What is sensory processing?

We experience the world around us through our senses, and most people can block out unnecessary sensory information to focus on the task at hand. For children with sensory processing difficulties, they are unable to do this and can become overwhelmed quickly.

Our sensory systems are touch, taste, smell, hearing, vision, vestibular (balance) and proprioception (body awareness). We also receive sensory information from inside our bodies such as thirst, hunger, temperature, bowel, and bladder awareness. This is known as interoception.

Some children will be sensory seeking, and some will be sensory defensive. But what does that mean?

  • Seeking – They are under-sensitive to sensory information and seek out more input because they need a lot to notice the sensation.
  • Defensive – They are over-sensitive to sensory information and avoid input because they only need a little to notice the sensation and can become overwhelmed quickly.

 

How sensory difficulties affect toileting

Toileting is a very complex sensory experience that encompasses undressing and sitting on a toilet seat, to wiping and hand washing. It’s a difficult skill for most children to master, and those who have difficulty reacting to sensory information appropriately may struggle with these functional tasks.

Here are some examples:

Sensory seeking
Sensory defensive
Touch
  • Playing with their faeces
  • Frequent accidents (liking the sensation of their pants being wet or soiled)
  • Using excessive amounts of soap
  • Discomfort removing pants because they like the pressure
  • Fascination with water
  • Disliking wiping with toilet paper or saying it hurts
  • Feeling the toilet seat is too hard or too cold
  • Being upset with the sensation of bowels and bladder emptying
  • Refusal to wear pants
  • Disliking the texture of soap
Smell
  • Wanting to smell and play with soap
  • Smearing faeces
  • Distressed or gagging at the smell of faeces
  • Disliking the smell of soap
  • Holding their nose when using the toilet
Hearing
  • Repeatedly flushing the toilet
  • Shouting to create echoes in the bathroom
  • Playing with hand dryers
  • Scared of the flush and hand dryer and saying they hurt their ears
  • Covering their ears in the bathroom
Vision
  • Finding the bathroom too dark and asking for the lights on
  • Squinting at the harsh bathroom lights and reflections in the mirror
  • Saying their eyes hurt
  • Finding there is too much to look at in a small room because of the product bottles, bright towels or patterned tiles
Vestibular (balance)
  • Needing to rock to maintain balance and feeling unstable on the toilet
  • Difficulties wiping when twisted around
  • Unable to balance on the toilet
  • Feeling scared they will fall down the toilet or fall off
  • Difficulties wiping when twisting around
Proprioception (body awareness)
  • Dislikes removing their pants, as they enjoy the pressure of them
  • Not wiping enough or wiping too much
  • Being unable to sit still on the toilet long enough for their bowels and bladder to empty completely
  • Bumping into bathroom furniture
  • Feeling unsafe or uncomfortable on the toilet due to the aperture of the toilet seat
  • For boys, holding their penis too tight and not being able to aim when urinating
Interoception
  • Enjoying the sensation of a full bladder or bowel, which leads to accidents by withholding
  • Pushing too hard and straining muscles
  • Not recognising the sensation of their bowel or bladder being full
  • Feeling they need to go but not distinguishing between urinating and defecating
  • Unable to push to open their bowels

Strategies to help 

Once you’ve identified that your child is sensory seeking or sensory defensive, there are some simple adaptations and strategies to put in place that can help. It’s useful to know what they need to feel calm and regulated so that those strategies can also be used in the bathroom.

Sensory seeking

Touch

  • Allow time for wet sensory play outside of the bathroom. Play with water, soap, bubbles and soft Play-Doh or slime to replicate the texture of faeces
  • Allow your child to wear tight pants, leggings, and trousers
  • Give a deep pressure massage or bear hug before using the bathroom

Smell

  • Use strong smelling soap such as lavender or peppermint
  • Have strong smelling air freshener in the bathroom and spray before and during any toileting

Hearing

  • Play music or sing whilst using the bathroom
  • Use ‘cause and effect’ toys that have buttons to push to distract them from repeatedly flushing the toilet

Vision

  • Fit extra lighting to make the room brighter
  • Take colourful toys and books into the bathroom
  • Have colourful bathroom products and towels on display

Vestibular (balance)

  • Do some physical games before using the bathroom such as running, jumping, skipping or rolling
  • Fit handrails and a footstep to help with balance
  • Ensure their feet are flat on the floor or a step to provide a good base of support

Proprioception (body awareness)

  • Do some gross motor play before using the bathroom such as ball games, dancing or yoga
  • Use a weighted lap pad whilst sitting on the toilet
  • Take their socks off whilst using the bathroom, as this will give them a better sense of grounding

Interoception

  • To help children understand their toileting needs, use visual prompts and social stories (these are stories that help children to learn certain skills and understand why we do things the way we do them)
  • Talk to your child about what they are feeling and how you feel when you need to go to the toilet

Sensory defensive

 Touch

  • Use soft toilet paper or wet wipes to wipe
  • Fit a padded toilet seat so that it is more comfortable to sit on
  • Wear pants in a bigger size so they are looser

Smell

  • Use scent-free soaps and cleaning products
  • Keep the bathroom window open to ensure smells do not linger

Hearing

  • Use headphone or ear plugs if your child finds bathroom noises severely distressing
  • Flush the toilet after your child has left the room
  • Fill the sink with warm water before they enter, ready for hand washing
  • Soften bathroom sounds with mats, towels, and fabric blinds

Vision

  • Simplify the bathroom by storing bathroom products and towels out of sight
  • Cover mirrors if they are opposite the toilet
  • Use task lighting to create a calming environment
  • Use sunglasses if your child finds the bathroom extremely visually distressing

Vestibular (balance)

  • Fit handrails and use a step to help with balancing on the toilet
  • Use a toilet seat with a smaller aperture to help them feel safe whilst sitting on the toilet
  • Use a bottom wiper to minimise twisting whilst wiping

Proprioception (body awareness)

  • Ensure the bathroom is clear of excess furniture to prevent their bumping into things
  • Fit handrails and use a step to help with balancing on the toilet
  • Use tape on the floor to show boys where they need to stand
  • Use tape on the step to show where to position the feet when sitting

Introspection

  • Use a toileting schedule to ensure regular trips to the toilet throughout the day
  • For boys, if they are unsure if they need to empty their bowel or bladder, teach them to always sit down on the toilet so they can avoid having an accident
  • Let them go without pants in the house so they notice when they have an accident. This helps them to recognise the sensation
  • Use visual prompts and social stories to help your child understand their toileting needs

Be patient and know there’s help if you need it

Toilet training is a complex sensory experience and can take time to master, especially for children with sensory processing disorders or additional needs.

But if you’d like some help, an occupational therapist can further assess your child’s toileting needs and provide you with a personalised sensory plan.