If you have been here the past couple of days you will know that Monday’s and Tuesday’s posts have been dedicated to potty training. The information from today and the past two days have come from The Best Practices Newsletter of The Interdisciplinary Council on Developmental & Learning Disorders. Some of what you read may have a familiar tone to the previous posts, but I figured why not give as much information regarding this topic as possible.
From Lisa DeFaria, MSW (masters in social work), LCSW (licensed clinical social worker): Considerations For Toilet Training
When considering toilet training there are a number of things that must come into play with any child before they are “ready.” With a child who has challenges, in communication, sensory disfunction and/or motor skill delays we have to be particularly patient.
There are a number of comprehensive books available on the subject of “toilet training” typical children as well as children on the autism spectrum (Go to www.SpecialNeedProject.com). In these books and with every person you talk with, you will find that there are many ways to approach toilet training. I typically recommend starting with the question of “readiness”.
Ask yourself- is my child truly “ready” to use a toilet for bladder or bowel elimination? This is a developmental milestone, just like others, requiring a hierarchy of skills in place before toileting can be achieved successfully. Here are a few tips. If your child is not ready in the following areas, please don’t push it. Perhaps begin to introduce one or two readiness strategies at a time, and be prepared for a long run (however, he or she may just surprise you!). Remember, every child is different.
1. Can your child sense that he/she has to relieve him/herself?
Many children with challenges do not have the sensory feedback that tells them their bladder is full or their bowel is about to move, and today’s plush wick away diapers don’t promote this awareness. Consider a few strategies to help inspire more awareness. Cut out the elastic on your paper diapers by day. When your child urinates, that will catch the bulk of it – but the wetness wil be more apparent. (Children with sensitive skin, prone to rashing, will need help cleaning and drying off quickly)
A couple of sunny days (that’s why people often wait for summer) where he or she can trot around the backyard sans clothing — eliminating spontaneously – may help your child begin to be more aware of his “output”. Be there with your child – draw his/her attention gently, “Jason, look the pee came out of your body and onto the grass.”
2. Is your child comfortable with his/her pee and poop? Meaning not upset by it…?
Use whatever term you and your family are most comfortable with labeling the elimination “pee” and “poop”, for example).
You can help reduce any anxiety he/she might have about eliminations by avoiding terms like “yucky”, or by acting revolted. (That may scare your child and increase dependency on the diaper)
Use terms like “wet”, “sticky”, “uncomfortable”, with facial affect that mirror the same and suggest that your empathize with his/her discomfort, but are not disgusted by it (Note: in Floortime fashion we are providing “intentions” where they may not yet exist…he/she may not yet identify a feeling of discomfort, but with a bit of practice and attention to the process, he/she may in fact become more aware, if not a bit uncomfortable). “Jason, that is a very wet diaper. Let’s get you a fresh one.”
3. Is your child ready to be brought into the diapering process?
Encourage your child to fetch the diaper or the wipes, and dispose of the soiled one, shake the poopy diaper refuse into the toilet, and flush.
4. Is he/she curious about the potty habits of others?
If you are comfortable, let him/her watch your or other family members use the toilet. If he/she is in a preschool, where other children are using the potty (often an open-door activity), encourage him/her to notice, “Jason, Luke is using the potty to pee in.” And suggest matter-of-factly that, “Someday you will be a boy/girl who uses a potty too.”
(Note: the sound of a toilet flushing, particularly in cavernous public restrooms can be quite upsetting to some children. Make a habit of “casually” visiting bathrooms at friend’s homes and public restrooms, just washing hands, perhaps. If comfortable, use the potty yourself, invite your child to do the flushing. Don’t force it.)
5. Does your child signal that he/she has to go?
For example, is he or she beginning to move away from others when pooping in the diaper – to a corner perhaps? Does your child’s face grimace, or are there gestures, even words perhaps, he/she uses? Note the obvious in a matter-of-fact tone, “Jason, your are in the corner. Maybe you are making a poop. When you are finished, you can tell me. Then we can change the diaper.”
For the child who’s overwhelmed by too much language, consider using “Boardmaker”, (your child’s speech therapist may have this computer program) or even still photographs that you paste down. Or a visual schedule that step-by-step sequences the actions: Jason in corner squatting to poop (wearing clothes and a diaper), Jason taking mom or dad’s hand and walking, Jason on changing table while a new diaper is put on, Jason and mom/dad smiling happily.
6. Can your child pull his/her pants down and up again?
Time to move to easy elastic waists if your haven’t already.
7. Can your child climb up and onto things in general comfort?
Some parents prefer to start with a potty chair, others try an adaptive toilet eat on the regular potty, with a step up stool or attached “ladder”. However, if your child is feeling off balance or at risk of “falling in”, he/she will be resistant. Make sure your attachment is a very steady one.
8. Can your child sequence (motor plan) the steps involved?
Consider sharing highly visual “potty books”, (such as Every-one Poops). If your have access to “Boardmaker”, create a visual schedule to post by every toilet in the house that sequences out the steps involved: from pulling down pants, to climbing on potty, to urinating, wiping, climbing down, pulling up pants, flushing and washing hands. Carry one with you when out and about. Let him/her eye the strip, long before your are hoping he/she actually does something with it.
Your child needs to have the opportunity for gentle, non-directive, exposure to the toileting process, before any expectations are put on him/her to begin attempting it. In fact, it is ideal to wait until your child initiates it by climbing on the toilet and imitating your for example. Much applause, for you are on your way…
Do note: when a child is ready, most children start with some control over urination, by day, progressing to being dry at night, and even later still day and night control for bowel movements.
Tomorrow’s post: Potty Training Part 4: Steps for Conducting Scheduled Opportunities for Toileting paired with A Task Analysis for Toilet Training