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Toileting

All children develop and achieve independence skills at their own pace. Children with additional needs may need extra time and support to make progress with toileting. For some children the process may be delayed and for others it may not be possible. Most children benefit from a toileting routine which is consistent and allows the child to take small steps towards the aim of being clean and dry.

 

  • With all children it is important to think if your child is showing any signs they are ready to be toilet trained.

    • Does your child know when they are wet or dry, and can they stay dry for about two hours?
    • Do they know when they ‘need to go’ – do they go and hide when a poo is on the way or can they get to the potty / toilet in time with help?
    • Are they ‘interested’ in using the toilet / bathroom?

    For some children with additional needs they might not show these signs of being ready but that is not a reason to put some simple steps in place to start the process. It might be helpful to think about lots of small steps rather than the end goal of being clean and dry. That is quite an achievement for any young child.

    • Start with simple changes like moving the changing materials to the bathroom and making this more private. Even getting a child to sit on the toilet with the lid down is a step in the right direction.
    • By building toileting into the daily routine, it will become familiar and will help your child towards those small steps of progress.
    • Start by keeping a diary of your child’s bladder and bowel habits – so that you know what their natural ‘pattern’ is.
    • Make sure they are drinking plenty of fluids and eating a 'high fibre diet'. This will make going to the toilet easier for them.

    If your child is cared for by others for instance family members, childminders or nursery staff, make sure that you all manage toileting in the same way, so that your gets the same message.

    Talk to professionals who know your child for advice and support to help you and your child. You can call Just One Number for health advice and assessment.

  • Children may have difficulties with language and / or understanding. 

    • They may not understand the words used or understand what you are asking them to do.
    • They may take what you say very literally.
    • They may not be able to say they need the toilet.
    • They may not know, or be able to tell you when their bladder or bowel is full.

    All children need information about all the stages of going to the toilet in a way they can understand.

    • Talk to any professionals supporting your child about communication methods you might try.
    • Get everyone involved in their life to use the same language and ways to encourage toileting.
    • You know your child best - watch out for the non-verbal signs they need the toilet like facial expression, ‘holding’ themselves, irritability or ‘dancing’ from foot to foot.

    Use clear and simple language or visuals such as the ‘Toilet Picture Steps’ for boys and girls which are downloadable below. You could make your own using photos of your own toilet.

  • Your child may have a lot of worries or be really sensitive to things around them.

    • They may be frightened of the toilet and / or not be able to use unfamiliar toilets.
    •  Not like the smells, sound or touch of being in the bathroom.
    • They may not like the feel of the toilet roll and have problems wiping. They might not like a drip of wee on their legs.
    • They may feel unbalanced when sitting on the toilet.

    Being sensitive to their worries can help reassure them.

    If they do not like the flush or other sounds;

    • Give warnings before flushing, or flush after they leave the room.
    • Use distraction such as music or other sounds they like. Use ear defenders or ear phones.
    • Put some toilet paper in the toilet before using it to reduce the chance of splashing.

    Make the bathroom as comfortable as possible. Is it too warm or too cold? Get a sturdy step or handrails to help them sit steadily.

    Let them choose their own toilet paper, seat, wipes and decorations in the bathroom. Use a toilet seat size reducer or a heated or padded toilet seat.

    Have a box of favourite toys or books in the bathroom that they can look forward to, but make sure you keep them clean.

  • There are many ways that behavioural problems can make toileting a problem for children and young people. They may be less likely to copy others to learn new skills. Some children resist following instructions.

    They may not understand that most people see passing wee or having a poo as a private thing done in the toilet. Your child may not mind feeling wet or dirty, they may like to touch and feel poo.

    This is difficult behaviour to manage and it is important to ask for help and support. For your child and for you.

    If your child touches or smears poo there are things you can do to make this behaviour less likely;

    • Try not to show a reaction and give minimum attention when your child does this, when things go well give lots of praise.
    • You could consider clothes that fasten at the back.
    • Give other sensory experiences like messy play with strong smells. Slime, finger painting or cornflour and water can be good too.

    If your child does not always find it easy to follow instructions or understand what is ‘private’ you could try using ‘social stories’. A social story breaks down an activity or experience into small, simple steps. It can use cartoons, pictures or photos to make it fun and easier to understand. Find out more about social stories *here*.

    When your child is displaying behaviours that you find a challenge;

    • Think about what your child is trying to tell you.
    • Repeat the ‘rules’ calmly and quietly giving the same simple messages.
    • Ignore as much of the unwanted behaviour as you can.
    • Praise even the smallest moment of progress.

    Managing toileting problems can be stressful. Small steps taken early can make a big difference, you don’t need to struggle alone - ask for help. There are contact details below of services that can help you.

  • Help your child to sit correctly when using the toilet - use the image below as a helpful guide;

    You can apply for;

    • Radar Key for access to disabled toilets when out and about. *Click here* for details.
    • Just Cant Wait Card to access other toilets quickly *here*.
    • Continence Assessment - you can call Just One Number on 0300 300 0123 to ask for a continence assessment for your child.

     If you claim Disability Living Allowance check that difficulties with toileting are part of your claim. 

Who Can Help?

You can contact the Healthy Child Programme by calling Just One Number on 0300 300 0123 or texting Parentline on 07520 631590. Our opening hours are 8am-6pm Monday-Friday (excluding bank holidays) and 9am-1pm on Saturdays.

The Patient Activation Measure (PAM) Health Questionnaire will help you to think about your knowledge, skills and confidence in understanding and supporting your baby or child’s health. The results of this can help us, to support you, in setting goals and priorities in a way that is right for you and your family. On completion of the questions you will be signposted to some self care resources which are tailored to your responses. This will help you to take steps to improve your family's health and wellbeing. *Click Here* to find out more. 

                  

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