Toilet Training the Special Needs Child
adapted by Helen F. Neville
When children have special needs, parents can be so overwhelmed that they’re tempted to delay toilet training. Other families don’t want to admit that a child isn’t reaching developmental milestones at the expected ages, and they insist on toilet training before the child is ready.
About 95 percent of special needs children do eventually manage toileting on their own. It is usually best to start training with other kids the same age, because this provides examples and incentive to join in. However, many special needs children will need more time to learn toileting, sometimes until age 5—or older. The process often requires more creativity and energy than with other children.
Before you start training, review what you know about your child’s capabilities and temperament. Combine this with information from health care providers, therapists and parents of other children with similar needs. Then plan how to help your child gradually increase independence in toileting. The more information and skill children develop in this life skill, the better equipped they will be to handle future tasks.
Once you are ready, get your child enthused. A straightforward approach is, “You want to be like other kids and go to the bathroom by yourself. Here are things that will help.” Invite your child to make suggestions and participate as much as possible.
Like other parents, dress your child in clothes that are easy to remove; use Velcro® instead of snaps, zippers, or buttons, and pants with elastic waistbands instead of overalls.
One seven-year-old skipped underpants. Her mother folded two towels in the wheelchair seat each morning. The child could remove the top one if it got wet and still have another in place to for the remainder of the day. Some girls in wheelchairs use a banana-shaped “female urinal” available in medical equipment stores and in some camping stores. It takes skill to avoid spilling urine, so practice at home. If wiping with toilet paper is difficult, try a “bidet spray.”
For children with muscle difficulties such as cerebral palsy, muscular dystrophy and spinal cord injuries, getting on and off the toilet is often the most serious issue. A child also have difficulty dressing, wiping, flushing, or washing hands. Grab bars or a potty designed for a corner may provide extra security. Portable toilet inserts, wheelchairs with removable arms (or a partially removable bottom) or a board to slide onto the toilet may also be hepful. Some boys can pee into a container and empty it into the toilet. Early on you may be the best support. Hold your child on your lap, with a pot between your thighs.
Children with such learning issues as autism, Down’s Syndrome, and pervasive developmental delay (PDD) may have difficulty expressing the need to go; and it may be hard for them to understand how to use the toilet and perform hygiene tasks.
Be creative in selecting methods. If your child isn’t talking yet, make up hand signals for “wet”, “dry”, “poopy” and “need to use the potty.” Put pictures of the following steps beside the toilet:
- Pants down
- Sit on toilet
- Stand up
- Pants up
- Wash hands
You might use an inexpensive voice recorder on a neck-band to provide step-by-step instructions at the push of a button. These reminders of the sequence can help your child focus. If you keeping track of your child’s urinating and elimination patterns, you can be in the bathroom to help.
Those with sensory issues get very little sensation from skin, bowels or bladder. They may not recognize the need to go, or a wet diaper. Others (including some with autism) get very strong sensations and may be overwhelmed by the flushing noise. Boy who are blind may need to sit to urinate or stand against the toilet and listen carefully to ensure they have aimed accurately.
It’s important that parents and caregivers recognize that children who have no obvious disabilities may still have special needs during potty training. For example, some receive little sensation from full bladders. These children are not being defiant in continuing to wet their pants.
Helen F. Neville (temperamenttools.com) is a San Francisco Bay Area parent educator and pediatric advice nurse, the author of Is This a Phase? Child Development & Parent Strategies, Birth to 6 Years, and the revised edition of Mommy! I Have to Go Potty! and the co-author of Temperament Tools: Working with Your Child’s Inborn Traits (Rev. Ed.). To use this article, credit Mrs. Neville and include Parenting Press’s copyright notice and its URL, www.ParentingPress.com.