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Toilet training is a significant adjustment for most children. To set your child up for success, it's important to maintain clarity and consistency from the beginning. This approach is particularly crucial for children with autism and IDD. Before starting the potty training process, we have to understand it first. There are several stages to potty training:
Scheduled Urination (Trip trained): At this level, your child remains accident-free when taken to the bathroom regularly.
Bowel Training: This stage involves your child independently having bowel movements in the toilet.
Self-Initiation: Here, your child begins communicating their need to use the bathroom, improving independence and self-awareness.
Nighttime Training: Finally, achieving nighttime dryness means your child can sleep through the night without accidents, indicating a more comprehensive mastery of toileting skills.
Each level represents a step towards independence and should be approached with consistency and patience. Every child is different, therefore as parents you have to first identify if your child is ready to be potty trained.
Here are the physiological signs of potty training readiness:
Awareness of the Need: Your child shows awareness by squatting, grunting, blushing, or occasionally seeking privacy like “hiding” in a spot (normally a specific corner, behind a couch, or they want you to be out of the room they are in before they can poop). They also may ask to be changed when wet, take their diaper and clothes off, or get fussy or upset until they are changed into a dry diaper.
Nighttime Dryness: No bowel movements during the night, and dry morning diapers. You should check the diaper very early in the morning before they wake up because they may pee right when they wake up, and then you will assume they peed overnight, when in fact they were dry all night and they had their first morning void before you got to them.
Extended Dry Periods: Long intervals with a dry diaper during the day. Can they stay dry for at least one to two hours?
Urination Patterns: Urinating in larger amounts at once rather than small amounts frequently throughout the day.
Regular Bowel Movements: Some consistency in the timing of bowel movements.
However, physiological readiness alone doesn't always indicate that your child is ready for toilet training. It's also essential to consider their motor, cognitive, verbal, emotional, social skills, and sensory processing, as all these aspects play a crucial role in the process. Children with additional needs often need more time to develop and consolidate their skills and may require components of the potty training process to be broken down into smaller, more manageable steps.
Let’s review some of the other necessary skills for potty training readiness. Children need to be developing the ability to dress and undress themselves. Can they pull down their pants and underwear on their own, and pull them back up? If the children are not showing these skills emerging yet, then you want to introduce dressing and undressing first, at least pulling pants and underwear down and up. This can be practiced every time children are changing clothes. Once you see intention, then you can start the potty training process, even if they are still working on the skill and need your help.
Potty training involves a complex interplay of physical and cognitive tasks. Your child must learn to recognize their body's signals, associate the physical sensation with the appropriate response, visualize their goal, plan the route to the potty, get there, pull down their clothing, and use the potty. Additionally, they need to stay on the potty long enough to finish, which requires memory and concentration. At the same time, your child has to be able to understand the instructions you are providing them, and be able to follow the commands. Your child must get familiar with specific potty training vocabulary words such as “dry/wet”, “pee”, “poop”, “pants up”, and “pants down”.
The desire for approval can be a highly effective motivator during potty training. Nonetheless, many children might not be highly motivated or adequately prepared to respond to social reinforcements that typically work well with other children, such as praise like "Yay, such a big boy!" Instead, for some children, rewards based on interest may be more effective. Pick a few highly motivated rewards that the child will only have access to during the potty training process. These rewards would not be able to be obtained in any other situation. With enough repetition and consistency, they will be able to understand the process and create the connections. Once potty use is integrated into their daily activities, it becomes a natural and expected part of their routine.
Lastly, the sensory system affects just about everything we do and that includes using the bathroom. Senses can affect potty training in many ways, for example:
The child doesn't notice or can't feel when their clothing is soiled or they've had an accident.
The child dislikes the sensation of urinating or having a bowel movement while sitting on the toilet.
The child plays with feces.
The child fears falling in or feels unsteady and insecure on the toilet.
The child feels the toilet seat is too high off the ground.
The child doesn't recognize the internal sensation of needing to use the bathroom.
The child can't differentiate between the need to urinate and the need to have a bowel movement.
The child is sensitive to upset stomach or cramping and associates it negatively with toilet use.
If your child is experiencing bladder or bowel control issues, it's important to reach out to your pediatrician for guidance and support. While most children can be successfully potty trained, the process may take up to a year or even longer in some cases. Assistance from an occupational or physical therapist may also be necessary.
Beginning the potty training process
Once you decide your child is ready for potty training, the next step is to set clear expectations not just for your child, but for yourself as well. Ask yourself if you are ready to provide consistent and regular support throughout the day to enhance your child’s learning. Are you prepared to invest the necessary time and energy? This commitment is crucial because, as mentioned earlier, maintaining consistency and clarity is essential to avoid confusing your child.
Important steps to start the potty training process:
ELIMINATE DIAPERS, INCLUDING PULL-UPS! Go straight to underwear. Once your child moves to underwear, you should not go back to diapers. It sounds difficult and intimidating, but modern diapers and pull-ups can be too good at whisking away the pee. As a result, your child may not even realize that he has urinated. It is also important that once diapers are out, they stay out. No diapers for car rides, or going out of the house. No diapers at night time either. This is why it is crucial to plan for yourself. Putting diapers on and off during potty training can give missed messages to your child. You can use washable potty training pads for the car, furniture your child uses around the house, and the mattress. For extra protection put a waterproof cover on your child’s mattress.
Get the necessary tools for your child to be comfortable sitting on the toilet. Children should feel safe using the toilet, and they have to be able to get on and off independently and sit unsupported. Some tools I found useful:
Toilet stools provide support for your child's legs to make them feel safer and comfortable when using the toilet.
Training toilet seats with handles and steps to make your child feel safer and comfortable, as well as giving them the opportunity to go on and off the toilet independently.
Bath seats for soaks are good for children that do not feel safe in the toilet because they are afraid to fall inside.
Fluid Loading: Increasing fluid intake increases the likelihood your child will need to urinate. This gives the opportunity to teach children what happens when they go on the toilet and what happens when he or she has an accident. Fluid loading is only temporary until your child links the pee and the toilet.
Stop fluid intake for your child 2 hours prior to bedtime.
Creating a potty training routine for your child
Bye-bye diapers, hello underwear! You can take your child's underwear shopping and let them pick the underwear they want. Get underwear with their favorite characters on it. Once diapers go bye-bye, they should not come back at all.
Establish a Consistent Schedule: If your child was able to keep the diaper dry for at least an hour. Then create a schedule to take your child every 45 minutes to the bathroom.
Introducing wet and dry! Before taking your child to the bathroom on the established schedule, you will check your child’s underwear. If the underwear is dry, smile and say "Dry!". If your child needs a more visual cue for praising, clap your hands as well, or do a little happy dance. Then you will take your child to sit on the toilet. If you check the underwear, it is wet, just say “Wet”. Help your child to change into new dry underwear and once changed, smile and say “Dry!” If your child needs a more visual cue for praising, clap your hands as well, or do a little happy dance. Then you will still take the child to sit on the toilet.
Do not make a big deal over accidents! Keep it simple. When it comes to communication, less is more. If your child has an accident, Say “wet” then bring your child into the bathroom to change into clean and dry clothes. Do not sit your child in the toilet. If your child had a “poop accident”, make sure you show your child the “poop” goes in the toilet. Dump the stool from the underwear in the toilet and ask your child to flush. Give your child some feedback such as “bye-bye poop, poop goes in the toilet”. Once your child is changed, smile and say “Dry!”If your child needs a more visual cue for praising, clap your hands as well, or do a little happy dance. Continue to take them at the scheduled time to use the restroom, even if they had an accident before it.
Potty time: Bring your child during the scheduled time. At the beginning, it is probably going to be at least every 30-45 minutes (Remember to set the time gap based on how long your child was able to keep their diaper dry). Try to keep your child on the potty for five to ten minutes at a time by staying with them, reading, playing children’s music, and engaging them to ensure they remain seated long enough to succeed. This is the time in which your child’s interests come in handy. Get toys, music, or specific things that your child really enjoys and leave it to be used only during the time they are in the restroom. At least during the potty training period. A great tip to have in mind, encourage your child to blow bubbles or try to inflate a balloon while they're sitting on the toilet – it uses the same muscles you need when weeing and pooing, so will help them get used to the sensation. When they urinate into the potty, give them a big smile and say "Pee!" (or the word you’ve chosen for this event. Sometimes the children themselves come up with specific wording, it is okay to use that as well, as it will be more relatable to them). Help them wipe, then praise them with a cheerful "Dry!" and offer a reward. This reward can be a small toy, a little “pee pee in the toilet” party with bubbles, stickers, anything that will work for your child. I am not a fan of screen time for reward, especially because during the initial potty training phase, they will be getting rewarded very often, and the screen time can backfire on you. Your child then may have a hard time, when screentime is done.
Honestly, based on my experience, a lot of children, teens, and young adults continue to struggle with some aspects of the process, especially with the wiping. I will address this topic in a different post. The important thing is first for your child to learn to be trip and bowel-trained (meaning pee and poop go in the toilet). They may still need physical, verbal, or visual cues to pull their pants on and off, wash their hands, and wipe.
The best approach to toilet training is to do so one step at a time. Don't expect your child to learn to signal their need to go, pull down their pants, use the potty, wipe, and wash their hands all at once, as their peers might. Focus on the act of peeing and pooping first, and address the other skills later. Keeping them motivated is more important than achieving instant success. As they become more aware of their bodies, and the urge of needing to pee or poop, you need to look for those signals, as they may need to be taught how to communicate the need. When potty training children with autism and IDD, repetition is the key. Enough repetition will help them understand the connection. That is why you have to maintain consistency in gestures, word choices, and routine.
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