Toilet training can be a stressful time for both a child and parents because there is so much to consider when passing these essential life skills on. One important thing to remember is that every child is different, and no two children have the same experience of toilet training.
For any families struggling with toilet training, an occupational therapist can assist as they have a holistic outlook to consider the whole process of toileting as well as the developmental stage of the child.
These are the areas an occupational therapist will examine:
Gross motor skills – mobility, transfers, sitting balance, bilateral coordination, crossing the midline.
Fine motor skills – hand grasp, dexterity, hand-eye coordination, hand strength.
Sensory skills – tactile, auditory, smell, proprioception, vestibular, introspection.
Cognitive skills – sequencing, safety awareness, communication, understanding.
The environment – size, noise, lighting, temperature, facilities.
So, what will an occupational therapist recommend if a child is having difficulties? Here are some adaptations and tips that might help.
Gross motor skills
- Sitting down to undress will help with balance and postural control
- Using a potty instead of the toilet will simplify the physical demands as there will be no need to stand on a step and with the feet on the floor, they will have more stability and balance
- Use a family toilet seat with a reduced aperture as this will assist with improved balance and feeling secure
- Ensure the child’s feet are planted flat on the floor or step as this will provide a stable base of support
Fine motor skills
- Wear easy to remove clothes with elasticated waists or a size bigger pants to assist with undressing before the child has an accident
- Use wet wipes instead of toilet paper as this will clean quicker and be less physically demanding
- Use a pump soap as this is easier to handle that a slippery bar of soap
Sensory skills
- Flush the toilet when the child is not in the room to reduce exposure to echoey noises
- Use task lighting so to reduce glare from all the shiny surfaces in the bathroom
- Use warm, soft towels and nice smelling air freshener to create a comfortable space
Cognitive skills
- Use social stories to explain the purpose and importance of toileting
- Use visual cue cards to support children with sequencing of the toileting process
- Use backward chaining as this gives the child a feeling of success. Break the task down into small sections and ask the child to complete just the last section, only move onto the next section once they have mastered the last. Continue like this until they are completing all the sections of the task
- Toilet train at a child’s pace and when they are showing an awareness and interest
- Use reward charts so the child experiences feelings of success
The environment
- Use a toilet seat with grab bars to provide additional support with balance
- Fit handrails to the wall if a child needs extra support with their transfers, sitting balance or when reaching for the toilet roll
- Fit nonslip floor to minimise the risk of an accident if the floor becomes wet
Play is the primary occupation of a child, and many life skills are learnt through play. The below activities will help develop the essential skills needed for independent toileting and can be incorporated into day-to-day play.
- Hand strengthening – play dough, Lego, threading beads, tearing paper, pegs
- Body awareness – Simon says, riding a bike, dancing, animal walks, balancing
- Motor planning – obstacle courses, floor is lava, dancing, animal walks
- Bilateral coordination – rolling play dough, jumping, crawling, catching a ball
- Word recognition – sensory play that includes wet, dry, dirty and clean
The most important tip for toilet training is to keep to a routine, children need consistency and repetition to learn. And remember, keep it fun as that will help engage a child and the parents!
