Toilet training tips

By Kelsey Farmer, MSOT

Bathroom difficulties can make everyday activities stressful, from a trip to the grocery store or day at the amusement park, to going to school. Occupational therapists can help address different aspects of toileting to reduce daily stress for your family.

When is the right time for toilet training?

Kids typically begin toilet training between 18 months and 3 years of age. They tend to stay dry during the day before they’re able to do so through the nighttime. Staying dry throughout the day and during the night usually occurs consistently between 5 and 7 years old.

Waiting for signs of readiness from your child before beginning toilet training will lead to a greater chance of success. These signs may include:

• Shows an interest in the potty. Does your child ask to go the bathroom with you? Are they incorporating the potty into play activities, such as having their stuffed animals or dolls pretend to use the bathroom? Are they asking you questions about going to the bathroom?
• Can follow your directions
• Can get onto and sit on the toilet
• Has the fine motor skills to manage their clothing, such as pulling their pants up and down
• Demonstrates more body awareness, such as noticing when their diaper is wet or bladder is full
• Stays dry for periods of time

Supporting your child through toilet training

Using the bathroom takes time and experience to learn, just like any other skill. Regressions are normal with life and routine changes, such as a new sibling being born or going on vacation. 

Avoiding the following can help support your child through the toilet training process:

• Shaming or punishing them when they experience incontinence, which is when they pee or poop involuntarily
• Using the term ‘accident’ when they experience incontinence, as it indicates they did something wrong. Instead, describe what happened in kid-friendly terms, like “it looks like your bladder was full and some pee came out."
• Preventing or delaying them from going to the bathroom

Using play to teach about going to the bathroom can make toilet training less stressful. You can use playdough to create pieces of food and then show how they travel through a stuffed animal’s body. When working on wiping, you can put pudding on balloons taped to the back of a chair to help them practice. Try checking out books from the library that talk about going to the bathroom with kid-friendly language and illustrations.

Sensory processing and toileting training

Are public restrooms overwhelming for your child? From long lines, crowds and loud hand dryers, to automatic flushing toilets, it’s understandable that public restrooms can lead to sensory overload for many kids. Try keeping sticky notes with you to cover the automatic flush sensor. This will prevent the toilet from unexpectedly flushing while your kid is still sitting on it. Noise cancelling headphones may help too.

Positioning on the toilet for toilet training success

Does your child say they need to use the bathroom, but once they’re sitting on the toilet, they aren’t able to go? Or maybe they say they don’t have to go while they’re sitting on the toilet but pee in their pull-up or underwear just a few minutes later. This could be related to how they are sitting on the toilet.

The ideal position for using the toilet is having the feet supported, knees above the hips, leaning slightly forward and with elbows resting on the thighs. When your child is properly supported, this allows their muscles to relax. At home, use a foot stool and kid-sized toilet seat to ensure the ideal position. It’s tougher to have your kid sit like this in a public restroom. There are small, portable toileting seats that fold up to fit easily in a diaper bag or an upside-down trash can will double as a foot stool in a pinch. If items you can buy at the store aren’t supportive enough, you can schedule an equipment evaluation with one of our occupational or physical therapists to find a toileting seat that works best for your child.

Constipation and toilet training

Constipation can lead to incontinence or difficulty emptying the bladder. It can also cause poop to leak out without your child noticing. This is very common. Kids can’t feel this leakage, and they aren’t doing it on purpose. Many factors contribute to constipation including changes in routine, picky eating and previous painful bowel movements. Talk with your family’s pediatrician if you have concerns about constipation in your child. 

Occupational therapists at CHoR can address many areas that make toileting difficult, including sensory processing, fine motor skills and picky eating. For more complex toileting challenges, your kid may benefit from an evaluation by an occupational therapist with training in pelvic health.

Contact our Brook Road Pavilion at 804-228-5818 to schedule an appointment with a therapist.

_References

_{Baird, D. C., Bybel, M., & Kowalski, A. W. (2019, October 15). Toilet training: Common questions and answers. American Family Physician. Retrieved January 16, 2023, from https://www.aafp.org/pubs/afp/issues/2019/1015/p468.html}

_{Halder, A. L., Pervez, M. M., & Khan, S. (2021). Chronic constipation enhances urinary tract infection in children: Experiences in a Tertiary Care Hospital Outpatient Department. Pediatric Oncall, 18(2). https://doi.org/10.7199/ped.oncall.2021.26}

_{Koppen, I. J., & Benninga, M. A. (2022). Functional constipation and dyssynergic defecation in children. Frontiers in Pediatrics, 10. https://doi.org/10.3389/fped.2022.832877}

_{Nepple, FACS, K. G., & Cooper, MD, FACS, FAAP, C. S. (2021, March 29). Etiology and clinical features of bladder dysfunction in children. UpToDate. Retrieved January 16, 2023, from Etiology and clinical features of bladder dysfunction in children - UpToDate}

_{Tharner, A., Jansen, P. W., Kiefte-de Jong, J. C., Moll, H. A., Hofman, A., Jaddoe, V. W. V., Tiemeier, H., & Franco, O. H. (2015). Bidirectional associations between fussy eating and functional constipation in preschool children. The Journal of Pediatrics, 166(1). https://doi.org/10.1016/j.jpeds.2014.09.028}