When you have a child with special needs, toilet training can seem pretty impossible, but there is greater success with a more structured and systematic approach. Get some help from expert step-by-step instructions.
The more opportunities you can "create" for successful toileting, the quicker the whole process will be. Physical guidance/prompting can be used to help your child through the steps but make sure you are not doing the steps yourself (i.e., you can help your child pull down his/her own underwear, but don't pull them down yourself). Following the steps below in a consistent and repetitive manner will help teach young children with developmental delays the toileting process.
How to Begin
1. Dress your child in a short t-shirt and underwear only. In case an accident occurs, you will be able to notice it quickly and rush to the bathroom.
2. Set a timer for 15 minutes (depending on the frequency of accidents, you can adjust this time).
3. Allow your child to play with toys while you closely watch nearby.
4. Encourage your child to drink liquids frequently and leave a cup of water or juice nearby (play a game of "cheers!" and drink with them!).
Timer Goes Off
1. Prompt your child to "request" the bathroom using his/her form of communication. For example, you say "potty" and have your child repeat the phrase right away.
2. Turn off the timer.
3. Prompt your child from behind to walk to the bathroom.
4. Prompt your child to pull down his/her underwear and sit on the toilet.
5. Encourage your child to remain seated (up to 20 seconds) by singing songs or having a conversation. Reading books and playing while on the toilet are not recommended so that children can learn to use the bathroom quickly and resume other activities.
Success on the Toilet
1. "Throw a party!"—use excessive social praise, high-fives, kisses, and hugs.
2. Use behavior-specific praise ("Great job making pee-pee on the potty!").
3. Give your child the reinforcer immediately after they eliminate on the toilet.
4. Prompt your child to complete the toileting routine (get off the toilet, pull up underwear, wash hands)
5. Re-set the timer and start again.
No Elimination on the Toilet
1. Give words of encouragement ("You can try again next time!").
2. Prompt your child to complete the toileting routine.
3. Re-set the timer.
1. Give reminders ("Remember, pee pee goes in the potty!").
2. If you see your child indicating the need to eliminate in any way ("pee-pee dance"), prompt them to request the bathroom, and usher them in.
1. Remain calm.
2. Prompt the child to rush to the bathroom to have the chance to continue eliminating in the toilet (this will help teach the concept that their eliminations go in the toilet).
3. Use neutral language—do not reprimand ("Pee-pee goes in the potty. You can try again next time").
4. Prompt your child to take off soiled underwear and put on a new pair.
5. You child can naturally take part in the cleaning-up process but it is not meant to be a form of punishment.
6. Prompt your child to complete the toileting routine.
7. Re-set the timer.
Taking note of your child's successes, accidents, and the times that they occurred will help you measure their progress. In general, when your child remains dry at 15-minute intervals for 3 consecutive days, you can increase the time interval by 5 or 10 minutes. Use your judgment to determine the new time interval depending on how often your child eliminates.
Children with developmental delays may require more time than others to generalize their daytime bladder control to nighttime. Some ways to help children achieve night time control are to:
1. Limit fluid intake for two hours prior to bedtime.
2. Encourage your child to eliminate immediately prior to bedtime.
3. Place a small potty next to the bed and move it closer to the bathroom over time.
4. Consider a water-proof mattress pad.
Some Helpful Tips
1. If possible, train directly on the bathroom toilet instead of a small potty to eliminate teaching a new step.
2. If your child is resistant to sitting on the toilet, put training aside for a little while and use this entire procedure to reinforce sitting only. Gradually increase the time that your child is expected to sit (i.e., reinforce sitting for 5 seconds, then 10 seconds the next day, and so on).
3. For young boys, teach them to sit down to eliminate at the beginning so they can be successful at all types of eliminations. Later on, when they have learned the process and can differentiate between urinating and having a bowel movement, you can teach them to stand.
4. For boys learning to stand, place a fruit loop or food coloring in the toilet to teach them how to "aim." This can also be highly reinforcing!
5. Do not allow your child to escape from toileting by throwing a tantrum or refusing to participate. Remain calm and use physical guidance and a firm tone when giving directions.
6. Requesting use of the bathroom can be very difficult for children with developmental delays, so using a picture symbol that is paired with verbal language ("potty") may be helpful.
7. If needed, create a visual schedule for toileting or hand-washing and hang it up on the bathroom wall for your child to follow.
Remember, toilet training in general is already tough enough. It requires free time to actively watch your child, a dose of extra patience, and perseverance. The first day or week may be the toughest, and you may feel like you're venturing on an impossible feat. Keep reminding yourself: It will happen eventually. It could take days, even weeks and months, to fully toilet-train, depending on the child and your level of consistency. So take a deep breath and celebrate this momentous milestone in your child's development—and as always, be your child's biggest cheerleader no matter what!
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