Families that have very little resources train from birth. No disposable diapers and limited access to cloth diapers, no washing machines or indoor plumbing require an approach that seems unconventional to our western society. However, infants in the East African Digo believe that infants can learn soon after birth and begin motor and toi
Families that have very little resources train from birth. No disposable diapers and limited access to cloth diapers, no washing machines or indoor plumbing require an approach that seems unconventional to our western society. However, infants in the East African Digo believe that infants can learn soon after birth and begin motor and toilet training in the first weeks of life. With a nurturant conditioning approach, night and day dryness is accomplished by 5 or 6 months.
Pediatrics. 1977 Aug;60(2):170-7. PMID: 887331.
Cultural relativity of toilet training readiness: a perspective from East Africa - PubMed (nih.gov)
According to Thi Hoa Duongm, Vietnamese others use a whistling sound at certain times to remind their children to eliminate and frequently checked for signs of need. With this process, all children use the potty by the age of 9 months. At the age of 24 months the potty training is completed, and most of the children managed the whole pro
According to Thi Hoa Duongm, Vietnamese others use a whistling sound at certain times to remind their children to eliminate and frequently checked for signs of need. With this process, all children use the potty by the age of 9 months. At the age of 24 months the potty training is completed, and most of the children managed the whole process independent of help.
Volume 9, Issue 6, Part A, December 2013, Pages 808-814
A study of 349 children in Iran suggests that about 52% of parents said they used the intensive toilet training method, about 44% said they used the child-oriented method, and about 3% had no idea about the method of toilet training they used when asked how they trained their child. However, “the mean age of being dry at day and night was
A study of 349 children in Iran suggests that about 52% of parents said they used the intensive toilet training method, about 44% said they used the child-oriented method, and about 3% had no idea about the method of toilet training they used when asked how they trained their child. However, “the mean age of being dry at day and night was 24 to 27 months,” said Dr. Nakysa Hooman, professor at Iran University of Medical Sciences and the study’s lead author.
Toilet Training in Iranian Children: A Cross-Sectional Study
Iran Journal of Pediatrics. 2013 Apr; 23(2): 154–158.
Split Crotch Pants (a pair of pants with a slit in them so the little booties hang out and make it super convenient to just squat to "go") is a pretty common phenomenon in China. Children are trained fairly early similar to the method used in Kenya. The split crotch pants are worn with or without a diaper.
To read more about how the Chi
Split Crotch Pants (a pair of pants with a slit in them so the little booties hang out and make it super convenient to just squat to "go") is a pretty common phenomenon in China. Children are trained fairly early similar to the method used in Kenya. The split crotch pants are worn with or without a diaper.
To read more about how the Chinese culture trains little ones to potty, read the article from the National Association of Child Development
TOILETING IS AN IMPORTANT SKILL FOR DAILY LIFE that has many social implications. In order for the child to achieve this important milestone, children and families need to establish a clear toileting routine. This will ensure a child has success in school and in social situations. The link below can be copied and distributed for personal and educational uses without written consent. Copyright © 2014 by the American Occupational Therapy Association.
Any parent can tell you that a child is born "ready to poop and pee". The illustration above showing the way different cultures manage toileting is a good example of children being born with capacity; however, the takeaway is that it is not the child who necessarily needs to show "readiness" but the adult who needs to show "readiness". (My opinion completely.) As noted in the AOTA brochure mentioned above, "Toilet training is a family commitment, so all members should collaborate for success."
In the United States, the majority of children are completely continent during the day (not wearing diapers) by the age of 2-1/2 and have control of their sphincters at night by age 3. (Schmitt, 2004)
HOW CAN YOU SUPPORT READINESS
STEP 1: Recognize that it is a skill that needs to be learned, just like walking. It happens little by little in small steps. We do not exit the womb and stand in 30 minutes; we generally take baby steps that that include strengthening sufficiently to sit, crawl, pull to stand and balance without support before we are managing steps. In the same way, you should resign yourself to little manageable milestones and
repetition, repetition, repetition.
STEP 2: Get comfortable with the child in the bathroom with you. This may not be the situation with all families...but I had a very open home as a child, and my husband and I raised our children with the same model. We bathed and showered with our children, they were present for our toileting events, and dressing. At the time, I didn't realize how important that really was, but it created an atmosphere of comfort with our own bodies, nakedness, and allowed our children to observe every routine of self-care.
STEP 3: Set up a routine. From the time they are very little, expose them to the toilet. What I am saying is that most infants are bathed at some point. The clothes need to come off and the water will be drawn for a little bath. Clothes off, bath water on, and bottom on the toilet. Guess what this accomplishes? A routine. You are helping them establish a pattern of clothing removal, the sound of water running and a sit on the potty as a cue to "go". They may not go... but they might! The opportunity here is profound. It is a matter of exposure. I am not proposing elimination communication, I am simply saying that we can expose infants to the routine if we choose to.
STEP 4: As they get older, and the infant learns to sit you can begin to add in additional times that you take them to the potty. Here are some ideas:
STEP 5: Don't forget about all the other skills that support toileting independence.
My point here is that if we wait until the child is 18-24 mos to initiate introduction, then it will be a scary thing. A novel event they have never done before. At this age they are beginning to exert more independence and may protest your attempts.
**If at any time the child resists and refuses, cries and screams, then I suggest you respect the communication they are offering. I am not suggesting that you cause the child trauma. What I am proposing is that we initiate and expose the infant early on to the concept and slowly build it into their normal daily routines so that it is "normal" and not something new and unusual that we suddenly spring on them when you feel it is "time". It's like learning to ride a bike-we start with a toddler riding toy, transition to tricycle, move up to a balance bike and then the real deal.
This is a question I am asked all the time. Should we get a toddler toilet or should I train my child on the adult toilet. My answer is Yes and Yes. I think the best way to manage this is to figure out what will work best for you, the age of the child, examine your resources and your child's needs. Most importantly, "Keep things simple!!" The toilet is not a play station. It doesn't need trinkets and toys and certainly not a iPad stand.
Infants will not be able to sit on a standard adult potty, so if you are bringing your infant to the potty, make sure you are doing it with a potty hat or pot. You could even place the potty hat between your own legs while holding them.
So, here are some considerations about whether to use the standard toilet or a toddler toilet.
First: Get to know what it is out there and why is used. See Potty Set Up below to view some of the typical equipment used for toilet training.
1. If you do not plan to get a step stool for the bathroom, then use a toddler toilet so the feet will be supported on the floor.
2. If you do not like to clean out a bucket of pee and poop, then use a standard toilet with toilet seat reducer and something for foot support so you can just flush.
3. If the child has difficulties with learning something new and gets ridged in "how" they do something, then use a standard toilet from the get-go (with a reducer and foot support).
4. If your child is gravitationally insecure (vestibular and proprioceptive issues) then use the toddler toilet as their feet do not need to leave the ground and there are no steps to manage.
5. If you have limited space in the bathroom and would be stepping over a toddler toilet, then consider a toilet seat reducer and stool that is foldable and can be moved out of the way easily when not in use.
6. If your child has special needs and balancing on anything is going to be a challenge, then work with your therapy team to determine what would be the best option for adaptive toileting equipment to meet your needs (both for the child and the environment it will function within).
Top hat potty for newborn early potty training, baby Elimination Communication, with cotton undyed Fleece Cozy and anti-slip rubber band.
Found on AMAZON
The Mini Potty is the shortest potty on the market, made for shorter, younger, smaller babies and toddlers who are doing elimination communication or early potty training.
Found on AMAZON
Keep it simple. Your toilet does not have toys or a place to suspend an iPad. Look for something that looks like the toilet that you use. Make sure the child's feet touch the ground. Many varieties on the market.
There are many varieties of toilet seat reducers. Some things to consider when getting one is a contoured seat with slight rise in the back for posterior support, a guard in the front to keep pee from spilling out and handles if this makes the child more comfortable.
This is an example of a combination unit that incorporates both a potty seat and a way to get up to the toilet. However, if the distance from the knee to the top step don't match, your child will not feel stable. This may only be suitable to older children with good motor skills.
Step stools come in many varieties. In my experience, younger children need 2 steps and are more confident when they have handrails to hold onto when climbing. A stool like this can also be used at the sink for handwashing.
I found this lightweight cedar in our shop and made a step stool for my grandchildren to use at our house. You can do the same thing. If your little one needs an additional step, you could add that too and take it off as they get older and need more leg room. I have a toilet seat reducer on the potty that seems to fit all the little bottoms. :)
A family toilet seat contains both a standard ring and a toilet set reducer ring mounted on the toilet. When child uses the toile
I am only showing 1 of many options when it comes to adapted toilet positioning aids. You will want to work with a DME supplier to discover what is available and if your insurance company will cover it as a durable medical equipment item as they can be costly.
Be a keen observer of the child's face and body communication. You will be able to tell when they are going to poop! If you still don't know what to look for, consider this:
scrunched up nose with grunting, furrowed brow, pouty lip, squatting (often behind something), quiet and far off gaze, signs of discomfort (especially with constipation), arms and body may tense, legs may stiffen, you may even see them try to bear down, finally relief!
Best of my knowledge, infants don't leak poop in trickles like urine, it exits as a bolus of waste at one time. Understanding their patterns and signs can give you opportunities to support catching this momentous event.
Control is another thing all together, they learn control when they can "hold it for a few moments while getting to the potty". This is where learning comes in and why repetition, repetition, repetition is important. Do what you can- when you can... and use formal training when the child is "ready".
Urine is trickier to "catch". The child has to learn to control his sphincter and to gain knowledge of what things feel like inside their bodies telling them it is "time to go". Typically, a child will take up to 6 mos to develop control of the muscles and acquire the learned recognition of it being "time to go". Experts agree that there are some signs of readiness:
The last 3 items in this list can be facilitated by following the "Readiness Steps" listed in the previous section. Control is when the child can "hold it for a few moments while getting to the potty.
Initially your infant will not be difficult to diaper (except for those super tight drawn up legs). Eventually, they learn to roll and then to crawl, and are quicker than you. This is when the struggle begins. Add to it any sensory challenges, and diaper (because it happens so often) can be a re-occurring nightmare. Here are some strategies to use.
1. ANNOUNCE IT: It is so much more pleasant to be asked to "take a seat" then for someone to grab you by the arm and bush you into a chair, right? Consider your child a human being and treat them accordingly. Say, "Time to change your diaper" in a pleasant, i love you kind of way. You can also hold the diapers and wipes while saying it so that she will associate the diapering event with the items you are holding as a visual cue to what is coming. You can even begin to ask them to "lay down" if that's the way you like to diaper. Now you are working on following directions and anticipating what will be coming.
2. MAKE A CONNECTION: In order to do this, you will need to become aware of yourself and the language you are using through your eyes, your actions, your touch, your gestures, and basically your whole being. This is an intimate thing you are doing. Use it as a time to build trust and love and communicate that while doing it. Bond with them.
3. BE SILLY & FUN: This cute little being is face to face with you. Smile, engage them with your eyes and blow raspberries on their tummy, kiss their neck, sing a silly song, and try to make the moment as enjoyable as possible so that they begin to associate it with a lovely time spent with you.
4. KEEP THEIR HANDS BUSY: A child is busy, busy, busy and you will need to use everything you have to support their need and desire to explore the world around them. Put a toy in their hands (something novel is best) but can be anything from your car keys to a koosh ball. I have even grabbed a hair clip off my bedside to let them explore while diapering. It works!!
5. TELL THE CHILD WHAT YOU ARE DOING: Talk to the child laying in front of you. They are absorbing language and are putting words with actions. Say, "diaper off" as you pull the tabs back. Say, "Poo-wee" or "stinky" when you find a load. Say, "just wet" when it is just a soggy diaper you discover. Say, "wipe your booty" when using the wet wipe against their bottom. If the wipe is cold, alert them before you place it down there!! Say, "diaper on" as you are latching the attachments. Say "all done" or "finished" to let them know the job is done. Say, "go play" to let them know they are free to go.
6. KEEP THEM WARM: There is nothing worse than taking clothes off in a cold environment. It is also startling and can cause an adverse response to have a fridged wet wipe placed on your bottom. Be mindful of the environment and the temperature of the wipes you are using. If you don't have the luxury of a wet wipe warmer, then run warm water at the sink and warm the wipe before using it. Try to get to a warm place to change a diaper.
7. STABILITY IS IMPORTANT: When a child feels unsafe in a situation, she may become anxious, fearful and her behavior will show it. I have seen many caregivers try to diaper a child on their lap. The ledge is small, the surface is moving, and the floor seems a mile away. Consider how scary this might be. If you need to sit to diaper, either place the child on the floor or on the sofa where they have a large stable surface area and there is little to no risk of toppling off.
8. STAND TO DIAPER: Some littles just crumble when placed on their back. The child may be sensory sensitive to changes in body position. You can change a diaper with the child standing and there are new diaper types that tear away at the sides and are put on like regular pull ups to make it easier to diaper this way. Don't let a diapering moment cause the next 30 minutes of tantrum and recovery. Be kind and adaptable for goodness sake.
This chart can be found with a simple Google search. It shows types of stools so that it can be described to physician. Breast fed infants typically poop after most feedings. Formula fed infants will go at least 1x daily. Sometimes the child's feces are so large in size it causes bleeding, and this can be scary for adults and painful for the child. When pain with defecation occurs, a child might begin withholding feces to avoid pain. This is serious and needs to be addressed by a physician.
This demonstrates how a large mass of feces blocks the rectum because it is too large to come out. However, the child may have leaking of a more watery and soft fecal matter around the stool that constantly soils the pants (encopresis). Again, this is important to address with a physician since in some cases where medications to soften the feces isn't working a manual process may be required to take care of the impaction. This would be followed by medical treatment to prevent re-accumulation.
The gut microbiota has broad impacts, including effects on colonization, resistance to pathogens, maintaining the intestinal epithelium, metabolizing dietary and pharmaceutical compounds, controlling immune function, and even behavior through the gut-brain axis.
Maintaining a healthy gut flora is critical. It is important for parents to know that antibiotics can affect this balance since the antibiotic will often kill important bacteria needed for gut health. Often physicians will recommend use of probiotics/prebiotics to support the gut during these times. Thats why use of antibiotics can cause diarrhea when being taken.
SENSORY OVER-RESPONDERS
Over responders tend to avoid that which will elicit a response from the sensory system. This means they may become upset with movement of clothing, sounds in the environment, change of location, the sensation of wiping, transitions, smell of feces, gravitation insecurity when feet are not supported or being high off the ground, or refuses to go in an unfamiliar place, etc. All of which is required for toileting.
SENSORY UNDER-RESPONDERS
Under responders tend to show poor awareness to sensory input. This means of the need to toilet and/or the desire to seek more stimulation than what is provided during the toileting process and may cause lack of awareness of the bodies signals of needing to "go" and be unaware of when wet or soiled.
SENSORY SEEKERS
Seekers are always looking for more input. They will have difficulty with sitting still long enough to "go" and don't want to stop long enough to "go" and may enjoy the sensation of the warm stool and play in it or enjoy the intense pressure sensation of withholding.
Assessment Options
Work with your Occupational Therapist to examine the sensory system in order to determine the profile type and particular strategies to support toileting.
There is no doubt you will be confronted with what to use while toilet training...
Here are some things to consider:
1. Pull-Ups and diapers absorb a tremendous amount of liquid, wicks it away from the skin and keeps the bum fairly dry. No leaking - no problem!
2. Training Underwear will get soaking wet, leak through, down the leg and puddle on the floor.
My suggestion is that you use what will offer the child the most sensory awareness that something has gone wrong when it does...and it will!
If you and the child never have an idea of when things are happening, then you are missing the mark. During the summer is a great time to train because you can let the bum stay bare, go outside and see what happens. My son potty trained off our front porch and behind trees in the back yard (we are very rural) and we just reeled in the behavior when he tried this at the park. However, I am going astray.... You will know right away when the little one wets or poops in training underwear. This is the best time to address what happened, not hours later when you decide to check for wet or dry.
I usually continued to use pull ups only at nap time and nighttime for a while until we would notice the child waking up dry and quickly transitioned to a thick towel or the nursery pad leak proof thingy under them to prevent me from needing to change all the sheets.
ABOUT TOILET TRAINING METHODS
CHILD ORIENTED APPROACH
Developed by pediatrician T. Berry Brazelton in the 1960s, is a gentle, gradual approach that follows the child’s lead, emphasizes praise over shaming/punishment, and assesses child readiness at each step.
BEHAVIORAL (OPERANT CONDITIONING) APPROACH
The behavioral approach, popularized by Azrin and Foxx’s “Toilet Training in Less Than a Day,” uses positive reinforcement (rewards, parental attention, candy) to reinforce toileting and removal of rewards and mild verbal reprimand to decrease accidents. It also uses a doll to model toileting. Children are given large volumes of fluids to encourage frequent urination and frequent “wet pants checks” to assess progress.
TIMER / CLOCK TRAINING
The timer is initially set for every 20-30 minutes, and the time is lengthened as the child maintains dryness for longer periods. Older children can be provided a vibrating watch to allow more independence with toileting activities. This method can be used independently or in combination with other toilet training methods.
Personal Opinion: Many children will benefit from a combination of all 3 approaches - minus the punitive, berating, scolding and other verbal or physical consequences. There is some value in all three and you can pick and choose the best method to work for your child.
Medications known to cause CONSTIPATION:
Medications that are known to cause DIARRHEA:
Broad spectrum antibiotics are more likely to cause diarrhea because they kill both the good and bad bacteria in the gut. Some of these include ampicillin, amoxicillin, cephalosporins, cephalexin, doxycycline, minocycline, erythromycin and clarithromycin
Social Stories are a social learning tool that supports the safe and meaningful exchange of information between parents, professionals, and people with autism of all ages.
This is a social story I developed, and you can use with some modification to include your child's pics and personal spaces and any special communication symbols that are familiar to your child.
A picture board is a simple step by step visual cue system to support children with following along with a process or activity. It is more simplistic than the social story.
Praise is powerful. Your child will love the attention. It is important to remember that children want to please you and make you happy.
A food item of high preference is perhaps the most rewarding of all things you can offer. Offer the single best preferred food to facilitate participation. Not the whole bag, just a little, you want them coming back for more.
Let the child make a choice of what his reward will be. Provide options that you can deliver. DO NOT put something on the board you are not willing to offer or have.
This is just one of many ways to use TOKEN ECONOMY. This is when the child has to be successful for a certain number of times before the reward is given. Google token economy for other suggestions.
Shout it out to everyone who knows the child. Share the news of success. Get on the phone or facetime the child's favorite people to let them share in her success.
Parent's Guide to Toilet Training Children with Autism
These materials are the product of on-going activities of the Autism Speaks Autism Treatment Network, a funded program of Autism Speaks.
If the child is bothered by getting his bottoms up/down with the frequency required for toilet training, then keep the child in a long T-shirt with no bottoms or use slit crotch pants so there is nothing to pull up/down.
Also, with nothing on below, the realization of an accident is immediate.
Here is a little something I learned from a Montessori Daycare where I provided services: Stand to diaper. If your child resists being placed on his back, then stand the child to do the toileting AND here is another little tidbit...do it in front of the toilet so you have the opportunity to place them on the toilet or at least they get the idea that they should be in this place for this kind of business. Some children simply have challenges with the change in position that is required here.
Use the 360 fit diapers (offered in many brands) that don't have tabs. They are elastic like pull ups at the sides and you tear the sides to remove the diaper. You can also put a onesie on over the diaper and under clothes to prevent hands from tearing the diaper or tabs.
If the child is at an appropriate age and you are ready...try using cloth training pants and begin toilet training because the child may just have difficulty with how it feels to be wet or dirty and being toilet trained may be rewarding enough to meet his/her sensory needs.
When the child is bothered by how toilet paper or wet wipes feel rubbing across their private domain remember the following to improve tolerance
Find a way to offer the child enjoyable experiences / distract the child while sitting on the toilet. Here are some ideas:
Desensitization: Pair being in the bathroom with positive experiences. Slow desensitization is best and at first may not even include sitting on the potty. Here are some ideas:
The sound of the flush may be too much for your hearing sensitive child. Here are some strategies to help with that:
You cannot fight this amount of control and slow incremental changes will be required. One way to support this child is to offer as many modeling and play experiences as possible and give them time in the diaper to "go".
Eating feces occurs in 16% of individuals with intellectual disabilities and more frequently in children with Autism.
Yep! I agree that this is gross, but it is minimally toxic and unless the person who defecated is sick, the poop only contains water, harmless bacteria, dead cels, undigested food and metabolic waste. Many animals eat their own poop to extract the nutrients out of it. That can be hard to swallow, (pun intended)!
Doctors are even now prescribing poop pills to support digestion for some in individuals because it has good bacteria.
All kidding aside, what can we do to make this go away!
This is the one thing you need to come to terms with when you begin toilet training!! It will happen and for some children it will happen a lot. Spanking, punishing, demeaning and embarrassing a child or other punitive consequences are not the way to handle a potty-training accident.
There needs to be consequences to all actions whether they are intended or not.
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