In this blog, we will discuss the key developmental milestones in terms of toilet training and reflect on some of the challenges and possible strategies that could be implemented.

Successfully toilet training our children is part of the parenting role.  Although not an exact science, there are certain skills that are acquired as a child moves through their developmental milestones, and parents will use these milestones to help their child build the skills with toileting. Children move from being completely dependant on others to emerging independence using a potty to complete toilet independence as they transition to adulthood. For children with development delays and additional needs however this can change the trajectory of what a parent would be expecting in terms of toileting.

What can we do to help support parents and carers with maximising autonomy in toileting for children with additional needs?

There are some fantastic resources that have been produced by different organisations that are worth looking at for more detailed information.  As well as general resources that Bladder and Bowel UK provide , June Rogers, specialist nurse presents a positive case for toilet training being a realistic goal in her article around toilet training children with additional needs, challenging some of the perceptions that children are “not ready” yet. Down Syndrome UK also has a wealth of resources that can be used to help with toilet training.

Fundamentally we should take an individualised and unique approach that is right for that child. This could require a range of approaches and strategies, often graded to build the skill development.

Little girl sitting on the potty, playing with a toy.

Key things to consider:

  • Don’t wait until you think they are ready; help facilitate the process by using a potty regularly and celebrate when they use it successfully. This will help build an association.
  • Is the child seeing others using the toilet to help with observational learning? This can be crucial for development and imitating. It may be easier for children with reduced physical function to be left for short periods while mum or dad pops to the loo, something you can’t do with a child who is mobile and who will go AWOL the minute you turn your back. However children learn and mimic others’ behaviours as part of their development and so being able to see the toilet used can be helpful.
  • Focus on the smaller things; to independently use the toilet, a child needs to have among other things, balance, coordination, range of movement, trunk control, dexterity, processing skills.  If we can analyse the requirements they need then it may be more appropriate to focus on one element e.g. sitting balance and trunk control.  This can then be graded if and when those skills are mastered. Use equipment if this helps.  A child may develop the ability to sit on a toilet but not have the dexterity to clean themselves so still needs support.  A wash/dry toilet would give them independence.
  • Take one step at a time. The Continence Foundation of Australia has produced a really helpful guide for parents using a 5 step process to help move a child with additional needs towards using the toilet independently. They suggest:
  1. Setting the scene
  2. Developing the skills needed
  3. Raising awareness
  4. Using the toilet for wee and poo
  5. Nighttime control

In conclusion, developmental delays do not necessarily mean that a child will not be independent using the toilet and so an appropriate understanding of their abilities will be key to taking the correct approach with them. Taking a person centred approach and grading activities accordingly will help maximise success.