Toilet Training Resource Pack

School Readiness - toilet use

This pack provides hints and tips to help you facilitate independence in toileting with the children you work with.
Please use the advice and strategies contained in this pack before you make a referral to the occupational therapy service. If you feel you require further information click here where you can also book onto one of our education sessions. Being independent in toileting is a difficult skill to master and requires a range of skills;
• Mobility and Transfers
• Dressing Skills
• Planning
• Hand washing
Successful toilet training can be demanding for both the child and the
carer. From the child/young person it requires sensory awareness,
balance, the ability to communicate and sitting tolerance, they need to be
comfortable and feel secure. If a child/young person does not feel
balanced and secure when sitting on the toilet, they may feel very
anxious. If they are concentrating really hard on being able to maintain
their sitting position on the toilet they will find it really difficult to
concentrate on actually using the toilet, resulting in less success. You
should contact Occupational Therapy if you think your child/young person
may need additional support when sitting on the toilet.

From the carer, it requires time, patience and perseverance. Toilet
training can take a long time for some children/young people to master,
parents/carers may begin by being enthusiastic and giving lots of praise,
however after time this can diminish. A mutual understanding of
communication is also necessary, does the child/young person use verbal
communication, makaton, or their own signs, symbols and
pictures/photographs. If signs and symbols are being used it is important
to make sure that all those working with the child/young person are using
the same ones to ensure a consistent approach is being used. Always use
the same words to ensure understanding, for example; “going to the
toilet” or “going for a wee wee”.

 

Understanding Toileting
Children/young people follow seven stages of toilet training as they
develop:
1. Show interest in toilet/potty
2. Express the need to use the toilet
3. Will sit on the toilet
4. Will use the toilet
5. Using the toilet if previously used the potty
6. Consistently uses the toilet at home
7. Uses the toilet in the community
Look and Listen
It is important to listen and observe the child/young person and they will
tell you when they are ready to start toilet training. Starting too early
can make the whole process take longer! Here are some things to look out
for to help you recognise when they are ready;
• Young children need their bladder to be at least half full before they can wee.
• Are they interested in using the toilet?
• Do they stay dry for a couple of hours?
• Have they developed a pattern of opening their bowels or bladder?
• The child/young person needs to be able to identify when they are wet.
• Do they seem uncomfortable when wet or dirty?
• Do they grunt or squat when they open their bowels?
• Do they tell you when they are about to wee?
• Can they sit for about 5 minutes?

Potty Training
Here are some things to try to help encourage the child/young person to
use the potty or toilet:
• Have a conversation with parents/carers to discuss what stage the
child is at and what strategies if any they are using at home to
ensure consistency. Use a notebook or home-school diary to
communicate the child’s progress with parents/carers.
• Take the whole class or groups of children/young people from the
class to the toilet at the same time so that the child/young person
realises that going to the toilet is something everyone does. This
may also help them realise what the bathroom is for and make a
connection – use signs and symbols to reinforce this.
• Use the potty when you expect to see success to make it as positive as possible.
• Ask parents/carers to dress the child in practical clothing and
send spare pants and trousers into school in case of accidents.
• Ignore saying anything negative about accidents, just clean up and
talk about something else, talking about the accident can reinforce
this behaviour as they child may realise that they get attention for
wetting themselves.

Keep Going
If toilet training seems to be going backwards, increase the level of
praise again to regain momentum. It’s easy to get out of the habit of
praising success. Ignore accidents completely and try not to show
disappointment if they don’t do anything on the potty/toilet. If
child/young person wets themselves when not on the toilet, take them to
the toilet as quickly as possible, try to get them there so some of the wee
goes in the toilet and they continue to make the connection between
weeing and the toilet.

What if the Child is not Aware
There are a number of ways you can teach a child/young person to
recognise when they are wet or dirty; again this is something you will need
to discuss with parents/carers.

Hints and Tips
• Communication – if the child/young person is non verbal think about
ways to help them communicate, this could be using signs, symbols
or photographs. Speak to Speech and Language Therapy about what
the child/young person’s level of communication is and the best
ways to communicate with them.
• Often the sensation of wetting/soiling heightens awareness when
the child/young person stops wearing nappies and this can
encourage bladder control. It’s often a good idea to start
encouraging awareness during the summer holidays as
children/young people can run around in the garden without wearing
nappies. Discuss this with parents/carers and be ready to start
toileting training when the child/young person starts back at school
in September.
• Kitchen roll in nappies can help with the very effective absorbency of nappies.
• Change nappies in the bathroom to encourage an association with this room.
• Develop a toileting routine to encourage awareness of the sensation experienced.

Toileting Patterns
Children/young people usually follow a toileting pattern; here are some
tips to encourage a pattern;
• Regulate mealtimes and drinks; this is usually easier in school than
at home, as the school day follows a structured routine.
• Having a warm drink can stimulate the muscles in the intestines encouraging bowel movements.
• Give the child/young person a big drink 30 minutes before they are expected to need the toilet to increase the chances of success.
• Start to fill in a training chart and check the nappy at half hour intervals this will help you determine a pattern of when and how often the child/young person wets/soils.
• After a couple of weeks you can then take the child/young person to the toilet at set times based on your observations.

Potty Vs Toilet
Children/young people should feel safe and secure, in order to sit on the
toilet they must; be able to balance, have good sitting tolerance, have
their feet supported, feel comfortable and be able to relax!
You may have to motivate the child/young person, to do this you need to
make the experience fun and positive;
• Play on the potty/toilet – blowing games such as blowing bubbles;
this relaxes the child/young person and can also stimulate the
muscles to encourage them to open their bladder.
• Sing a song
• Monitor the time spent on the potty to prevent boredom.
• Encourage the child/young person to rest their hands on their
lower tummy to develop an awareness of their muscles and when
they are working.
• If you continue to encourage a routine without any success you may
wish to discuss this with parents/carers and suggest that they
discuss it with their consultant if they too have not had any
success.

Children with ASD and Learning Difficulties
Children/young people with ASD and learning difficulties often find toilet
training particularly difficult as it involves; changes in routine, increased
expectations, understanding of a complex process including planning and
sequencing, a range of sensory experiences.

Hints and Tips
Try to be consistent and use visual aids to support the child/young
person’s understanding, you could also try using social stories to aid
understanding. Try and change routines gradually for example, start off
sitting on the toilet with the lid down to wash hand and face. Don’t
encourage ritualistic or obsessive behaviours as these can be very
difficult to break. Talk to parents/carers to discuss what strategies they
are using, share ideas and ensure a consistent approach.
Sensory Difficulties
Some children/young people can be very sensitive to sensory input such as
touch, sounds and smells, others can be under sensitive to these things.
You need to bear this in mind when toilet training as certain sensitivities
may impact on success of toilet training. Here are some examples;
The sound of the toilet flushing – Some children/young people are very
sensitive to noise and so this sound can make them upset and anxious,
feelings which we don’t want to be associated with toileting. You should
therefore allow the child/young person time to prepare for this sound
before it happens, they might want to put some earphones on when they
flush to block out the noise.
The feel of the toilet seat – Some children/young people are very
sensitive to touch and they may feel that the seat is too cold, hard or too
hot. Try to compensate for this when possible so that the experience is
not negative for the child/young person.

Reluctance to be touched or get hands dirty – Some children/young
people may not like to be touched so you need to try and prepare the
child/young person for his when helping them wipe or get dressed. Talk
them through the process, you could go through a visual schedule
specifically for toileting with them so they know what to expect. Some
children/young people have a fear of getting their hands dirty, again go
through the process with them before so they know what to expect. You
could also try some calming and deep touch activities to help prepare
them such as; massaging hands and body, weight bearing activities such as
lying over a therapy ball on their stomach and walking forwards on their
hands, rocking forwards and backwards or side to side is also very calming
to the sensory system.
If you require further advice regarding sensory difficulties please
contact the Occupational Therapy department.
Smearing
Some children/young people smear their poo, this may be due to a lack of
understanding, behavioural difficulties or they may be sensory seeking. It
may be that the child/young person is bored and does not know what else
to do in this time. It may be that the child/young person has done this in
the past and received a lot of attention from doing it. It could also be
that the texture or smell is something that the child/young person
enjoys.
Hints and Tips
• Minimise social interaction or talking whilst cleaning up to ensure
they child/young person does not receive any positive
reinforcement for this behaviour.
• Wear clothing that discourages this behaviour, such as clothes
where the child/young person can not get their hands inside their
pants, some children/young people wear all in one outfits – you will
need to talk to parents/carers about this.
• If the child/young person appears to like the texture consider
encouraging them to play with other similar textures such as play
doh, shaving foam or gloop (cornflour and water).
Refusing to use the Toilet or Potty
When children/young people first stop wearing nappies, some may hold their wee and poo until they can go in a nappy. This may be because they find it difficult to learn a new way of toileting. It could be because they are uncomfortable on the potty or toilet. It may also be because the firm pressure of the nappy helps them relax.

Tips
Try cutting a small hole out of the nappy so the child/young person can
wee through it into the toilet/potty, this way they can still feel the
comfort and security of wearing a nappy but they are using the
toilet/potty. Gradually make the hole larger so that eventually they only
have a section of the nappy around the waist, this way you can slowly
remove the nappy entirely.
Bottom Wiping
In order to achieve success with bottom wiping the child/young person
needs to be able to demonstrate a good range of movement for reaching,
the ability to balance whilst wiping, body awareness, touch awareness and
control.
Hints and Tips
• Encourage the child/young person to stand to wipe if possible, they
may need a grab rail to help them balance. It may also help them to
have a stool which they can place one foot on to make wiping easier.
• Guiding the child/young person’s hand so they can develop an
understanding of where to reach for – play games to encourage this
skill such as getting the child/young person to pass a balloon
through and around their legs.
• Use wipes or damp tissues so that the child/young person can feel
where they have wiped.
• Encourage the child/young person to look at the tissue they have
used before throwing it into the toilet so that they can see for
themselves if they are clean or not.
Hitting the Spot
When boys are able to distinguish between when they need to open their
bowels or their bladder they may like to stand to wee. Some boys can
struggle with aiming successfully, as this task requires; good hand-eye
coordination, balance and concentration.
Hints and Tips
• Ensure the room is free from distractions such as noise by closing
the door, try not to interrupt concentration.
• Consider putting ping pong balls or cereal in the toilet for boys to
aim at – don’t worry these items can not block the toilet.

Poo Facts and Suggestions
• Ensure the child/young person has lots of fruit and vegetables and
drinks lots.
• Sitting on the toilet after mealtimes is more productive, eating
pushes food through the bowel.
• Consider poo in a positive light.
• The rule of three – no more than 3 a day and no less than 3 a week.
• Tip the poo from the nappy into the toilet so the child/young
person can learn where it goes, say “bye bye poo, off to poo land”.
• Change the child/young person in the bathroom so they can
associate the room correctly.
Resources
http://www.promocon.co.uk/aboutpromocon.shtml – information about
toileting.
www.fledglings.org.uk/ – products and advice for parents and carers of
disabled children (e.g. suits to prevent children from smearing).
http://www.dotolearn.com/ – symbols.
http://www.autism.org.uk – social stories about toileting as well as other
resources.
http://www.coventrycarers.org.uk (0247663 2972) – A confidential
service to support the needs of carers including supplying information
about benefits/finance, respite, support groups.