What is toileting?
Toilet training is the process of training a child to use the toilet for bowel and bladder use (i.e. wees and poos). Toilet training may start with a potty (small toilet bowl-shaped device) or you may skip this and simply begin with the toilet. Most children will find it easier to control their bowel before their bladder and it usually takes longer to learn to stay dry throughout the night than daytime.
Why is toilet training important?
Many kindergartens and preschool have a policy that children attending their centres must be toilet trained, meaning that only if the child is toilet trained are they able to access an education*. Not being toilet trained may not only limit a child from accessing the academic setting, but also from other social settings where it becomes difficult to take the child out when many of their peers are toilet trained and they are not. As children become more aware of the lack of toilet training, there may be some bullying or public ridicule by other children.
*This is not always a hard and fast rule but toileting independently is the desired goal at this age in readiness for school transition.
What are the building blocks necessary to develop toilet training?
1. Physical skills
- Consistency of bowel and bladder movements.
- Control of sphincters(muscles responsible for controlling the evacuation process).
- Physical ability to sit upright on toilet or potty and not fall off.
- Ability to undress and dress as needed (including managing buttons, zips and knowing how to plan and sequence dressing and undressing).
2. Sensory Processing
- Awareness of soiled and wet nappy (i.e. body awareness, tactile discrimination).
- Awareness of need to toilet (with enough time to get there).
- Ability to cope with the sensory environment of toileting (noises of flushing toilet and taps at the sink, echoing sounds of tiles, hand dryers, bodily smells, smell of air fresheners).
- Attention to task and ability to sit still long enough to toilet (more than 5 mins without an adult needing to help them stay sitting).
- internal (i.e. reading the body’s signals and managing the feelings of toileting).
- external (including toilet seat, toilet paper, smell, noise, clothing on skin).
3. Concept understanding
- Comprehension of the sequential steps of toileting and dressing (e.g. pull pants down before sitting on the toilet).
- Attempts to remove clothing in readiness for toileting.
- Attempts to request or communicate needs to others (e.g. I need to go to the toilet).
- Awareness of the routine or sequence of toileting.
- Awareness of the task that is required of them when in the bathroom.
- The ability to follow simple adult-directed routines (i.e. doesn’t demonstrate avoidance behaviours where the child simply doesn’t want to do it because an adult is telling them to do it and interrupting what they were doing).
How can you tell if my child has problems with toileting?
If a child has difficulties with toileting they might:
- Not notice when they are wet or soiled in their nappy or underwear.
- Notice but not tell an adult when they have wet or soiled.
- Struggle to undress independently so they are ready to toilet.
- Be fearful to sit on the toilet or potty.
- Wet very soon after being taken to sit on the toilet or potty.
What other problems can occur when a child has difficulties with toileting?
When a child has toileting difficulties, they might also difficulties with:
- Following instructions: The ability to understand and be able to initiate the tasks to be done as per requested by others.
- Receptive language (understanding): Comprehension of language.
- Self care: Involves the everyday tasks undertaken to be ready to participate in life activities (including dressing, eating, cleaning teeth).
- Sensory processing: Accurate registration, interpretation and response to sensory stimulation in the environment and their own body.
- Planning and sequencing: The sequential multi-step task/activity performance to achieve a well-defined result such as the sequence of what to do before during and after toileting.
- Self regulation: The ability to obtain, maintain and change their emotion, behaviour, attention and activity level appropriate for a task or situation in a socially acceptable manner.
What can be done to improve toileting skills?
- Building blocks: Develop each of the four building block steps outlined above.
- Visual schedule: visually mapping out the steps involved in toileting.
- Reward chart: For independent toileting (whether successful or not initially) or telling an adult of the need to go.
What activities can help improve toileting?
- Physical setup: Be prepared with the right equipment. If the child is using the toilet it will be helpful to get a step for the child to stand on so they can be independent in this part of the sequence. A smaller seat insert that fits securely inside the existing toilet seat can help children nervous about falling in.
- Role play: Role play toileting with teddy bears.
- Read books: Buy one of the many children’s books that serve as a social story about toileting (many books have the flushing noise maker in them!).
- View IPAD apps and u-tube segments on toileting. These are numerous!
Why should I seek therapy if I notice difficulties with toileting in my child?
Therapeutic intervention to help a child with toileting difficulties is important as:
- Toileting difficulties may not just be a result of conscious choice behaviour. There may be a neurological reason (sensory based) or other fear related issues that contribute to the challenge and need to be checked out as early as possible.
- Left unchecked, toileting difficulties can lead to social isolation, possible bullying and a disruption to daily social events. They may not be able to attend parties with ease or have sleep overs at other friends or families.
- Toileting ‘accidents’ at preschool or school can severely damage precious self esteem.
- Toileting independence is required for school entry.
- Toileting difficulties often impacts the entire family, not just the child involved and can contribute to curtailing social outings when toileting independence has not been mastered.
If left untreated what can difficulties with toilet training lead to?
When children have difficulty with toilet training, they might also have difficulties with:
- Difficulties with sensory processing and ‘feeling’ other sensations such as cuts and burns which can be very dangerous as well as delay other skill development.
- Have difficulties with the planning and sequencing of other self care tasks, which can look like disinterest or “I wont” when in fact it can be “I cant”.
- Social isolation, possible bullying and a disruption to daily social events. A child may not be able to attend parties with ease or have sleep overs at other friends or families.
- Difficulties transitioning into school.
What type of therapy is recommended for toileting difficulties?
If your child has difficulties with toilet training, it is recommended they consult an Occupational Therapist.