Toilet Training
I have an 18 month old toddler and I would like to get him toilet trained before our next child arrives, two months from now. I am also concerned that the increased number of diapers for two children will be environmentally unfriendly. Are there any methods of toilet training which will speed up the process? It has been said that in politics and war, it is all about timing. One can add this is also true in the area of parenting. Just as surfers wait to catch the right wave, parents must wait for the right moment to get a child toilet trained. But the exact moment and timing remains a contentious issue. The “Parenting Corner” of the American Academy of Pediatrics (HUwww.aap.orgUH) suggests that parents look for these signs of readiness:
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the child stays dry for at least 2 hours at a time during the day or is dry after naps
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bowel movements are regular and predictable
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there are some facial expressions and body postures indicating that the child is about to urinate or have a bowel movement
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the child can follow simple instructions
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the child can help undress himself or herself
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the child does not like soiled diapers and wants to be changed
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the child asks to use the potty or grown-up underwear
Some experts discourage toilet training introduction at stressful times for the family such as moves, major illnesses, a recent death in the family, recent parental separation or divorce, or when a new baby is expected. Physically speaking, the average child younger than 12 months of age has little or no control over bladder and bowel movements. Between 12 and 18 months, many children start to show signs of being ready. Essentially, there are three main recognized methods of toilet training:
1.
A child-centered approach
2.
The alarm-centered diaper training method
3.
The timed potty training approach
With the child-centered method, the parents wait for the child to be ready and free of stress. They basically do nothing until the child is willing, ready, interested, and keen to get out of diapers. The child is in control and the parents get into step with a natural trajectory. This is the least likely method to succeed when parents are keen to get the child toilet trained in a short period of time.
With the alarm-centered diaper training method, the child is wearing a moisture sensitive detector in the diaper which goes off when the child eliminates. When the alarm sounds, a parent should put the child on a potty and encourage the child to finish. This method is labor intensive and requires a commitment of at least 5 consecutive days from a parent. The timed potty training approach involves a parent bringing the child to the potty four times a day. The child is then encouraged to void. This also requires close parental involvement for at least 5 consecutive days. A recent study from Belgium, published in the Journal of Developmental and Behavioral Pediatrics (2008, 29 (3): 191-196), compared the alarm versus the timed training method. Thirty-nine children between the ages of 20-36 months participated. The study excluded children who were constipated, stressed, had developmental delays, or had recent changes in their family life.
After 5 days, 77.8% of children in the alarm training group were dry versus 41.2% in the timed
potty training group. One month later, 88.9% in the alarm training group remained dry compared with 52.9% in timed training group. The speculation is that when children were trained to be more aware of their body signals through an alarm system, they were more successful. This makes the alarm method attractive for parents who are keen to see results over a short period of time. Another method which recently received significant attention on national television is a method known as the “potty whisperer” (see HUwww.pottywhisperer.comUH). It is a method based on positive conditioning which reinforces learned behaviors. A “sssss”, “pssss” or “tssss” sound is made in the baby’s ear at potty time to help him or her learn to associate this sound with releasing the sphincter muscles. The author of this method is an experienced mother from Chicago, who also has a nursing background. She disagrees with traditional medical thinking that infants lack bladder control at an early age. However, on her website she explains that the Potty Whisperer method does not involve any pressure, punishment, coercion, shaming, competition, obsessing, or negativity. When a child is 24 months old, this method is no longer useful – it is too late for it to work (This position is based on 26 years of research). Some parents have very strong feelings about using only environmentally friendly diapers. A number of stores in Calgary specializing in natural foods and products provide environmentally friendly diapers (For the previous article “Green Babies”, see the Archive of Monthly Articles). In the end, the decision to toilet train a child depends very much on the parent’s philosophy. Girls tend to be faster than boys at achieving bladder and bowel control. The average age for both genders of completing this important task is under 4 years of age. If the child is older than 4 years, it may be wise to have him or her examined by a doctor. Children who are constipated have more trouble being toilet trained. Currently, there is no information on this topic on the website of the Canadian Pediatric Society.
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http://www.healthykids.ca/secure/articles/pdf_articles/toilet-training.pdf
Toilet Training Made Semi-Easy
by Kent Moreno
Copyright 1996 by Kent Moreno, All rights reserved
http://www.ds-health.com/images/rulered.gif
(Note: Kent Moreno is a Behavior Analyst and father of a child with Down syndrome. He is employed by the West Virginia Austism Training Center at Marshall University as an education specialist. He can be reached at knm@access.mountain .net.)
The process of teaching a child to use the toilet can be a frustrating one. This is especially true if the child has a developmental disability. The protocol listed below has been used successfully, with individuals with developmental disabilities of all ages.
In addition to the protocol listed below, It can be helpful if a child is able to observe others using the toilet. This may be something which a family is not comfortable with or is not appropriate in certain settings. That’s fine.
A major factor in the success of this program is based on the development of an effective toileting schedule. To determine the right schedule for the child, data needs to be taken for at least 2-3 days on how often the child goes to the bathroom. To do this, dry pants checks should be done every 20 – 30 min (20 minutes is preferable). If your lucky, you can find diapers which have a strip which changes color when the child voids otherwise, it will be necessary to feel for moisture. Take special care to write down the times of the day that the child defecates as most people defecate at approximately the same time each day. This procedure is called baseline data. Once 2-3 days of data has been gathered, it will be necessary figure out approximately how often the child goes to the bathroom. To do this, divide the number of waking minutes by the number of times the child went to the bathroom.
The toileting schedule can now be set up. As a rule of thumb, the child should be taken to the bathroom, twice as often as the child’s average for urinating and defecating. So, for example, if the child goes to the bathroom an average of once an hour, the child would be taken to the bathroom every 1/2 hour. When setting up the toileting schedule, keep in mind the times of the day that the child is most likely to defecate and try to have the toileting schedule occur close to these times.
Prior to taking the child to the bathroom, give the child a cue that it is time to go to the bathroom. I recommend helping the child to make the sign for toilet until they can make it independently. Using the sign for toilet will not stop those children who are verbal from saying “toilet” and will give the child a way of communicating when they have to go to the bathroom once they have mastered the toileting procedure thus making a toileting schedule unnecessary.
It is important that the bathroom be a very fun place. Reserve a couple of the child’s favorite toys or books which they can only have access to while they are seated on the toilet. Also, music can be very helpful. Mozart and Rockabilly seem to work well.
When having the child sit on the toilet, don’t force it. The experience needs to be a positive one. If the child doesn’t want to sit on the toilet, leave the bathroom and try again at the next scheduled time. Also, don’t have the child sit on the toilet for more than 5-7 minutes. If the child is going to void in the toilet, they will usually do it within that time frame. If the child voids in the toilet, make a big deal out of it, praise the child verbally and tactilely (hugs, pats on the back…) and give them access to a small very preferred edible reinforcer (not always necessary). While it will be important to reduce the use of the edible reinforcers as quickly as possible but, in the early stages of acquiring toileting skills, it will be more important to make voiding in the toilet an extremely momentous and positive experience for the child.
One modification which can be made to the protocol which many times will increase the child’s rate of success at voiding in the toilet is to give them something to drink 15-20 min prior to the scheduled toileting time
http://www.ds- health.com/train.htm
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Toilet training children with Down syndrome.(Special Needs: Realizing Potential)
Publication: Pediatric News
Publication Date: 01-DEC-06
Author: Grace, Nancy
COPYRIGHT 2006 International Medical News Group
Toilet training is a fairly easy experience for most families, but the task can be more difficult when training children with Down syndrome. Many parents of children with developmental delays or disabilities wait for their child to show significant signs of readiness, such as interest in the toilet, willingness to sit, or interest in wearing underwear. These are things that even typical kids don’t often demonstrate.
Instead, I advise parents that even if the child is not intrinsically interested in the toilet, they can set up rewards and consequences so the child’s interest can be tipped in favor of needing and wanting to use the bathroom. This is not to say that every child is ready when the parents are, but parents don’t have to wait for those signs to develop before beginning training.
I don’t use chronological age to determine a child’s readiness to begin using the toilet, hut feel it’s more important that certain intellectual and psychological signs of readiness are in place.
A child needs to have some degree of compliance. If a child is not under any kind of instructional control and you ask him or her to comply with some very nonpreferred demands, it’s unlikely that training will be successful.
Although not required, it’s also helpful if the child has some ability to communicate. The child’s ability to stay dry in his or her pull-up is another good sign, as is the presence of a urine stream when the child urinates, which suggests that the child is able to hold and release the urine with some deliberate intention.
Finally, the parents have to be ready and willing to go through the training, because initially it is very time consuming and labor intensive. We recommend that parents take a long weekend when the child does not have other therapies and when someone else can take care of other children in the family.
It’s best to avoid starting toilet training during a period of change or stress for the family, such as starting a new job, moving the household, integrating the arrival of a new baby, or going on vacation.
It’s also important to have the cooperation of the child’s day care or school; otherwise, there could be discrimination when the child needs to use the toilet. There is more leverage for a school to become involved if the child is first trained at home and has reached a 70%-80% success rate.
Rather than taking baseline data to develop a set toileting schedule, I recommend using a simple rule of thumb: The child should be taken to the bathroom twice as often as the child’s average for urinating and defecating. So if the child goes once an hour, he or she should be taken to the bathroom every half hour. We also intentionally encourage fluids during training to give the child lots of opportunities for accidents and success.
Once a child has obtained a certain level of success–such as 70% success for a day–then the parent can extend the time between bathroom visits by 15 minutes. If a child’s bowel movements are regular, parents can plan on being more vigilant at that time and offering more sits.
It isn’t necessary to have a special toilet for children with Down syndrome. There are children who feel a little less grounded when they are on the toilet, and sometimes a potty insert is helpful so they are not frightened by such a large hole. Also, having a small stool right by the toilet helps children climb on and off, and can create a bit of a resting place for their feet when they strain to move their bowels.
You want the bathroom to be moderately fun, but you don’t want to create a Disneyland. There are two ways to reinforce voiding behavior in children: The first is giving the child a positive reinforcement- -like a bite-size candy bar–as a reward for using the toilet, and the second is creating the anticipation that the child will get to leave a moderately adversive situation as soon as toileting is finished, and can then do something more fun.
So if parents start making the bathroom environment too rich, the function of those motivations will lose their value. In addition, if bathroom activities are too stimulating, then the child will become tense and that’s incompatible with having a relaxed bladder and wanting to urinate.
The use of food as a reward is somewhat controversial. We prefer using an edible snack or whatever is a truly preferred item, because stickers and reward charts can be a bit too abstract for children with special needs. Food is an immediate reinforcer. A lot of parents don’t want to give their kids a sugary snack, but I just ask them to make an exception. So, let’s not give a child a carrot for voiding.
We also insist on the child’s wearing underwear from the start of training. A wetstop or moisture-sensitive detector about the size of a paper clip is attached to the outside of the underwear and connected to a battery fanny pack. An alarm sounds when the child wets, providing an immediate opportunity for a consequence. The consequence is not a punishment, but simply involves walking the child to the bathroom and practicing the steps of using the toilet. Positive practice after accidents or overpracticing is somewhat irritating for a child and thus helps motivate the child to use the toilet independently.
A child should be continent during the daytime for 3-4 months before night training is started.
We use the wet-stop and some fluidloading, and ask the parents to do night training over a long weekend. The alarm is intended to wake the parents to facilitate their child’s getting to the bathroom, rather than to wake the child and signal him or her to go the bathroom.
Even for typical kids, the latter isn’t very useful because kids who have trouble are usually the heavy sleepers, and unique kids need to have the training right then and there. I recommend doing a little positive practicing, giving them some more water, resetting the alarm, and sending them to bed. Parents may have to do 5-6 wake-ups over the course of a night. This method is usually very successful.
It’s very reasonable to expect that a child with Down syndrome will be trained by the age of 4-6 years. I’ll often ask parents with children who are untrained by 4 years of age if they would like help. Parents should seek professional help if they have started toilet training with a child who was not initially opposed, but is beginning to show an aversion, or if the parent is becoming frustrated. Additionally, if a child isn’t showing any improvement over 3-4 weeks, parents should consider getting professional help.
An international leader in the fields of research, treatment, and education for disorders and injuries of brain and spinal cord, the Kennedy Krieger Institute provides a wide range of services to over 12,000 children each year with mild to severe developmental concerns. For more information, visit www.kennedykrieger. org.
DR. GRACE is a child psychologist and director of the Kennedy Krieger Institute’s Developmental Disabilities Clinic in the department of behavior psychology.
Potty Training Children with Special Needs
Potty Training Information
By Vincent Iannelli, M.D., About.com
Updated: December 9, 2004
While parents often complain of difficulty potty training their children, for most families, potty training is a fairly easy experience. Even when there are problems or children show signs of potty training resistance, usually they will eventually become potty trained.
However, this is not always the case for children with developmental delays or disabilities, such as autism, Down syndrome, mental retardation, cerebral palsy, etc. Children with special needs can be more difficult to potty train.
Most children show signs of physical readiness to begin using the toilet as toddlers, usually between 18 months and 3 years of age, but not all children have the intellectual and/or psychological readiness to be potty trained at this age. It is more important to keep your child’s developmental level, and not his chronological age in mind when you are considering starting potty training.
Signs of intellectual and psychological readiness includes being able to follow simple instructions and being cooperative, being uncomfortable with dirty diapers and wanting them to be changed, recognizing when he has a full bladder or needs to have a bowel movement, being able to tell you when he needs to urinate or have a bowel movement, asking to use the potty chair, or asking to wear regular underwear.
Signs of physical readiness can include your being able to tell when your child is about to urinate or have a bowel movement by his facial expressions, posture or by what he says, staying dry for at least 2 hours at a time, and having regular bowel movements. It is also helpful if he can at least partially dress and undress himself.
Children with physical disabilities may also have problems with potty training that often involve learning to get on the potty, and getting undressed. A special potty chair and other adaptations may need to be made for these children.
Things to avoid when toilet training your child, and help prevent resistance, are beginning during a stressful time or period of change in the family (moving, new baby, etc.), pushing your child too fast, and punishing mistakes. Instead, you should treat accidents and mistakes lightly. Be sure to go at your child’s pace and show strong encouragement and praise when he is successful.
Since an important sign of readiness and a motivator to begin potty training involves being uncomfortable in a dirty diaper, if your child isn’t bothered by a soiled or wet diaper, then you may need to change him into regular underware or training pants during daytime training. Other children can continue to wear a diaper or pullups if they are bothered, and you know when they are dirty.
Once you are ready to begin training, you can choose a potty chair. You can have your child decorate it with stickers and sit on it with his clothes on to watch TV, etc. to help him get used to it. Whenever your child shows signs of needing to urinate or have a bowel movement, you should take him to the potty chair and explain to him what you want him to do. Make a consistent routine of having him go to the potty, pull down his clothes, sit on the potty, and after he is finished, pulling up his clothes and washing his hands.
At first, you should only keep him seated for a few minutes at a time, don’t insist and be prepared to delay training if he shows resistance. Until he is going in the potty, you can try to empty his dirty diapers into his potty chair to help demonstrate what you want him to do.
An important part of potty training children with special needs is using the potty frequently. This usually includes ‘scheduled toileting’ as outlined in the book ‘Toilet Training Without Tears’ by Dr. Charles E. Schaefer. This ‘assures that your child has frequent opportunities to use the toilet.’ Sitting on the potty should occur ‘at least once or twice every hour’ and after you first ask, ‘Do you have to go potty?’ Even if he says no, unless he is totally resistant, it is a good idea to take him to the potty anyway.
If this routine is too demanding on your child, then you can take him to the potty less frequently. It can help to keep a chart or diary of when he regularly wets or soils himself so that you will know the best times to have him sit on the potty and maximize your chances that he has to go. He is also most likely to go after meals and snacks and that is a good time to take him to the potty. Frequent visits during the times that he is likely to use the potty and fewer visits to the potty at other times of the day is another good alternative. Other good techniques include modeling, where you allow your child to see family members or other children using the toilet, and using observational remarks. This involves narrating what is happening and asking questions while potty training, such as ‘did you just sit on the potty?’ or ‘did you just poop in the potty?’
Even after he begins to use the potty, it is normal to have accidents and for him to regress or relapse at times and refuse to use the potty. Being fully potty trained, with your child recognizing when he has to go to the potty, physically goes to the bathroom and pulls down his pants, urinates or has a bowel movement in the potty, and dresses himself, can take time, sometimes up to three to six months. Having accidents or occasionally refusing to use the potty is normal and not considered resistance.
Early on in the training, resistance should be treated by just discontinuing training for a few weeks or a month and then trying again. In addition to a lot of praise and encouragement when he uses or even just sits on the potty, material rewards can be a good motivator. This can include stickers that he can use to decorate his potty chair or a small toy, snack or treat. You can also consider using a reward chart and getting a special treat if he gets so many stickers on his chart.
You can also give treats or rewards for staying dry. It can help to check to make sure he hasn’t had an accident between visits to the potty. If he is dry, then getting very excited and offering praise, encouragement, and maybe even a reward, can help to reinforce his not having accidents.
Another useful technique is ‘positive practice for accidents.’ Dr. Schaefer describes this as what you should do when your child has an accident and wets or soils himself. This technique involves firmly telling your child what he has done, taking him to the potty where he can clean and change himself (although you will likely need to help) and then having him practice using the potty. Dr. Schaefer recommends going through the usual steps of using the potty at least five times, starting when “the child walks to the toilet, lowers his pants, briefly sits on the toilet (3-5 seconds), stands up, raises his pants, washes his hands, and then returns to the place where the accident occurred.” Again, although you are trying to teach him the consequences of having an accident, this should not take the form of punishment.
While it may take some time and require a lot of patience, many children with special needs can be potty trained by the age of 3-5 years. If you continue to have problems or your child is very resistant, then consider getting professional help.
http://pediatrics. about.com/ cs/parentingadvi ce/a/sp_needs_ potty.htm
Toilet Training Children With Down Syndrome
Jane Orville
Most parents wonder how their children with Down syndrome will learn to become toilet trained. This is understandably an anxious time for a parent, as you might be thinking about sending your child to a preschool program and wonder if he will ever be out of diapers. Teaching any child to use the toilet can be a frustrating time for parents, and the child, but if you relax and remember that you cannot “make” him learn before he is ready, he will leave those diapers behind someday.
One professional suggests taking a few days to document your child’s voiding schedule. Check his diaper every twenty to thirty minutes to see when he is going, and what (urine, bowel movement). When data is taken for a few days and you can see some semblance of a pattern, you will want to schedule toilet times for those specific times of the day.
One suggestion is to give your child some fluids to drink about 15 to 20 minutes before you plan on toileting him. Tell your child he is going to use the toilet, and if needed, use the sign for it and help him make the sign.
Make his toilet training experience pleasant. Have books available for looking at during this time, and keep the toileting time short, about 7 or 8 minutes at the most. If your child does not void during this time, don’t force it or use an unpleasant or frustrated tone. Have him get off and then try again at the next scheduled time.
A lot of praise is necessary when toilet training your child, especially for a child who has Down syndrome. Giving an edible reinforcement might be tried, but this can lead to the child expecting something to eat every time he has success on the toilet. Since children with Down syndrome already may struggle with weight issues, it is recommended that reinforcements such as verbal praise, hugs, high fives be used instead.
Some parents may have expectations for their child in the area of toilet training that are too high. Remember that not only is your child delayed mentally, he also may lack the proper muscle control at the average age that an “average” child is toilet trained. He will eventually learn this too; it will be on his own individual timetable.
Night training may be even further behind the average child’s schedule. Manufacturers are now making disposable underwear (commonly called “pull-ups”) in sizes large enough to accommodate a child up to 125 pounds. This does not mean that your child will be night trained so much later, but he just might not learn until he is that size, and you need to be aware of that fact.
“Megan was a few months older than four when she was toilet trained during the day, and in retrospect, I wish I had relaxed more with her in the preceding years in trying to get her trained. I felt a lot of pressure from other people, but you can’t “make” her learn something until she is ready to learn it. She wasn’t night trained until she was ten and a half. It just happened when it did, and that’s all there is to it,” says Valerie, mother of a 17 year old daughter with Down syndrome.
http://www.pottytra ininghowto. com/Toilet- Training- Children- With-Down- Syndrome. html
