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Training your child to use the toilet is an exciting milestone for both child and parent alike. In this first of the two-part series, SPD’s occupational therapist Jahzeel Ann Adan Eleazar gives an overview of toilet training and some common barriers affecting it.
What is toilet training?
This is a process of teaching a child to initiate going to the toilet. It involves getting him/her to recognise their body signals for urinating and bowel movement and using a potty chair or toilet correctly at the appropriate times. Source
Signs that your child is ready for toilet training
A child’s readiness for toilet training should not be determined by their age. Some considerations for toilet training are physiological and psychological readiness which typically occurs between the age of 18 months to 2.5 years.
Awareness
Usually, the first sign that a child might be ready to start toilet training is when he/she starts to become aware of their need to go to the toilet. Children who are aware usually start to demonstrate changes in behavioural patterns e.g. appearing distracted or fidgeting when they have soiled themselves. They might be able to inform their parents when they need change out of their soiled diaper or clothes.
Bowel and bladder control
With improved bladder and bowel control, children may have a dry diaper over a span of two hours in the day, or they may stay dry throughout their nap or night-time. This can be one of the signs of their readiness.
Cognitive and communication skills
Signs of readiness also include motor planning, memory and concentration that are needed to start and finish the task. Verbal skills allow children to express their needs. Parents will notice that the children have sufficient vocabulary to make the association between words and some body parts related to toileting. Children must also be able to follow simple directions and to find their way to the toilet (Dunn & McGarry, 2017).
Socio-emotional skills
Children who are ready might express desire for independence. They also like to imitate adults. They show interest in toileting habits of grown-ups or siblings and express desire to be a big boy/girl. They seek parental approval and take pride in their achievements. (Dunn & McGarry, 2017)
Motor skills
Development of both gross and fine motor skills are important in helping children achieve toileting independence. Some of these skills include their ability to walk to the toilet or potty and position carefully, and their motor ability to manage dressing/undressing their clothes. These developmental milestones promote the children’s independence and self-efficacy, and they are part of the toileting process.
Note: Children who have certain physical illnesses or medical conditions may not be ready for toilet training. For instance, children who have a urinary tract infection have a perpetual urge to go to the toilet, thus making it difficult for them to determine when they actually have to urinate.
Common barriers affecting toileting independence
- Constipation due to restricted dietary habits
- Urinary Tract Infection
- Loose stools or diarrhoea
- Poor sleep-wake-feed habits
- Decreased or lack awareness of the need to go to the toilet or when clothes are wet or soiled
- Fears (e.g. scared of sitting on the toilet seat, fear of enclosed spaces or sound of toilet flushing)
- Language & communication difficulties (e.g. inability to request or ask for permission to go to the toilet)
- Cognitive – difficulty in understanding and following instructions
- Lack of understanding of social concepts (e.g. may not understand that toilet training is a healthy and beneficial part of growing up and that wearing a nappy can be socially unacceptable when one gets older)
- Lack of joint attention and imitation skills
- Difficulty in accepting changes in routines
- Difficulty in processing sensory stimuli (e.g. dislikes the feeling of wiping/being wiped, chokes at the smell of stool, fears the sensations associated with urinating or defecating etc)
Look out for more strategies on toilet training in the second part of the article here.
Resources
Toilet Training Guidelines: Parents—The Role of the Parents in Toilet Training Pediatrics June 1999, 103 (Supplement 3) 1362-1363;
Guide to Toilet Training (Copyright © 2003 American Academy of Pediatrics)
https://pediatrics.aappublications.org/content/pediatrics/103/Supplement_3/1362.full.pdf
http://theinspiredtreehouse.com/what-is-interoception/
https://www.continence.org.au/information-incontinence-english/poor-bowel-control?id=533
https://pediatrics.aappublications.org/content/pediatrics/103/Supplement_3/1353.full.pdf
https://childdevelopment.com.au/areas-of-concern/self-care/toileting/
https://www.camhsnorthderbyshire.nhs.uk/learning-disabilities-toileting-and-asd
Dunn, A., McGarry, M. (2017). 12 Elimination Patterns. In; Burns, C., Dunn, A., Brady, M., Barber Star, N., Blosser, C., Garzon, D. (Eds). Pediatric Primary Care (6th Ed.). Elsevier. St. Louis Missouri
