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PFA Tips: Potty Time!

By Shelly McLaughlin, Director of Safety Programs, Pathfinders for Autism, and Steven Lindauer, Ph.D., Assistant Director, Pediatric Developmental Disabilities Clinic, Kennedy Krieger Institute

Download a printable version of “Potty Time”

For two years I tried M&M bribes, Cheerios in the toilet for target practice, I let him run around the house naked, I put him in regular underwear thinking he’d hate having all of his clothes wet and soiled, tried the Dr. Phil advice my mom swore would work, and I might have even bought a voodoo doll. Nothing I did worked. “If I wear a pull-up, I don’t have to get out of bed during the night, stop playing with my toys, move away from the TV, …” And admit it – the last time you went to a football game you considered that option for yourself. And then magically, one day my son woke up and announced he was done with pull-ups. Just like that. Are there things I could have done to have shortened this two-year time frame?
potty time

If toilet training is still not successful, investigate the barriers. Start a journal or keep data on when your child goes, when she drinks, where she typically has eliminations, etc. This can be useful for the shaping process, or to share with your doctor.

Rule out medical or physiological issues
Don’t automatically assume that your child is making a choice not to use the toilet. Discuss this with your pediatrician to confirm that your child does not have biological problems that are interfering with his ability to control his bladder and bowel functions. Some of the medical issues you may want to assess with your medical doctor include constipation, blockages, food allergies or intolerances, etc. Your child may also have difficulty physically feeling the urge to go.

Ease his fears of being flushed away
Where do our deposits go once we flush them? How strong is that tidal wave swirl that goes to that unknown place? All your child sees is that everything in that bowl gets wooshed away never to be seen again. You may need to reassure your child that he can’t be taken away with the flush. He may not directly tell you about this fear, but keep in mind, expressing fears and other emotions aren’t necessarily easy skills for our kids.

Other sensory sensitivities in the bathroom
There may be environmental reasons your child is resisting the bathroom. Is the toilet seat too hard? Does the cold toilet water splash up? Is the toilet paper too rough? Is the sound of the flush, or automatic hand dryers too loud? Don’t judge these factors using your perspective – only the perspective of your child counts here. These culprits may also play a role if your child does better in some situations (your home toilet), but refuses to go in others (such as industrial loud toilets at the mall). Be prepared to make environmental adaptations.

It’s a three-step process
Think of potty training as three different components:

  • Going in the potty
  • Being dry between going
  • Initiating on his own going to the toilet

All three components may need to be taught. In addition, some children may be great at going on the toilet, but not great at indicating they need to go, or staying dry in between scheduled tries.

Set a schedule
Whether you take her to the bathroom every 15 or 30 minutes, give her a visual schedule to let her know that another opportunity to be successful in the bathroom is coming up very soon. You may want to increase her fluid intake during this process with the intent that she will need to go to the bathroom more often, and therefore will have more opportunities to be successful when you take her to the toilet.

Teach your child to sit
Although sitting isn’t necessarily required for urinating, learning to sit on the toilet helps DRAMATICALLY once the child urinates on the toilet and the parents are then ready to tackle bowel movements. So many kids learn to use the bathroom standing up and therefore never have the opportunity to have a bowel movement in the toilet. Standing can be taught later, while it is difficult to re-teach the child to sit after they have learned to stand.

Shape and reward in small increments
Change is hard – and even harder for our kids. And now you are going to try to teach your child to do something differently than he has for the past several years. He has gone in the diaper/pull-up several times a day for several years, so getting him to do something new may be very difficult. Therefore, rewards should be immediate and powerful. Begin with small steps. Put your child NEAR the toilet (still in his pull-up) and reward him. Next step, put him ON the toilet (still in his pull-up) and reward him. Step three, put him ON the toilet WITHOUT his pull-up and reward him. And of course the last step is victory when he’s sitting on the toilet, without a pull-up, and eliminates in the potty!

Reward for initiation
For self-initiation, some children may need to be provided with rewards just for the self-initiation part (whether or not they have a continent elimination). Again, you are teaching a new skill, and a difficult one at that. Therefore, powerful rewards may be needed.

Use visual cues
In each bathroom your child may use (and you may need a laminated copy for times away from home and school), keep a written or pictorial list of the steps your child must follow in the bathroom. For instance: 1) close door; 2) pull down pants and underwear; 3) lift toilet lid; 4)sit on toilet; 5) pee or poop; 6) get six squares of toilet paper; 7) wipe butt; 8) repeat wiping butt until clean; 9) pull up underwear and pants; 10) flush toilet; 11) close toilet lid; 12) turn on water at sink; 13) get soap; 14) rub hands together with soap; 15) rinse hands with water; 16) turn water off; 17) dry hands; 18) all done.

Let the pictures do his talking
If your child is not able to verbally communicate when he needs to use the bathroom, keep a small picture of a toilet in his pocket, hooked to a key chain on a belt loop, etc., so that he can easily signal to someone when he needs to go.

Withhold preferred items to increase their value
If Oreo cookies are your daughter’s favorite snack, only offer them when she uses the toilet.

Use a social story
Social stories are commonly used to narrate an experience. Social stories help the child understand what to expect during a particular situation. Carol Gray, the creator of the social story model, has a book, “My Social Stories” and the first chapter is Using the Toilet. Here’s an example of the social story, “Going Potty”. You can create your own social story, and use pictures of your child for each step of the toileting process.

Investigate the barriers
If toilet training is still not successful, investigate the barriers. Start a journal or keep data on when your child goes, when she drinks, where she typically has eliminations, etc. This can be useful for the shaping process, or to share with your doctor.

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