To Pee or Not to Pee:  Toilet Training A Child With Special Needs

Toilet training can be a highly charged issue in any household, producing anxiety in parents who don’t know how long it will take and how hard it will be. But if a child has developmental delays, or motor or cognitive problems, the process can be fraught with extra difficulty.

Children are usually introduced to toilet training in our culture at about 2 to 2 ½. Current wisdom says that by that age most children can understand the connection between peeing and pooping and the toilet, and can talk well enough to tell their caregivers what they need and want.

But not all children operate according to this schedule. As Kathy Egan-DiPaola of the Ben Samuels Children’s Center said, the main difference for children with special needs is that they are likely to get off to a later start – they may not be ready for potties until age 3, 4, or even 5. And it may take them longer to train than more typical children.   However, the basic aspects of the process are similar for all kinds of kids – boys, girls, 2 year-olds, 4 year-olds, and kids with and without special needs.

The Developmental Skills That Make Toilet Training Possible

Children with motor planning difficulties or language delays sometimes start and/or finish training later than average because they lack one or more of the developmental skills required for toilet training. These include:

• A nervous system mature enough to process and react to the internal sensations of needing to urinate or have a bowel movement

• A sensory processing system that registers wetness and squishiness

• Muscular control that lets the child “hold it in” long enough to get to a toilet and “let it out” once he or she gets there

• Language to express needing to go and needing help, and to understand what the adult is saying.

By the time these milestones have been achieved, a child with special needs may be more than 3 years old, and his or her parents may already be exasperated and fearful that toilet-training will never occur. Waiting for the child to become ready may be frustrating – but it’s better than not waiting.   Starting before the child is ready usually means that the child will feel she has failed, and everyone will be miserable. So it’s better to start the process at a point when success is likely.

Preparing for Toilet Training – Techniques to Try

Every parent probably wishes for a magic formula that would make toilet training easier. There’s no formula, but there are some specific techniques that may help a child get ready to train. You could try these:

Make the connection between “needing to go” and the toilet: Introduce the child to the toilet and the potty seat. Take the child to the bathroom when you are going, explain what you are doing, and let the child watch as much of the process as you feel comfortable with. Explain that the toilet is the place for pee and poop.

Tune in to the child’s body language. Check your child’s diapers frequently, and when you see from the child’s expression and body posture that he is peeing or pooping, pick him up and put him on the potty. The child will probably stop peeing or pooping at that moment, but the association is being made.

Help the child understand wetness. One problem in toilet training today’s kids is that, thanks to super absorbent diapers, kids don’t have the experience that peeing results in wetness — they don’t make the association as readily as kids used to. Time spent playing in water – bathtub, wading pool, sprinkler, etc. – is useful for helping children identify and understand wetness.

Play games that help the child become more aware of his body. Exercise is good preparation for children with motor delays. Jumping and clapping heighten children’s awareness of their own bodies. Letting a child run around without a diaper can also help. Being without pants or a skirt gives the legs more stimulation from air and objects, and provides more feedback about the process. Young children learn quickest with as much feedback as possible. (PS. Accidents will occur when using this method!!!)

Some parents have found that brushing the child’s back and upper arms with a very soft brush (corn silk brush) helps children become more aware of their bodies by stimulating sensation and internal feedback.

Teach the child words for the process. Pick terms you are comfortable with, and be consistent. Check and identify the signs verbally: “Are your socks wet? Are your shoes wet? Next time, tell me, and we’ll go to the potty first!” Talking about the process helps take away the mystery.

Aids for Toilet Training

Once the child is ready to start toilet training, there are no limits to the imagination when it comes to inspirational aids. Some helpful possibilities are:

Use equipment that suits your child.   The child needs to be balanced and feel safe and secure on the potty. This is particularly true if a child has difficulty with motor control or balance. It’s usually helpful to start out on a small potty, or use an insert (like a “Skwushy Tushy”) on the toilet. Make sure the child’s feet can rest securely on the floor or on a stool.

 Help the child find a comfortable position. The toilet may seem like a tall and scary place for young children. Sometimes children feel more secure facing towards the toilet tank. Boys standing in front of the toilet may need you to stand behind them. They may need to use both hands to hold and aim with.

Kids aren’t mature enough to sit or stand for a long time waiting for something to happen. You could try reading a book or playing a favorite tape while the child is sitting on the toilet.   For boys, sitting may work better than standing, because they can play with toys or books while trying to “make”.

Use “Peepee” targets. Aiming can be hard for children with fine or gross motor delays. “Peepee targets” can help: put a handful of cheerios in the toilet, and encourage the child to aim at them. Or you can put several drops of food coloring in the toilet, and shoot them with a water pistol to show the child the pretty swirl he will make if he pees in the toilet. Put paper boats or other flushable objects into the toilet bowl, and challenge the child to sink them.

Only flush after the pee is in the toilet – flushing is fun for kids, and can become a reward – so “No peepee (or poop), no flush!!”

Have a positive attitude. Although toilet-training children with special needs may start later and take longer, it doesn’t have to be grim. If parents relax and project a mood of calm confidence, it will go more smoothly. Don’t fight or blame if at all possible! Like most other developmental milestones, the achievement of toilet-training is based on trust and rapport – the bond with the child is the basis, and the relationship with you gives the child the motivation to master this challenge.

Your praise and excitement are the best rewards. Using toys or candy as rewards or bribes doesn’t teach children to use the toilet, and children can reject rewards if they don’t want to comply. Success is cause for celebration of growing up. Every child loves hearing, “You’re such a big boy or girl now” – and you have made the connection to their progress in toilet training.

Hang in there! Take small steps toward the goal, and try to have fun with it! Expect success – assume that all children (without interfering medical issues) can be trained. Most kids continue to have accidents even after they are mostly trained – so accidents don’t mean the process isn’t working.

 

By the time these milestones have been achieved, a child with special needs may be more than 3 years old, and his or her parents may already be exasperated and fearful that toilet-training will never occur. Waiting for the child to become ready may be frustrating – but it’s better than not waiting.   Starting before the child is ready usually means that the child will feel she has failed, and everyone will be miserable. So it’s better to start the process at a point when success is likely.