encourage your child to take ‘big drinks’ instead of lots of little sips during the day. This helps build up a full bladder and provide clear sensory information needed to go to the toilet. It also helps when collecting toileting data.
- Instead of disposing of a soiled nappy, show your child tipping the poo into the toilet to communicate “this is where it belongs.”
- Allow your child to watch family members using the toilet and to model the routines if they feel comfortable with it. This could be effective to show them how toileting works.
- Include all the steps of toileting: dressing, washing hands, flushing the toilet, so it all comes together as one process.
- If your child is scared to wipe, put their hand on top of yours and wipe to practise the action— with your hand being the closest to their bottom. Once they’re comfortable, you can swap sides.
- Start with the last wipe, then give a reward. Gradually add the last two, the last three wipes until they are doing it all independently.
- If a child is sensitive to the toilet paper texture and doesn’t want to touch it at all, try a glove and take it off eventually. Try using a mirror, because seeing where the hand is and what it is doing can sometimes reduce anxiety.
- Give lots of praise (for children who respond positively to praise).
Including nappies in your NDIS plan
The NDIS can provide funding for nappies if your child is five or older and not is toilet trained, or if they were toilet trained when younger but have lost the skill because of an acquired disability. The funding is based on the number of nappies that are needed per day.
Funding needs an assessment by a continence nurse.
Plumtree runs regular workshops on Toilet Training for children with disability or developmental delay, NDIS and other parenting workshops and courses. Mostly free of charge to families.