What is Toilet Training in Childhood?
Toilet training in childhood is the process of learning to use the toilet so that accidents do not occur. This training is a step towards self-care and independence in childhood.
Toilet training is often a challenging process. The process can be difficult whether your family has children with or without developmental difficulties or special needs. Parents may hear they should wait for the child ‘to be developmentally ready.’ However, in clinical practice, we often see that the parents need to be ready.
Children with a developmental age over 20 months are generally old enough to start potty training if the parents are ready to work on it. Some children are way easier to toilet train than others. Factors like sensorimotor development and behavioral compliance play a role. That said, parents who want to get started around age 2 can do that.
The child doesn’t need to know when they have to go to the bathroom or communicate that need. Instead, as a parent, you have to be willing to commit to the process. For example, some families may wait until 30 months, which is okay.
Prepare to be patient, consistent, and positive. It is helpful to track your child’s natural schedule for urinating or having a bowel movement.
Think about your child’s diet. Consider reducing dairy products and increasing foods that are rich in fiber and liquid, such as fruits and fruit juices. You may need to consult your child’s doctor to ensure that no medical issues restrict the potential to toilet train. The doctor can also supervise any dietary changes.
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Symptoms of Toilet Training Issues in Children
- Refusing the toilet: not using the toilet, asks for diapers instead
- Seeming unaware of sensory feedback: not realizing they are wet or soiled
- Struggling to have normal stools: often either constipated or having diarrhea
- Pooping or peeing outside the bathroom: finding accidents around the house
- Having accidents after successful training: noticing your child is having accidents again, into prekindergarten and kindergarten
- Feeling self-conscious about accidents: missing out on doing a birthday party or sleepover due to accidents or bedwetting
Causes of Toilet Training Issues
Toilet training falls under the adaptive skills or activities of daily living. Any child could struggle with toilet training, and children with disabilities tend to have additional challenges. There are many contributors to toilet training challenges.
- Lack of motivation to toilet train: some children have zero motivation to move from diapers to using the potty
- Need for Control: sometimes children who have behavioral difficulties can lead a child to avoid toilet training. They want a way to exert control. Examples of such challenges include inflexibility, rigidity, and noncompliance. This child may have bowel control but struggle emotionally
- Emotional causes: some children who have experienced trauma may have more difficulty with toilet training
- Lower degree of social skills and social reciprocity: some children do not feel any social pressure whatsoever to use the bathroom or be a “big kid”
- Sensory processing differences: some children are not bothered by the feeling of a messy diaper. They do not receive the same sensory cues or know how to read the cues of having a full bladder or needing to go to the bathroom
- Delayed development of language: children who struggle to communicate or understand others are much more likely to have trouble with toilet training
- Digestion issues: children with very loose stools or constipation may not feel enough of a warning in their bodies that they need a bathroom break or may avoid using the toilet
What to Do About Toilet Training Issues in Children
If your child is over 3 years of age and still has significant toilet training struggles, it may be time to ask for support. Professionals such as a pediatrician or occupational therapist can help.
Here is a program you can try on your own or with the help of a therapist.
This program is a best-practice approach to toilet training. It can be effective for children with or without developmental disabilities. The program prescribed below is provided in consultation with and the permission of Susan Hepburn, Ph.D., Clinical Psychologist.
Step 1: Pre-Training
- Introduce toileting words to your child (such as ‘potty,’ ‘pee,’ and ‘poop’ and use proper terms for anatomy as well). It can also be helpful to tell your child that ‘accidents happen.’
- Try to change the child’s diaper in the bathroom.
- Try to change your child’s diaper as soon as possible so they don’t get used to the feeling of being wet or soiled.
- Dispose of waste in the toilet (from diaper) in view of your child.
- Provide opportunities for your child to see mom or dad or siblings use the toilet.
- Keep track of when your child is most likely to go.
Step 2: Prepare to go without diapers
The most success comes from experience without diapers. It is important to begin with daytime urination training. Later, you will teach bowel training and night training. So, for now, the child can wear pull-ups at night.
Special circumstances, such as a long car ride or school field trip, may make going without a diaper impractical. In those moments, you can decide to put one on your child. But, more time spent in diapers will make the training go slower. You have choices, don’t make yourself crazy, but know the trade-off. Also, you may find you want to put plastic sheets on car seats or furniture.
Step 3: Identify motivators
- Create a list of rewards that you can give for cooperating with a toileting routine (e.g., special food/drink, sensory experiences, toys, etc.).
- Rewards should not be available outside of toileting.
- Keep rewards on hand in the bathroom but out of reach of the child.
- Check out websites for toilet training products that are supposed to make the process fun (such as toilet targets – items that change size or color when urinated upon – yes, these things do exist).
Step 4: Decide how you will handle accidents
- Do not punish or scold – your child is learning a new, difficult skill.
- Option 1: gently correct and change the diaper.
- Option 2: immediately place your child on the toilet and reward if they get the tiniest bit out.
- Option 3: allow your child to feel the sensation of being wet and involve them in the clean-up
Step 5: Make a schedule
For most kids just starting, combine scheduled trips with taking them as soon as it looks like they might be voiding.
Scheduled trips are planned times when you take them to the toilet when you think they might be successful. Look at your child’s typical toileting patterns to do this approach well. For example, how long after your child eats or drinks do they usually go? We don’t want to do too many trips for most kids – or else this becomes meaningless – so aim for no more than 1 trip per hour.
Step 6: Choose your teaching methods
Any combination of methods may help, depending upon the child’s learning style. For example:
- For a highly visual child, use structured teaching techniques. Examples include visual cues of each step of the toileting routine or a 2-picture sequence of toilet and reward.
- For an active child, use a music box or radio and develop a routine of sitting until the music stops. Then, you might reward them for sitting for very short periods and build the time up slowly. A timer works well for most kids too.
- For a really social child, use more modeling and praise during the routine. Make a big deal out of rewarding success.
- For a distractible child, try not to talk during the routine. Instead, use physical prompts to focus the child on the activity.
- For children who like books, you might make a homemade book that shows pictures and narrates the toileting routine. Published books and videos may also be helpful.
Step 7: Commit to 3 weeks
Whatever methods you choose, commit to following your plan for at least 3 weeks before changing it. If possible, have the child practice this skill in many different places.
Step 8: Design a way to keep data on your progress
You need to know the times the child voids and where it happened (accident or in the toilet).
Step 9: Just do it
- Lose the diapers during the day
- Take the child on scheduled trips to the bathroom
- Prompt the child through a toileting routine (sitting for 1-2 minutes, always flushing and washing hands after the time is up)
- Provide a small reward for cooperating with the routine
- Provide a huge reward for getting anything into the toilet
- If possible, interrupt accidents by startling the child “Toilet!!” and getting them there. This moment is your best teaching opportunity.
- Practice, practice, practice.
Step 10: Review your progress after 3 weeks
Talk to your team (school, family members, child care, or other parent or caregiver) about when the successes are happening. When are they able to stay dry? What can be done to make that happen more often? Add any additional rewards or structure of teaching that you think will help to learn this skill.
Step 11: Make modifications as needed and try to stay consistent
Remember, most behavior plans do not work immediately. Your child may not be motivated by the rewards you chose. Your child may get frustrated and lose interest suddenly. You may find that the plan does not work as well when you are on the go. Regardless of these issues, don’t give up.
Step 12: Celebrate all successes!
When to Seek Help for Toilet Training Issues
If you do not see enough progress within 3 months, seek guidance from a professional. Examples include Occupational Therapists, ABA Therapists, or Psychologists who specialize in this area. New methods are always available to try!
Further Resources on Toilet Training
If your child is struggling with toilet training to the point that it is getting in the way of their learning, relationships, or happiness, the following professionals could help. They may offer diagnosis, treatment, or both.
- Speech-language pathologists: to help with functional language skills and communication that could impact toilet training
- Occupational therapist: to help with toileting skills, self-dressing, sensory needs
- Psychologist: to consider in developmental and mental health context
- Pediatrician: to consider health issues. If there is a sudden change in toileting behavior or experiences diarrhea, pain with elimination, digestive problems, or dietary issues, consult your child’s family physician
- Developmental pediatrician: for more specialized needs or for children who are really behind in this area, these pediatricians are specifically trained in helping to meet the developmental needs of children
- ABA or applied behavior analysis therapist: These therapists can be very helpful in supporting a family who has trouble toilet training. They are experts in using positive reinforcement to reward success. Look for therapists using a pivotal response model.
Similar Conditions to Toilet Training Problems
- Domestic skills: doing chores and managing a daily routine may be difficult for those with challenges with toilet training
- Hygiene: toilet training troubles may relate to self-care, such as with showering and brushing teeth
- Learning problems / learning disabilities: toileting accidents at school might signal learning problems
- Emotional symptoms: traumatic experiences may be a cause of accidents
- Anal retentive: refusal to void urine or feces in order to maintain control
Resources for Toilet Training
Toilet training products: http://www.galaxy.com/rvw93474-41438/Toilet-Training-Made-Easy-Sinkems.htm
Toilet training products: www.webehave.com
Bed wetting solutions. THERApee: www.bedwettingtherapy.com
Books on toilet training: http://www.parents.com/fun/entertainment/books/potty-training-books/
Toilet training tips for children with disabilities: http://www.specialchild.com/tips06.html
Toilet training for children with down syndrome: http://www.ds-health.com/train.htm
Tips for children with autism: http://www.bbbautism.com/pdf/article_25_toilet_training.pdf
Alarms and adaptive equipment for older children www.bedwettinghelp.com
Toileting Tool Kit: www.autismspeaks.org
Article from autism treatment network on toilet training: Autism Speaks Toilet Training Dilemma
Article on dealing with constipation in children with autism: Autism Speaks ATN/AIR-P Guide for Managing Constipation in Children
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