Toilet training
Toilet training can be a stressful time for parents and children. Some children take to toilet training easily whereas others have much more difficulty. Some are ready to tackle toilet training at 2 years, some at 3 and 4 years old and others not until they are much older.
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In order for a child to succeed at toilet training, they have to be physically and mentally ready. For example, a child cannot voluntarily use the muscles that control their bladder and rectum until they are at least 18 months old.
There are a number of stages a child will go through while developing bladder and bowel control:
- STAGE 1: The child becomes aware of having a wet or dirty nappy or clothing.
- STAGE 2: The child recognises when they are doing a ‘wee’ or a ‘poo’.
- STAGE 3: The child can tell you in advance that they need to go to the toilet - this can be done through words or actions.
- STAGE 4: The child gains more control of their bladder and can ‘hold on’ for a while.
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Finding a suitable potty or toilet support
In order to ‘let go’ on the toilet it is important that children feel safe (that is, that they won’t fall off or in!) and comfortable (seating that fits and supports their bottom, back and feet). If they feel unsafe, uncomfortable or are anxious, the normal reaction is to tense up and it is then harder to let go to do a wee, or coordinate the ‘pushing’ movement to do a poo.
Every situation is different and may therefore require different potties. Some of the choices include:
- A potty that is low to the ground – making it possible for the child’s feed to touch the floor.
- A regular toilet with a step, rail or seatbelt – helps the child to feel secure.
- Special supportive and elevated seating – makes it easier for parents with lifting the child.
An occupational therapist can help you find the most appropriate toilet seating for the child.
Talking about toileting
It is important to talk with the child about body parts and what the body is doing. Some examples:
- If the child does a smell, talk about it and how it might mean they need to do a poo - this might be a good time to get your child to sit on the toilet.
- If you see the child straining when wearing their nappy, acknowledge what they are doing, “You’re doing a poo”.
- If the child does a wee in the bath or while being changed, you may say: “You’re doing a wee”. These things help children learn the language of toileting and be more aware of their bodily functions.
Disclaimer: General information only - you should consult with the relevant professional before applying it to a particular situation. See disclaimer details.
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Tips to help children get used to sitting on the toilet
- Display the potty you are going to use or the equipment you will require around the house - allow the child to play with it (disinfect it first), and encourage them to practice sitting on it (don’t force this as we want toileting to be a pleasurable experience not a form of punishment).
- Put the potty in the bathroom to stir the child’s interest - they may explore the potty and use it as a plaything, or even a hat! This playtime with the potty will help reduce any anxiety or fear.
- Use a teddy or a doll can as a role model sitting on the potty or toilet - if you find one that can ‘wee’ it is even better! It is important that you reward the doll for successfully using the potty.
- Try to keep a sense of humour and to see the funny side of life while toilet training. Many children resist sitting on the toilet or potty, as it is different. They often won’t sit long enough for any ‘accidents’ to happen. Children are also experts at picking up on our anxiety so if we get stressed out about toileting, chances are that they will too.
- Aim for small goals first - the first few times the child sits on the potty, aim to just get them to stay there for about a minute, and don’t worry about them doing a wee.
- Gradually increase the time spent on the potty to up to 5 minutes.
- Use distractions to help the child relax and remain seated (for example, a book, a favourite toy, blow some bubbles or sing a song).
- Try placing the potty in the play area so the child can go to it whenever they like.
- Practise sitting on the potty at a regular time, such as before bath time or after each meal.
- If your child successfully uses the potty or toilet, praise them and make a fuss!
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- Use the potty consistently rather than expecting your child to use the potty one-day and the toilet the next - children respond better to a routine.
- Introduce the names you will use to describe toileting behaviour (for example, ‘wee’ or ‘poo’) and ensure that everyone involved in your child’s toilet training uses these words.
- Be sure to reward any attempts to use the potty or toilet and make a big fuss when the child is successful.
- A speech pathologist may be able to help you with communication during toileting - for example, suggesting the level of verbal instruction to give or providing picture symbols.
There are no clear rules about when a child is ready for toilet training, but there are some commonly used signs that are useful to know about. It is useful if the child can do the following:
- Can sit still for at least 2 minutes.
- Is of an age where it is reasonable to expect that they may have some control - for example, over the age of two for bladder control.
- Can understand simple instructions and or simple words or signs.
- Is able to use simple words or signs to communicate.
- Stays dry for 1 to 2 hours at a time.
- Does a reasonable–sized wee each time.
- Appears to dislike being wet.
- Shows signs that they are weeing or are wet.
- Indicates or tells you they are, or that they need to, wee.
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Children with disabilities (physical, intellectual, and learning disabilities) are often slower to achieve control over their bladder and bowel. The reasons vary depending upon the child and the disability. Generally, children with physical disabilities may:
- have difficulty recognising the sensation of needing to go to the toilet
- have difficulty performing toileting tasks such as getting to the toilet, removing clothing and sitting on the toilet
- have difficulty telling carers that they need to go to the toilet
- have difficulty learning skills involved in toileting especially if intellectual/learning difficulties are also present.
Many children with physically disabilities also have medical issues or problems with muscle tone that may contribute to constipation and /or abdominal discomfort. Further, problems with posture and increased muscle tone can influence the ease with which children can empty their bladder or bowel. For example, children with spasticity can experience increased muscle tightness following stress, excitement and quick movement – these are often involved in toilet training. Many children with a physical disability may be less mobile or active than other children – this can also contribute to constipation.
Many children with disabilities are able to be fully toilet trained however there are some that will be unable to be toilet trained. Some children may be partly toilet trained (where they are placed on the toilet at regular intervals) with only occasional accidents. Different children have different abilities and needs. Therefore, it is important to tailor toilet training around your child’s individual abilities.
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It is very important to immediately reward any successful attempt to use a potty or toilet. The best rewards are verbal – lots of fussing and attention however you may wish to use a small treat as a reward.
Responding in a positive way shows your child that you approve and support their achievement. This attention increases the chance of the child repeating the behaviour.
The rewards and verbal encouragement should not be difficult, time consuming, or expensive. Ensure the rewards are:
- given immediately
- do not replace praise
- used specifically for toilet training and are not available at any other time (for example, a specific treat which is only given to reward toileting behaviour)
- given for the toileting tasks your child can already manage.
Once the child is managing the new skill, continue to use praise but gradually reduce other rewards.
- Don’t punish your child if an ‘accident’ occurs. Some children get upset over their accidents and frustrated with toilet training. It may help to say things like, “That tricky poo! It wouldn’t wait for the toilet. See if we can catch it next time.”
- Overall, try to stay calm and positive when toilet training. When toilet training is fun and relaxed, children are more likely to learn more quickly and be proud of their achievements.
Books
The following books may be obtained through the Novita Toy & Resource Centre. If you are registered with the Centre, you can borrow them by completing the on-line request form.
Continence Foundation of Australia. (2000). 1 Step at a time: Toilet training a child with an intellectual disability. Victoria: Victoria Branch Corporation
Dunnaway, A (1990). Toilet training. Communication Skill Builders
Gilbert, Jane. (2003). Potty training: Making the transition to dry days and nights. London: Octopus Publishing
Heins, T. & Richie, K (1988). Beating sneaky poo., 2nd Edition. Canberra: Phillip Heath
Parenting SA (1996). Toilet Training. Parent Easy Guides, 10. South Australia: Parenting South Australia
Wicks-Nelson, R. & Israel, A.C. (1997). Behaviour Disorders of Childhood, Third Edition. New Jersey: Prentice Hall
Contact a Novita therapist
Send an on-line message to a psychologist
Send an on-line message to an occupational therapist
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