Tackling Toilet Training

Alicia Eden, BOccThy

Toileting– it can be considered a taboo topic to chat openly about, however it is one of the most important skills a child learns. Being able to go to the toilet by yourself is important as children start to venture into the community for playdates, kindy, and school. It also starts to foster independence and confidence. Most parents know that toilet training is no easy task, although some children have more difficulties developing these skills than others. Difficulty with toileting can stem from:

  • Difficulties with motor skills. You need to be able to reach around your body and complete movement tasks with your arms and hands that you cannot see.
  • Difficulties understanding and reacting to the feeling within your body when you need to go to the toilet e.g. what a full bladder feels like. Your ability to feel internal sensations is called interoception. If your body feels internal sensations differently to others, understanding the body’s cues that you need to use the toilet can be difficult
  • Previous traumatic experiences, including (but not limited to) falling in a toilet, painful constipation, having a skin condition (eczema/dermatitis) where pain is associated with skin contact or a sensory based aversion to the feeling of poo on the skin. Some children can be scared by the sound of a toilet flush, and that their poo is ‘going away’ (they may feel as though it is a part of them).
  • Difficulties with cognition and understanding how and why to use a toilet. Communication difficulties can affect the child’s ability to understand the instruction you’re giving them.
  • Difficulties with behaviour. Some children struggle to form good toileting habits due to difficulties with control, following instructions and coping with new tasks.

When is the right time to start?
In general, children start to toilet train on a potty between 18 months to three years. Before starting toilet training, your child needs to understand the different sensations of being wet and dry. Usually, children need to be able to hold and not wet themselves for approximately 2 hours at a time, although this is not completely necessary especially if there is a medical condition or difficulties associated with holding. Even if your child is not ready for forming a toileting regime as they cannot hold for this time, you can still however have a routine of sitting the child on the potty when you change the nappy so they become familiar with the potty. The demand for teaching children how to go to the toilet is high and requires a lot of effort, but is necessary and carries long term rewards.

Collecting some information:
Collecting baseline data may sound like hard work, but this is important to ensure that your child has every opportunity to “go” in the toilet when taken and to ensure they are ready for training. There are a number of different record sheets that can be used to collect the information, however in general, you want to look at the following:

  • Checking the child every 30 minutes and record if they are wet, dry, soiled (dirty) or both. At this stage you are not required to take the child to the toilet; just keep with what you have been doing.
  • Anything from 20-30minutes after meals/drinks it is more likely that your child will need to use the bathroom. To see the link between meals/drinking and toileting you could record when your child ate and drank.
  • Keep this record for 2 – 3 weeks.

Scheduling toilet times
Children may not naturally develop the understanding that they need to use a toilet for wees and poos, we have to teach them! Start off by sitting them on the toilet based on a regular schedule, at multiple times throughout the day. Look at the baseline data and see if you can determine a pattern; this may guide you as to the times to sit your child on the potty.  For example, if your child was wet just after breakfast, then again during their regular TV show mid-morning, sit them on the potty just before these times. Make it relaxed and no-fuss, but of course, praise them if they produce a result.

Top toilet tips

  • Try giving your child warning prior to when it’s time to sit on the toilet. You could do this verbally or with pictures
  • Use songs, nursery rhymes, books or bubbles to encourage kids to sit on the toilet
  • Ensure child is comfortable positioned on toileting with feet supported on floor or stool.
  • Use hand over hand guidance to teach the child how to manage toilet paper
  • Show the child that using the toilet is what makes you happy with lots of positive praise if they do wee or poo on the toilet. Try a sticker chart for the prize-motivated child!
  • If accidents happen stay calm and don’t get angry. Just reiterate that we all go to the toilet, and involve the child in the clean up

Night time toileting
Keeping dry through the night takes different skills, and often comes after you initially start toileting. It comes back to interoception- the body’s ability to feel internal sensations including the feeling of a full bladder or bowel. Once they understand this feeling, they then need to be able to respond appropriately and timely. Having a consistent bedtime routine, and limiting lots of drinks in the afternoon and evenings can help.

OTs help trouble shoot difficulties with toileting and toileting routines. Don’t hesitate to contact us to discuss your child’s toileting with us (we’re not scared of potty talk!)