Toilet training can be a very challenging experience for both parents and children. Although the process is often handled in different ways for different children, here are a few general tips to keep in mind as you pursue this important skill:
Before you begin:
- Team up with your child’s teachers and/or therapists so that everyone can work together and practice consistency across settings. Make a plan about when you will start toilet training and map out how you will get there. Give yourself 2-3 weeks to make plans.
- Start to keep track of when your child is drinking, urinating, eating, and having bowel movements. Take note of anything unusual in the frequency or consistency of the output.
- Visit the pediatrician to make sure the child is healthy and is physically ready to start toilet training. Take your written records with you. For children who experience chronic constipation or diarrhea, your doctor may recommend treating those conditions before beginning training.
- Think about your child’s diet. If possible, reduce dairy products and increase water, fruits, fibers and juices. A good fiber goal is to take the child’s age (e.g., 6 years) and add 5 grams: 11 grams per day.
- Think about your daily routines – what kind of toileting schedule would you like your child to be on?
- Look for behavioral signs that your child needs to go to the bathroom and share them with your team.
- Think about the very near future – is this a good time to start toilet training full force? The best times are when both home and school are working together and there are few changes to daily routines. And when you are ready to go without diapers – which is critical to succeeding.
- Adopt a personal philosophy of persistence. As one father of a boy with developmental disabilities said: “It’s a marathon, not a sprint!”
- Consider readiness: We find that you can begin pre-training (see below) when the child has a developmental age of 20 months or older. Readiness criteria for typically-developing children are not always relevant – for example, we don’t wait to start toilet training for the child to use toileting words or to indicate being distressed by being wet. Sometimes those parts come later.
Step 1: Pre-Training
- Introduce toileting words to the child
- Try to change the child’s diaper in the bathroom
- Try to change the child’s diaper as soon as possible so he/she doesn’t get used to the feeling of being wet or soiled
- Dispose of waste in the toilet (from diaper) in view of child
- Provide opportunities for the child to see mom or dad or siblings use the toilet
- Gather data on when child is most likely to go
Step 2: Prepare to go without diapers.
Talk to the folks involved in your child’s care and discuss the possibility of losing the 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. Also, if there are special circumstances (such as a long car ride or school field trip) where going without a diaper is just not practical, you can decide to put one on; however, just know that the more time spent in diapers the slower the training will go. You have choices, don’t make yourself crazy, but know there is a trade-off involved. Also, you may find you want to put plastic sheets on car seats or on furniture.
Step 3: Identify motivators
- Create a list of rewards that can be given for cooperating with a toileting routine
- Rewards should not be available outside of toileting
- Examples include: special food/drink, sensory experiences, toys
- Keep these 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 on toilet and reward if he/she gets the tiniest bit in
- Option 3: allow child to feel the sensation of being wet and involve in clean-up
I often use options 1&2 for younger children, or those just beginning, and option 3 if the child has been working on it for a while but is successfully only part of the time. Interrupting an accident and getting to the bathroom in mid-stream (so to speak) is the most effective way of teaching the connection.
Step 5: Make a schedule
For most kids just starting out, we like to combine scheduled trips (where you initiate taking them to the toilet at a time when you think they might be successful) and taking them as soon as it looks like they might be voiding. To do this well, look at your data for patterns – how long after your child eats or drinks does he/she usually go? For most kids, we don’t want to do too many trips – or else is becomes meaningless – so aim for no more than 1 trip per hour.
Step 6: Choose your teaching methods
I like to use a combination of methods, depending upon the child’s learning style. For example:
- For a highly visual child, I use structured teaching techniques (e.g., visual cues of each step of the toileting routine, or a 2-picture sequence of toilet and reward).
- For an active child, I use a music box or radio and develop a routine of sitting until the music stops. I also 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, I use more modeling and praise during the routine.
- For a distractible child, I try not to talk during the routine, but use physical prompts to focus the child on the activity.
- For children who like books, I 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 you change it. If possible, have the child practicing this skill in many different places.
Step 8: Design a way to keep data on progress
What you need to know are the times the child voids and where it happened (accident or in 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 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 him/her there. This is your best teaching opportunity.
- Practice, practice, practice.
Step 10: Review your progress after 3 weeks
Talk to your team – when are the successes happening? What can be done to make them happen more often? Implement 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
Step 12: Celebrate all successes! If you do not get sufficient progress within 3 months, seek some more guidance from a professional who does a lot of toilet training. There are always new methods to try!
Best of luck in the process. Here are some resources that you may find helpful:
www.sinkems.com : toilet training products
www.webehave.com: more products
www.specialchild.com/tips06.htm: tips on toilet training for children with special needs
www.ds-health.com/train.htm: tips specifically for children with down syndrome
www.bedwettinghelp.com: alarms and adaptive equipment for older children
www.autismspeaks.org — look for their Toileting Tool Kit.