The issue of when and how to begin
toilet training can
be particularly challenging for parents of children with special needs.
While no parent wants to push an already challenged child to perform in
ways that are impossible, the sense of accomplishment experienced when
he does succeed in this important aspect of self-care can make an
enormous difference in his level of self-esteem.
Perhaps
more than other parents, those who have children with physical,
intellectual, or developmental disabilities can appreciate the
toilet-training process as a way to follow and celebrate a child’s
overall growth. Rather than focusing on their child’s mistakes, which
are inevitable in any case, they can use this opportunity to discover
how he learns best and to demonstrate to him that he is able to
progress.
Toilet
training works best when parents of children with special needs have
access to the guidance, instruction, and encouragement of their
pediatrician, other trained professionals, or support groups. The first step you must take is to determine whether your child is ready to begin.
Signs of readiness are the same for your child as for all children:
Is your child aware of the difference between being wet and being dry?
Can he stay dry for at least two hours at a time?
Can he sense when he needs to urinate or have a bowel movement?
Is he capable of reaching the toilet or potty in time (perhaps with your help)?
Can he undress and dress himself or is he ready to learn?
Is he motivated at some level to take this next step?
If
your child is in a resistant phase, is not ready to take on a new
challenge, or does not yet feel the urge to behave “like other kids” in
this way, you might take some extra time to prepare him mentally before
starting the training process.
If
you feel that your child is ready, ask your pediatrician for her
opinion. She can examine your child to offer a physical assessment and
perhaps offer special insight into the particular needs of your child.
She can also provide further information that you may need before
starting, and let you know what types of special equipment may be
advisable.
It
is also important to prepare yourself emotionally before you and your
child embark on this experiment. Children with special needs often begin
toilet training later than other children, frequently completing the
process at age five or even later. (Of course, children with severe
physical disabilities may always need help with clothing and accessing
the bathroom). Learning to use the toilet can be physically painful to
some, initially incomprehensible to others. Accidents will happen, of
course, and you will need to draw on an extra dose of patience and humor
when they occur. Lining up help from your spouse, relatives, or friends
before you begin training—to spell you periodically as well as to help
boost your morale—is a wise move for your child’s sake as well as your
own.
Physical Challenges
A
number of physical disabilities and illnesses can hinder a child’s
ability to become fully toilet-trained or easily adjust to bathroom use.
If your child faces such a situation, you will need to think about how
her disability affects each stage of toilet training and how you can
compensate for this disadvantage. Whether your child is unable to sense
the need to urinate, has difficulty getting onto or staying on a
standard potty or toilet, or must adjust or readjust to toilet use after
having used an ostomy device, she will need extra support from you and
her other caregivers as she learns to master this new skill.
Visual Disabilities
Children
with visual disabilities and those with sight deficiencies experience a
disadvantage at several stages of toilet training. First, they are
unable to observe family members and peers using the toilet, so they
cannot mimic their behavior. So many details of toilet or potty
use—where the potty is in the bathroom, how the body is oriented to it
as one sits down, how the urine and feces get into the potty, how one
tears off and uses toilet paper—are simple to understand if a child can
observe the process but difficult if she cannot. Without sight to help
her, your child will need to rely more on language to understand how the
process works. Therefore, you will probably want to wait a little
longer to begin—until she is three or four years old (or even later,
since language delays can accompany blindness)—so that she can fully
comprehend what you are telling her.
When
you are ready to introduce your visually impaired child to the concept
of toilet use, start bringing her with you when you use the bathroom.
Allow her to explore the bathroom and locate the toilet. (Be sure it’s
well ventilated and smells pleasant so she will want to return.) Place
her hands on your shoulders so she can feel you sitting on the toilet,
explain what you are doing and why, and guide her hands to the toilet
paper dispenser. Also show her the flush handle and the sink for hand
washing. Once you have placed a potty in the bathroom, lead her to it,
let her accustom herself to its presence, and keep it in the same place
throughout the toilet-training process. Talk to her about toilet use at
other times, too—pointing out that most of the people she knows use the
toilet and that toilet use is a sign of being a big kid who can take
care of herself.
Once
she begins practicing potty use herself, you will need to keep the
bathroom and the passage to it clear of obstacles. A musical potty that
is activated when urine hits the bowl might make the learning process
more fun. Teach her to feel the inner edge of the seat before tossing in
the toilet paper and, if the child is a boy urinating standing up at a
toilet, to position his body so he doesn’t urinate on the toilet.
Finally, as she grows more comfortable with bathroom use, make a point
of taking her to the bathroom at each public place you visit. By helping
her familiarize herself with the wide variety of bathroom layouts and
toilet styles,
you will help build her self-confidence when away from home and prevent
accidents. And don’t forget to reward her progress with praise, hugs,
or a small, favorite treat.
Hearing Disabilities
Children who are deaf or have difficulty hearing may or may not find toilet training challenging, depending on their ability to communicate. A child who is already fluent insign language can
rely on a combination of visual observation and explanations from you
to understand what’s expected of her—much like any other child. Children
who do not yet have the ability to understand your signals and simple
signs may not be ready for toilet training until they are somewhat
older.
The
key to training in these cases is to keep the process simple. When
introducing the concept, emphasize the visual: Allow your child to
observe you (and, even better, other children) using the bathroom, and
show her picture books about it. Choose one gesture or sign for the
essential terms
(pee, poop, potty, wet, dry, and
need to go). Use
these gestures each time you use the bathroom, and use them with her as
well—signing “wet” (with a sad face) when you change her diaper or wet
underwear, “dry” (with a happy expression) once she’s been changed, and
“need to go” after lunch when it’s time to sit on the potty. As long as
you are consistent and stick with the half-dozen signals you need, your
child will get the hang of potty use without longer explanations. When
she does, be sure to reward her with plenty of hugs, stars on a potty
chart, or even candy or another small treat.
Continence Problems
Some
conditions have no effect on a child’s ability to understand the
process of toilet training but make it difficult for a child to comply.
Your child may grow increasingly frustrated in her efforts to stay dry
and may even give up trying. The best solution to this dilemma is to put
your child on a regular potty schedule. By placing her on the potty
frequently (reminding her every hour or so to visit the bathroom), you
remove the burden of having to acknowledge so many times each day that
she must interrupt an activity to tend to her physical needs. Going to
the bathroom at the top of every hour can become a habit similar to
brushing her teeth twice a day or receiving her insulin—freeing her up to focus on other activities between visits.
Cerebral Palsy
Children with
cerebral palsy not
only tend to be slow in developing bladder control, but may not have
enough bladder awareness to begin toilet training at age two or three.
If your child has cerebral palsy, she will need to be helped to develop
an awareness that she needs to go (which may be signaled to you when you
see her clutching her genitals or fidgeting anxiously) before she can
begin toilet training. She will have to be able to delay urination until
she is in position on the potty. She will need to remove her clothing
and then hold herself on the potty (with supports) long enough to
achieve success. Again, these challenges mean that it is usually best to
wait to toilet-train until she is older.
Chances are that limited physical activity, undeveloped muscle tone, or medications tend to cause constipation for
your child with cerebral palsy, so pay special attention to her diet as
you initiate the toilet-training process. Be sure that she is drinking
plenty of fluids and ingesting lots of fiber. As she begins to practice
removing her clothes before getting onto the potty, make it easier by
providing clothes with Velcro fasteners or loose elastic waistbands.
(She may find it easier to remove her clothes while lying down.) Since
she will have trouble supporting her back, you will need to provide a
special potty with back and side supports. (Potties designed to fit in a
corner work especially well, since the right-angle back support holds
the child in position with shoulders forward, hips bent, and knees
parted.) If your child has severe disabilities, you might begin by
sitting in a chair with the pot from a potty wedged between your knees.
Place your child on the potty with her back against you and hold her in
position until she urinates or has a bowel movement. Later, you may be
able to graduate to a potty with adequate supports.
Spina Bifida and Spinal Cord Injury
Spina
bifida, spinal cord injury, or spinal tumors create toilet-training
problems for young children similar to those of cerebral palsy, but
since most children with this condition never develop an awareness of
when they need to go, few can ever fully use a toilet. You can, however,
teach your child to remove urine through a catheter on a regular basis,
and to visit the bathroom for bowel movements on a regular schedule. (A
high-fiber diet with plenty of liquids and meals served on a regular
schedule will make this process easier. Sometimes a stool softener or
even a suppository or enema is required.) Since your child will find it
difficult to remove her clothing, be sure to provide her with Velcro
fastened clothes and allow her to lie down to undress if necessary.
Parents
of children with physical disabilities such as cerebral palsy or spina
bifida may become so distracted by the need for special equipment or
physical support that they neglect the necessary cognitive and emotional
input that all children need to succeed at toilet training. Don’t
forget, while installing that special potty in the bathroom, to talk to
your child about bathroom use and why it’s important, to let her observe
you and others using the bathroom, and to praise and reward her when
she succeeds even a little bit. Resist the temptation to let things go
when she resists or protests a little, and remain firm about the
schedule or routine you have created—unless the experience becomes
negative and your child becomes very resistant. Remember, her progress
in this arena is especially significant if it increases her
self-confidence and prepares her for more challenges. Give her all the
information, attention, and support she needs to succeed.
Behavioral Disorders
Your
experience toilet-training a toddler who is behaviorally,
intellectually, or developmentally challenged will depend a great deal
on your particular child’s temperament, behavior patterns, and
coexisting conditions. In this arena more than any other, perhaps, the
parents’ knowledge of a child’s strengths, weaknesses, tendencies, and
interests will help her through the process as much as any general
guide.
Toilet
training can be particularly trying for parents of children who have
intellectual or developmental disorders or who are behaviorally
challenged—including those withautism, fetal alcohol syndrome (FAS), oppositional defiant disorder (ODD), and, in cases when it is diagnosed this early, attention deficit /hyperactivity disorder (ADHD).
Many children with these conditions may not be strongly motivated, or
sufficiently equipped, to respond to the social reinforcements that work
so well with other children (“What a big boy!”), though small tangible
rewards such as candy or a toy can be effective. Most find it extremely
difficult to adjust to any change in routine. Some are particularly
sensitive to touch and other sensory input and become upset by the
frequent pulling off and on of clothing, the physical closeness with an
adult, and the unfamiliar surroundings of the bathroom. Simply getting
across the concept of potty use can be complicated by the fact that some
children with behavioral disorders do not naturally imitate their
parents’ or peers’ behavior, while others learn only through simple
imitation or other concrete, nonverbal demonstrations. Such
complications in the training process mean that early efforts can create
a high level of frustration in your child and may lead to displays of
temper, stubbornness, and refusal to cooperate.
Still,
nearly all children with these conditions can be toilet-trained—though
in some cases the process may take up to a year or even longer. Your
first step, again, is to determine whether your child is ready to start
training. There is no point in beginning until you see that he can stay
dry for an hour or more at a time, has regular bowel movements, is aware
that he is about to urinate or defecate, and dislikes being wet or
soiled. It is also important to have your child examined by his
pediatrician, since he may be at a higher risk for constipation or loose
stools, which may interfere with training.
Once
you have decided to begin, observe your child and consider carefully
the specific traits, patterns of behavior, and obstacles that may impact
his learning process. If he seems to dislike entering the bathroom,
determine what the cause of his discomfort is—the smell of disinfectant?
the cold floor? the flushing toilet?—and change or neutralize it if
possible (change cleansers, put socks on his feet, move his potty away
from the noisy toilet). If he does not overtly signal the need to
urinate or defecate, does he pause just before voiding or otherwise
behave in a way that will provide you with a cue? At what times, or how
long after eating or drinking, does he usually urinate or defecate? What
foods, toys, or other objects is he most passionate about? (These can
be used as tangible potty-training rewards, which may prove more
effective than praise.) How does he learn best—with firm but gentle
physical demonstrations (being placed on the potty at regular times), a
formal routine containing a series of simple and predictable steps
(verbally explained and reexplained, illustrated with pictures, or
listed on a chart), or offhand comments and conversations that inform
without inviting resistance?
Once
you have made the necessary adjustments in your child’s environment and
your teaching style, it is time to start working toward his first
success. Some parents like to begin the training process with actual
potty use—putting their child on the potty at a likely time and
rewarding him when he uses it. Others—particularly those with a child
who resists entering the bathroom—may want to focus on preliminary steps
first. They may start by rewarding the child for entering the bathroom,
then for approaching the potty or toilet, then for sitting on it, and
finally for using it. To make this process easier, and to avoid the
physical closeness that your child may resist, consider letting him wear
only his underwear at first, or even nothing below the waist. Handling
clothing can be taught at the very end of the process, once the bathroom
routine has been accepted as part of his day.
Your
child is likely to be resistant to adopting this new habit. It’s
important to insist, however—firmly but matter-of-factly—that he try.
When accidents occur, point out that you disapprove, but don’t punish or
criticize your child for making a mistake. If he is verbally
challenged, be sure to stick to simple instructions such as “Wet! No!”
As he gradually gets better at using the potty—motivated for the most
part, perhaps, by the prospect of a tangible treat—your child’s love of
routine will begin to work in your favor. He will expect to visit the
bathroom at predictable times and may even become upset if this doesn’t
happen. Until then, you will need to remind yourself how difficult this
major step forward is for him. You should also think about how to find
support for yourself as you search for the patience you will need to
succeed. Both you and your child are embarking on a difficult
developmental task.
Intellectual Disabilities and Developmental Disorders
Most
children with a developmental delay, an intellectual disability, or a
pervasive developmental disorder (for example, autism) can be
toilet-trained, though the time it takes to achieve success ranges from a
few months to a year or more. The process becomes easier as your child
achieves at least a minimal level of verbal ability, is able to manage
his clothes (perhaps with some help from you), and shows awareness of
the need to go. As you introduce your child to the concept of potty use,
be sure to keep your explanations very simple. Start by checking the
state of his diaper or pants every hour or so and offering a one-word,
nonjudgmental comment when he is wet (“Wet!”). Shake your head and then,
after you change him, smile and say “Dry!” If his verbal skills are
very limited, you might substitute a special gesture or sign for the
words
wet, dry, potty, need to go, and
so on. Begin bringing him to the bathroom with you when you need to use
it. Smile and say “Dry!” after you’ve finished and pulled your pants
up. If at all possible, have your child observe other children using the
bathroom, too. He may make the connection between himself and another
child more easily than between himself and you. After you’ve finished
and are dressed, show him how happy you are and tell him “Dry!” If he
has a favorite doll or stuffed animal, use it to play “
potty,” demonstrating again how the potty is used.
When
he is ready to begin using the potty, begin setting him on it at
regular times—quite frequently at first (as frequently as you checked
him for wetness earlier) and then gradually settling down to the times
when he usually voids. Try to keep him on the potty for five or ten
minutes at a time—keeping him company, reading to him, playing tapes of
children’s music, and otherwise ensuring that he stays in place long
enough to succeed. Once he does urinate into the potty, give him a big
smile and say “Pee!” (or whatever word you have chosen for this event).
Help him wipe off and then praise him with a happy “Dry!” and give him
a treat. Food treats are often very effective and can be phased out once
he has been trained. Eventually, with enough repetition, he will
understand the connection.
Children
with an intellectual disability or developmental delay are best
toilet-trained one step at a time. Don’t expect your child to learn to
signal or announce his need to go, pull down his pants, use the potty,
wipe his bottom, and wash his hands all at once, the way his peers
might. Toilet training will work best if you focus on the actual act of
elimination first and address the other skills later. It is more
important to keep him motivated than to achieve instant success.
Read the information and more on potty training tricks book:
Potty Train in Three Days & No Cry Potty Training Solution
Potty Training Girls - How to Potty Train a Child