Toileting

General tips

• Breathe! We know it can be an overwhelming and daunting process, try and approach it in a relaxed manner. If you are relaxed and calm with the process, this will model to your child that this is not a stressful situation. Try and have fun with it, as odd as that sounds. If you find yourself getting frustrated, it’s okay to take a break or change the approach. There is no rush to get your child potty trained by a certain age, just have in mind what is best for your child.
• Think about what type of potty to use. If your child is bigger, try and get a bigger potty with a higher base so your child can sit comfortably. Get more than one if you can.
• It will be messy so be prepared for that. Have cleaning supplies ready and if necessary, put your child in clothes you don’t mind getting messy. Have spare clothes ready especially when out of the house.
• To reduce the mess put a plastic tablecloth or a urine mat (there are disposable and reusable ones) underneath the potty.
• Associate the toilet with fun! Build a positive relationship with the toilet and your child. For example, play fun games, have a sing-along in the toilet or make up a toilet song. Continue to do this throughout the potty training process.
• Create routines with going to the toilet, for example, when they wake up, before bedtime or before going out. Follow this routine as well to model it to your child.
• Most importantly, make sure your child is comfortable! Decorate the toilet with things they like, create a fun interactive potty corner or ensure they are wearing clothes they can easily take off. If the process is becoming too overwhelming for your child, don’t be afraid to take a brief pause to reassess a better way.

Here are some steps in creating an effective toilet training programme. They can be run concurrently and consistently for the toileting programme to be effective:

Have a toilet schedule

• Having a schedule creates a routine around using the toilet. It also builds tolerance for the toileting space.
• When starting, take your child to the toilet at short regular intervals and encourage them to sit on the toilet for at least two to five minutes.
  • For example, your child can be taken every 15 minutes and encouraged to sit on the toilet for five minutes.
• If your child wees on the toilet for three days in a row, then increase the interval time another five minutes.
  • e.g.,15 minutes to 20 minutes then 20 minutes to 25 minutes and so on.
• If your child has three accidents in a row, then take five minutes off the interval time: the schedule decreases by five minutes.
  • e.g., 25-minute schedule is reduced to 20 minutes.
• If you have varied results like two accidents and one successful wee on the toilet, keep the same time interval.
• The time continues to increase until the schedule between sits on the toilet reaches 120 minutes, the average time.
• Every child is different and the interval between toilet visits vary depending on factors such as:
  • Water intake
  • Diet
  • Bladder size
  • How long they can hold urine

Response to successful wees on the toilet

• If your child wees on the toilet, make a big deal about it (because it is a big deal!)
• Provide them with lots of reinforcement. This increases the behaviour of successfully weeing on the toilet. It lets your child know they are doing the right thing.
  • For example, when they successfully use the toilet, the reinforcement can be to give them praise and access to a preferred item such as a favourite book, toy or snack.
• Use specific praise for successful wees on the toilet e.g., ‘Good job going wee on the toilet’.
• The reinforcement should be immediately provided following the toileting routine. Have the reinforcer readily available with you when transitioning to the toilet so they can access it right after.
• If they start to wee off the toilet but finish on the toilet (for example they began weeing outside the toilet, but you were able to quickly direct them to toilet and they sit and finish), this is considered as successful and they should get reinforcement.

Responses to accidents

• If your child has an accident outside of the toilet, remind them in a neutral tone what the expectation is of them. For example, ‘We wee on the toilet’.
• Take your child to the toilet immediately to finish the toilet routine. Where possible, get your child to help you remove their soiled clothes. They can also help you get them dressed.
• If they can, get them involved in the cleaning process; this could be them flushing the toilet.

Teaching initiation

• We teach initiation so your child can recognise when they need the toilet and communicate it.
• Think about your child’s preferred communication method. Make sure your child can use that method to ask for the toilet.
  • For example, their PECS book has a toilet symbol.
• The symbol for toilet should be always visible for your child (front page of the AAC device, on their table or in a common place). A picture of the toilet must be clearly visible to your child throughout the day. This can also act as a prompt for a child who communicates primarily with spoken word.
• In the beginning, model the use of the communication method when taking your child to the toilet (exchange the PECS symbol with your child, point to the toilet picture in a communication book or emphasise the word toilet when speaking).
• When your child is beginning to become familiar with the routine, you can begin to prompt them to exchange the toilet visual, select it on their AAC device or say ‘toilet’ prior to each trip to the toilet.
• If your child self-initiates, take your child immediately to the toilet. Provide reinforcement for successful wees.
• If your child self-initiates but does not successfully use the toilet, take your child back to what they were doing, you can offer feedback e.g., “We will go to the toilet in a little bit”.

Fluid intake

• The amount of fluid intake by your child will determine their need to use the toilet.
• Ensure your child is drinking fluids regularly throughout the day and make sure they have access to water or a drink as well.
• Keep track of how much liquid your child is drinking throughout the day. Usually, the more they drink the more wee you can expect.

Generalisation

• You want your child to be able to use the skills they have learnt during toilet training in all possible toileting contexts.
• Straight from the start work on generalising your child to different toilets. Use different toilets if you can, toilets in your house, toilets in other people’s houses or toilets in public.
• Make sure everyone supporting your child follows the same routine. Consistency is key!
• When your child is going to the toilet successfully at a regular time interval for example a full day at 120-minute intervals with zero accidents for a couple of days; you can begin to slowly reduce access to the tangible reinforcement but still keep the social praise!

Other things to consider

When your child is toilet training, it is more successful if they are out of nappies. It can get messy and can be time consuming. It might be easier to start toilet training at home over the weekends then gradually transition to underwear full time.

Other factors might be a hindrance to successful toilet training such as noisy hand dryers, smells in the toilets and other sensory issues. Bear this in mind when generalising to other toilets. You may have to work on those skills separately.