Abbey Wash, occupational therapist at the Midtown office of Child and Family Development, follows news from the American Occupational Therapy Association.
Recently, she discovered an updated tip sheet on potty training that she uses in occupational therapy and shares with parents.
Abbey notes that potty training can be a great source of stress for families. Our communities and schools put a lot of pressure on success! Keep in mind that most children don’t consistently master bladder control until 4.5-5 years. Bowel control comes a little earlier at 3.5-4 years. Before attempting to toilet train, you’ll need to first make sure that your child is showing signs of readiness and then prepare for a training routine. A half-hearted failed attempt can actually hinder success!
The tip sheet includes:
Identify signs when the child is ready to begin participating in a toileting routine. Children will often demonstrate signs when they are ready to be toilet trained. These signs include:
- Interest in the bathroom or in the toileting process, which includes wanting to visit the bathroom, playing pretend toileting, touching toilet paper, or being curious about how the toilet flushes
- Wanting to observe others using the bathroom
- Reporting to a caregiver when they have gone in a diaper and/or asking to wear underwear
- Starting to “hold” their urine or bowel movement and/or getting upset when a diaper is soiled
It is important that families begin toilet training when it works for them and the child, typically between 18 months and 3 years of age. Toilet training is a family commitment, so all members should collaborate for success.
Set up a successful routine for potty time. An important aspect of toileting is for children to learn their body and the cues it is giving them to know when to go to the bathroom. But families should also encourage toileting routines, including the following times during the day for bathroom visits:
- When waking up
- Before and after naptime
- Before and after a new play activity
- Before a meal
- Before bedtime
- Before leaving the house for an event
Consistently taking a child to the bathroom at established times helps identify a routine for the family and child. If a child is showing signs of needing to go to the bathroom by wiggling or grabbing his or her clothes, families can ask if it’s time to visit the bathroom. But it is also important to teach children to recognize their body signals and go on their own.
Increase independence in toileting skills. Part of successful toileting is to ensure children wear clothes that can be easily removed. This often means clothing with elastic waistbands. If a child has a difficult time grasping the waistband, families may attach a loop the child can pull on.
Provide a comfortable and inviting environment. The bathroom can be a scary place with lots of noises, sensations, and smells. Some strategies for setting up a good toileting routine include making the space accessible and inviting, including:
- Placing items needed for toileting, such as toilet paper, within easy reach, and having a sturdy stool nearby to help the child get onto the toilet.
- Allowing the child to do an activity while on the toilet, like reading a favorite book.
- Talking to the child about the bathroom and how the toilet works to avoid fear.
- Placing brightly colored towels and fun-smelling soaps at the sink to make hand washing fun.
- Addressing smells with air fresheners as appropriate.
- Adapting the toilet seat so the child feels secure. For example, consider using a potty chair, potty ring, or foot rest.
Offer steps to help your family learn a positive
routine. Learning to toilet may take time, and it is important not to rush a child. Children may need to sit for a bit to be successful. They may benefit from:
- Running the sink water to initiate pottying
- Singing a song or two to relax
- Looking at a book while on the toilet
If a child cannot remember all the steps in the process of toileting, a series of pictures of each step posted by the toilet may help. Remember, children need to practice, and toileting has a lot of steps! Bathrooms are also different, so a child may need additional time when in a new bathroom.
Help your child learn proper hygiene. Some children may need assistance getting clean after toileting. They may need coaching on how much toilet paper to use, and visual checks to ensure that they are clean. Hand washing is important, and children should be able to access the sink with a sturdy stool. Soap and towels should be easy to reach. In order to protect children from water burns, families can label the faucets with colors to indicate which is cold and which is hot.
Encourage positive behavior. Toileting accidents are a part of the learning process and to be expected. Children may be so interested in something else that they forget about getting to the bathroom until it’s too late. A child should never be punished for an accident. Instead, praise a child when successful and clean up accidents calmly. If necessary, carry extra clothes so children won’t be embarrassed if they have an accident. Consider plastic sheets on the bed as a temporary measure and reduce fluids before bedtime. Children can also help clean up the mess, which may help them learn to avoid future accidents. Reward children for their responsibility and participation as they learn toileting skills by complimenting their “big boy” or “big girl” underpants, and by praising their successes in keeping their bed and clothes dry.
Click here for the AOTA article.
If a struggle persists, consult your pediatrician. There may be a medical issue hindering success. If no medical issue is found, contact an occupational therapist. We can address things like sensory awareness, dressing independence, and core strength to improve the process.
Abbey and the other pediatric occupational therapists are available.
Learn more about developmental milestones on our website.