A Parent’s Guide to Toilet Training Challenges: Supporting Every Child’s Unique Journey

Toilet training can be a challenging time for many families and children. Children typically start displaying signs of toileting independence around 3 years of age, however, this is not always the case. Children with developmental delays, disabilities or additional needs will require more support and time with toilet training.

Toilet training focuses on supporting the child to independently urinate and have bowel movements on a toilet. Occupational Therapy can play a vital role when it comes to toilet training and understanding what may be contributing to any toileting difficulties.

In this article we will focus on some general toileting tips for parents when starting on the toilet training journey. It is important to note that these suggestions may not be suitable for every child and certain children may require a tailored approach to toilet training. If you are concerned about your child’s toileting or you have been trying toilet training for a while with no changes, you can contact our Occupational Therapy team at Lift Health Group to enquire about the NDIS services we offer to address this goal.

Building Parental Awareness for the Toilet Training Journey

There are many factors that can impact a child’s readiness when you are about to start the toilet training journey. The image below covers some questions parents may ask themselves when considering whether your child is ready for toileting.  If your child is experiencing ongoing constipation, this must be addressed with your local GP prior to starting toilet training. Long standing constipation can alter the size of the bowel as the bowel will stretch to accommodate its contents. This can then “squish” the bladder and make it increasingly difficult for the child to understand their body’s signals, which may be trying to tell them to go to the toilet.

Common challenges experienced by children when toilet training may include:

• Difficulty understanding their body’s signs telling them they need to wee or poo (also referred to as the child’s body awareness or interoceptive skills).
• Difficulty getting on to an adult sized toilet.
• Refusal to go to the toilet, especially if they have a history of constipation or toileting fears.
• Sensory related challenges impacting them using the toilet.

When addressing toilet training, it is recommended to first focus on addressing faecal (poo/bowel movement) continence before urinary continence. It is important to note that bedwetting is not uncommon for children to experience beyond 7 years of age. If you are still having difficulty with night-time toileting at over 7 years of age, it is recommended you discuss this with your GP or seek advice from an Occupational Therapist that specialises in this area.

Key Resources to Assist with Toilet Training

Before starting toileting, make sure you have all the resources you need. Consider things such as whether you have a potty or only access to an adult sized toilet. Some children will need to build their independence by first using a potty and then slowly transitioning to an adult toilet. If you only have an adult sized toilet you may want to ensure that your child can get up/off the toilet and sit on the seat without falling in. Stepping stools and smaller toilet seats which can be placed on top of the regular toilet are recommended. The more supported and stable your child is the better. The image below shows the recommended position for a child when sitting on the toilet.

When choosing a stepping-stool you will want your child’s knees to be above their hips. This is recommended as it will best support your child when they are trying to have a bowel movement as it opens the bowels. If their knees are not above their hips and their feet are unsupported, this may lead to your child straining to poo which can be painful.

If you notice your child is having increased difficulty sitting on the toilet and sinking into the toilet, it is recommended that you engage an Occupational Therapist or physiotherapist to ensure your child has the core strength and muscle strength they need to avoid this happening.

Indicators and Parental Strategies for Toileting

Some children can find it very difficult to understand when their body is telling them to go to the toilet, or they may not notice when they have an accident. These children may have reduced body awareness and/or reduced attention skills. Therefore, it is of utmost importance that caregivers provide support enhance awareness around toileting accidents. The following are important indicators that your child may have reduced body awareness around toileting:

• Child fidgets with their pants and hold themselves while asking to go/taking  themselves to the toilet. You may also notice your child doing the “wee dance”.
• Child not noticing when they have a toileting accident.
• Child not going to the toilet until the very last minute, which may result in near misses or accidents.

Some common strategies parents can adopt to support this skill are:

If your child sits on the toilet and nothing happens after a couple of minutes, this is ok! Praise them for giving it a go and let them know that maybe next time they have success with a wee/poo.  You want to make toileting a positive experience for your child as this will help them build confidence and make them want to keep trying. If you find yourself feeling stress or getting frustrated, take a moment to breathe. Your child can pick up on stress and in turn will feel stressed themselves, which can make toileting even harder.

Identification of Sensory Processing and its Impact with Toileting

Other difficulties related to toileting include sensory processing needs. Sensory processing is how every person sees, hears, feels, and experiences the world around them. How a child understands and interacts with their world is largely influenced by their sensory processing. Think about the child who hates loud noises and covers their ears, or the child who hates the feeling of certain clothing or their hands getting wet. These can all be signs that your child may have sensory processing needs.

There are many sensory components to toileting as shown in the below image. This explains why toilet training is difficult for children with sensory sensitivity. It is recommended you seek help from an Occupational Therapist as they can assess and help you to understand what your child’s sensory needs are. If you child has a NDIS plan, Lift Health Group can provide the clinicians that will help with diagnosis and treatment for children with these additional needs, especially relating to toileting difficulties.

Other things to consider:

Another area which can impact toileting includes your child’s cognitive skills, in terms of how they think and understand. There are lots of things to consider with toileting and the skills required for success, these include:

• Knowing how to undress/dress.
• Understanding and remembering the steps of toileting.
• Knowing how to ask for help or to take themselves to the toilet.
• Ablility to pay attention so they can complete the task.

To support a child to learn toileting, there is a need for frequent repetition and assistance. This will best support their learning and memory. A good start is just being there and providing hands on assistance as the child gains independence. In time this may reduce to verbal prompts or light supervision. You may also like to try using visuals such as pictures to show them the steps of toileting:

• Pull pants down.
• Sit on toilet.
• Wee/poo.
• Wipe until dry/clean.
• Pants up.
• Flush.
• Wash hands.

Toilet training can take time, and you may feel like you are taking one step forward two steps back. THIS IS NORMAL. Toileting can be tricky, especially when your child has additional needs that need attention. For children showing signs of toileting difficulty, it is recommended you connect with an Occupational Therapist, as early intervention and support is the best way forward for you and your child. Enquiries regarding how you can use your NDIS plan to access Occupational Therapy services and address toileting goals can be made by contacting Lift Health Group.