Teaching a child to use the toilet can be a difficult task irrespective of additional needs. All children are different and progress at different rates. Talk to your doctor about whether your child’s condition will affect their ability to control their bladder or bowel movements.
To help improve on success, introduce toileting at home and at school at the same time, liaising with staff to ensure a consistent approach.
Be aware that for some children it can take longer for them to develop a toileting routine. Every child is different. Children with Autism may not be socially motivated to go to the toilet but rewarding them may reinforce the behaviours you want to encourage.
Being consistent can also help. If you change a child’s nappy in the toilet they will begin to relate toileting activities with that space. Try to use the same equipment at school and home - the same toilet seat insert for example. For some children it may be best to go straight to training on the toilet rather than using a potty first as this will avoid having to repeat training.
Observing when your child wees or poos can help identify a regular pattern leading to an increased chance of them using the toilet. If your child wets at other times get them to the toilet as soon as possible, ignore the wetting and praise when the child successfully makes it to the toilet.
Decide on a time when there are going to be fewer distractions or changes. Indicators may include:
+ Changes in behaviour, fidgeting when wet
+ Seeming to be aware that they need changing
+ No accident for over 2hrs indicating increased bladder control.
Toilet Training a Visually Impaired Child
Children who are visually impaired are unable to watch family members using the toilet. When they are ready to start, take your child to the bathroom and let them locate the toilet, toilet roll, sink etc. Try to keep the pathway free of obstacles and have a window open to help reduce smells your child may be sensitive to.
Teaching your child to feel the rim of the toilet to help them know where to put used toilet paper. As your child gains confidence they can be introduced to other bathroom layouts. As with other children, give praise you feel is appropriate for your child.
|Having a washable seat pad handy when out and about can help in case of accidents.|
Toileting a Hearing Impaired Child
Children who have difficulty hearing may or may not find toilet training a challenge depending on their communication skills. In addition to the visual cues used for children with Autism sign language may also be useful.
Toileting a Child with Cerebral Palsy
Children with CP usually do not obtain bladder awareness until 2 or 3 years old. Under-developed muscle tone, medication and limited physical activity can lead to constipation so it may be best to consult a dietician when thinking about starting the toilet training process with your child. Children may require a supportive toilet seat with back support.
Having comfortable clothes with elasticated waists can help your child undress/dress easier. Teaching dressing in small steps, starting with the last stage of the sequence first and then previous step. This way your child is always finishing the action and these can lead to increased self-esteem.
Follow the same steps each time prompting your child from behind. Prompting can be slowly withdrawn. Some children can become dependent on verbal prompts so this is something to be aware of. Be careful when teaching children to use a hot water tap as the temperature may vary greatly between bathrooms.
When teaching a boy to use the toilet you may wish to decide whether they need to sit or stand if they are able to differentiate between a wee or poo.
This involves training the body to go at set times and can be successful with children who lack awareness. Through observation, work out the best times to take your child to the toilet.
Ensure a relaxed environment and if appropriate let them hold an item that helps them to relax. To help avoid your child soiling the floor by getting up too early from the toilet, count to 10 slowly or give them a timer to hold.
Vibrating watches can be worn that are set to vibrate at certain times reminding your child to use the toilet.
|Use a word for the toilet that will still be appropriate when the child is older. Give your child a drink about 15mins before taking them to the toilet.|
Try to create a calm environment and remove any distractions from the bathroom. Consider any sensory issues your child may have. Use foot stools, smaller toilet seats etc.
An Occupational Therapist can be a good source of information for suitable equipment. A physiotherapist can show you the best position for wheelchair users who need help transferring to the toilet.
Staying dry overnight can take longer than day-time training and there may be the need for night-time pants initially. Bedwetting is a common occurrence with children and your health visitor should be able to offer advice.
Fledglings is able to advise you on a range of available products, such as waterproof mattresses, bedding protectors, waterproof pillows and duvets.
National Autistic Society http://www.autism.org.uk/about/health/toilet-training.aspx
ERIC - Children’s Bowel and Bladder Charity https://www.bladderandbowelfoundation.org
Accessible Toilets http://www.livingmadeeasy.org.uk http://www.changing-places.org
The RADAR National Key Scheme The scheme has around 8,000 disabled access toilets around the country. These can be unlocked using a Radar key. https://nks.directenquiries.com/nks/