Toilet Training
Toileting doesn't have to be a struggle; success will come when your child is physically and emotionally ready. Toilet training is just another learning process and it takes time.
Read about several different toileting techniques and choose the one that seems best for you and your child. Don't set a rigid schedule - take one day at a time. Prepare your child by reading about toileting, acting as a role model, and having the child sit on the toilet. You will need special equipment to help your child sit on the toilet comfortably and safely.
Readiness
Your pediatrician can tell you when your child is physically ready for toilet training. One approach says that your child should be able to stay dry for two hours before you attempt toilet training.
Help your child recognize what urination and bowel movements feel like by giving your child words for what has just occurred. That will help your child learn to figure out and react to internal sensation. The toileting program you use should give details on what words to use and further readiness skills.
Support people
Many children with physical disabilities have problems with constipation and abdominal discomfort. Along with your pediatrician, here are several specialists who can help:
- A nutritionist can tell you what foods and fluids are best for your child.
- People who are certified through the International Association of Infant Massage can instruct you in abdominal massage. Many of their techniques help relieve stress, constipation, and abdominal muscle tension.
- Some occupational and physical therapists are trained in ways to move the trunk and lower body to change abdominal muscle tone.
- Some registered nurses and nurse clinicians who work with urologists train parents to handle catheters, implants that trigger bladder release, and other specialized medical devices.
Preparing your child
The toileting program you use should clearly outline how to prepare your child psychologically for toilet training. After your child knows what to expect, help the child become familiar with the potty you've chosen. To reduce our child's anxiety, stick to a toileting schedule and make sure the child is secure on the potty.
Toileting equipment
Your child's school should use the same program and equipment that you use at home. Work with your child's teacher and therapist, and your extended family, to choose toileting equipment.
Often, specially adapted equipment is necessary for secure positioning. Medical supply companies have catalogues of toileting equipment, and your therapist will also know about available equipment.
Most specialized toilet chairs are expensive, so try to borrow or rent a chair before you buy it. Some families have built heir own toilet chairs or worked with therapists and medical supply companies to develop special chairs. Make sure that the chair fits your bathroom as well as your child's needs.
Choosing toileting equipment
Straps: Many toddler toilet chairs have straps to secure the child. Do not use the straps as restraints, and never leave the room with your child is strapped onto the toilet.
Most children who are mobile and can get in and out of the toilet chair by themselves will use it within five minutes of getting on the toilet. Some parents read to the child to help the child stay in one place for five minutes.
The more disabled the child is, usually the more straps are needed. The child may also need more time on the toilet - it may take ten minuets for the child to relax enough to actually use the potty.
Splash guards: Check the width and edges of the splash guard. Some guards can cut into the legs of a child who has cerebral palsy. Some toileting equipment comes with a permanent splash guard, which a girl may not need.
Cleaning: Try cleaning the equipment. Can you remove the pan easily from the base? Does it slide along the tracks smoothly? Can the equipment be removed so other family members can use the toilet?
Toileting for children with specific cerebral palsy symptoms
The child whose muscles are spastic needs a potty seat that keeps the hips securely back in the potty, supports the legs, and spreads the hips apart. Foot rests are recommended.
Quick movement and excitement tend to make muscles tighten. Use a quiet voice and slow movement as you move the child onto the potty seat. Help the child keep hips flexed and spread apart.
One way to move the child is to hold the child's back against your chest. Flex your child's hops by leaning your trunk forward. Keep the legs apart by holding a leg in each hand.
Some parents sit in front of the child while the child is sitting on the toilet. The parent then spreads the legs and rotates them outward.
Make sure the deflectors don't dig into the insides of your child's legs.
The child whose muscles are hypotonic needs a potty with back trunk and hip support. Footrests stabilize the rest of the body. A potty lap tray will help with posture. Your child may need additional trunk and pelvic straps.
The child with low tone tends to slip out of your arms, and head and trunk control is difficult. The potty chair should give a stable base and sides to work from. When lifting the hypotonic child, keep the child slightly forward, legs bent together. Support the head and/or trunk as necessary.
You can use your own body as a toileting device. Sit on the back edge of the toilet and hold your child in front of you on the potty. That lets you support the child's trunk, keep the legs separated, and lean forward to flex the child's trunk.
The child who has athetosis needs a potty with a lateral support, back support, and hip support. The child does very well with supinator bars on the potty tray.
Athetosis makes controlling movement difficult. The child's movements are usually involuntary, making it very hard for the child to move into a position. The child needs firm, stable handling.
Keep the child well collected before moving to the toilet. Sometimes it helps to ask your child to achieve a quiet body before you lift. Move slowly when lifting. Hold the child slightly forward with legs bent and together. Try to keep the child's arms tucked in slot to the body.
Some parents sit on the toilet behind the child so they can provide trunk support and control of the child's movements. Other parents sit in front of the child so the child can use them for stability.
The child whose muscles are ataxic will have toileting needs that vary according to the degree of muscle tone.
Many children with ataxia find amazing ways to climb into and out of equipment. They often tip their potty chairs over as they try to crawl up and into them. To prevent tipping, use a potty with a wide base of support, or screw the legs of the potty chair into a large wooden base.
Warning: Some parents teach their children to sit facing the back of the toilet. This is dangerous, because the child can easily fall backwards onto the floor. The position is easy to get into, but hard to get out of safely.
Books about toilet training
There are many toileting books and programs available at the library. Your pediatrician, neurologist, or urologist can help you choose the one best for your child. It's important that you understand your child's development of bowel and bladder control, because toileting is such a vital part of independent living.
by Autar Dunaway, O.T.R.
