Why is my child having trouble with toileting?
When looking at our child’s skills, we will commonly be puzzled to why they are having so much trouble completing a task that we take for granted. The role of an occupational therapist is to break down the smaller steps that are required for your child to be successful in completing a skill such as toileting.
Toileting is a complicated task and requires a huge number of smaller skills to be developed first. These skills include (but are not limited to):
- Fine and gross motor skills: being able to get on and off the toilet, undressing and redressing (manipulating buttons and zippers), reaching to wipe their bottom, tearing and folding toilet paper, flushing the toilet, washing and drying hands.
- Body control: bladder and bowel control.
- Postural control: to be able to sit in an upright position on the toilet.
- Attention span: to remain seated on the toilet for the required time.
- Planning, sequencing and memory: to be able to follow and recall a sequence of steps in order to complete the task.
- Language: to be able to express the need for a toilet and to understand instructions when toilet training.
- Social skills: to be able to understand socially acceptable behaviours, e.g. toileting in the appropriate place.
- Sensory: knowing when needing to go and being able to cope with sensory environment (flush sound, dryer sound, strong smells, feel of wiping, fear of releasing poo into toilet bowl instead of nappy).
Is there anything I can do at home to support?
Model behaviour – have your child watch you go to the toilet and talk about the steps while you are doing this. This will help your child understand the instructions you are giving them when it's their turn and to know it is a safe environment.
Pretend play – Play with dolls or puppets on a toy toilet and let your child play and have their doll/puppet do it too.
Make it a fun environment and a ‘less scary’ space – For example, painting the bathroom in favourite colour, putting up posters of characters they like, having toilet toys in the bathroom to increase engagement.
Don’t force them onto the toilet if they are visibly afraid or upset
Try learning on a toilet rather than a potty – This will minimise transitions and will mean they will not have to re-learn how to use the toilet later. This is good for children diagnosed with ASD who may have difficulty coping with change.
Create helpful visuals – Have a visual schedule of the steps as a reminder of what to do. You can also utilise videos, books, visual signs, hand signs, social stories and songs to support with toileting.
Use clear and consistent language – For example, “It’s toilet time!” or saying the steps to toileting "Pull your pants down".
Rewards – Provide a lot of praise, use reward charts (e.g. collecting stars to work toward a reward) and then slowly reduce the rewards as they become more consistent and independent with their toileting.
Schedule toileting – Take the child to the toilet frequently (e.g. every half hour and slowly reducing the frequency).
Make a routine – For example, go to the toilet before leaving home, when arriving at destination, before bed and first thing when waking up, etc.
Remove nappies – You can utilise waterproof sheets in the car if this is a concern.
Set up the environment for success – For example, use a step for child to put their feet on if their feet don’t touch the ground and to help with bowel movements.
How can occupational therapist support these skills?
It is common that families and teachers will identify concerns with activities of daily living, such as toileting. Occupational therapists are trained to analyse your child’s current skills and difficulties to identify smaller goals for your child in order to be able to achieve the larger goal, such as toileting independently. As every child is different, the skills that one child needs support in, is likely to be different to another child. Hence, a thorough assessment is always the place to start. Supports for working towards toileting may include, but are not limited to:
- Assessing current skill sets and environmental factors.
- Building the skills required to be able to go to the toilet (i.e. gross and fine motor etc.).
- Assisting parents to set up an appropriate environment for the individual child.
- Providing parents with resources, e.g. visual schedules, reward charts, toileting diary etc.
- Providing education and ideas to parents to continue working on the goal at home.
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