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Here are some of the issues to consider if your disabled child is moving out of nappies.
Some conditions like cerebral palsy affect each individual differently so it’s difficult to make generalised statements. How much a child can be responsible for their own toileting needs will vary greatly.
Some children, particularly those with severe or multiple impairments, may never achieve full independence in this area of their personal care.
However, just mastering some aspects of the skills can increase a child’s personal dignity and self-esteem.
Before toilet training your child, talk to your doctor about whether your child’s condition will affect their ability to control their bladder or bowel movements.
If your child is unable to feel when they need to use the toilet or to control the muscles needed to regulate the passing of urine or faeces, it’s best to seek specialist advice on how to manage their continence. Your doctor should be able to refer you to a suitable health professional.
Some children have constipation that makes passing faeces extremely difficult or painful. If this is the case, try to find a solution before toilet training.
Having to strain or feel discomfort may set up a negative association about using the toilet or potty. Your doctor may advise on medication or changes to diet that may help alleviate constipation or suggest more specialist help from a paediatrician or dietician.
If there are no medical concerns about starting toilet training, it’s worth spending a few days noting when your child naturally urinates and passes faeces. You may notice that a pattern emerges, such as always after eating, at a certain time of day or at fairly regular intervals. This pattern will be a guide in knowing when to place your child on the toilet or potty. If there’s not already a natural pattern, you’ll need to establish one once toilet training begins.
If other people are involved in the day-to-day care of your child, it’s sensible to talk to them about how you are planning to toilet train your child so that everyone is taking a co-ordinated and consistent approach.
Start toilet training when your child is in good health and not experiencing any other unusual changes to their routine. You need to be able to devote the necessary time to teaching your child. Some parents find it easier to begin toilet training at a time of year when the weather is mild, as less clothing means it is easier to get them on the potty or toilet quickly.
Not all the items on the list will be appropriate to every child. The more items on the list that you have ticked, the more likely toilet training will be successful.
Children’s skills and abilities may improve as they develop, so don't worry if you have not been able to tick many of the boxes yet.
It’s important to ensure that your child feels safe using the toilet or potty.
For many children a good-quality potty with a wide stable base and some sort of back support will be adequate. Such potties are readily available in high street stores. For a little extra you can buy one that has extra features, such as a ‘musical reward’. This may encourage use.
If your child has particular problems maintaining a sitting position, you may need more specialist equipment and advice.
An occupational therapist is a good source of information on suitable equipment and sources of supply. A physiotherapist may be helpful in showing you how best to position your child; especially for children who are wheelchair users and need specific help in transferring from wheelchair to toilet.
Some children are able to say when their nappy needs changing or when they want to sit on the potty or toilet. Even if your child has no verbal communication, he may show discomfort at having a wet or soiled nappy by:
Keeping the potty easily visible or providing a sign, for example a toilet roll, is likely to encourage the child to show you their need.
Try to make sure that everyone involved with your child’s daily care knows how your child indicates their toileting needs and use the same words or signs. Agree these in advance to avoid confusing the child.
If your child has a natural pattern of needing the toilet, you need to enable your child to access their potty or the toilet just before this.
If they don’t have a pattern, you need to help establish one by toileting them immediately after waking, before going to sleep, after eating or drinking and at regular intervals.
Unless professionals say otherwise, the process will be much the same as for toilet training any other child, although it may be more difficult and take longer.
Always communicate to your child what you are doing and why you are doing it. When your child ‘performs’ in the appropriate place, praise and reward them in whatever way seems to work best.
Remember that it’s important that your child views using the toilet or their potty as a positive experience. In time they will show you when they need it in preference to using their nappy. If they don’t manage to go, don’t leave them sitting there, just try later. If they are reluctant to sit on the potty, try keeping a couple of favourite toys or books that they are only allowed whilst using the potty or toilet.
Praise your child when they manage to stay clean and dry. Check with them regularly if ‘they need to go’ but avoid asking so often that they become stressed, anxious or simply bored with the question.
Hopefully, in time your child will develop the ability to use the potty or toilet more than nappies, especially during the day.
As your child grows, they will need to progress from the potty to using the toilet, possibly with adaptations. This is often a fairly straightforward process as most children are keen to copy older children or siblings and be ‘grown up’.
Some children may be fearful of the toilet. Often such fears are based on either falling down it or something coming up to get them. However, with sensitivity, support and lots of praise, you can help them overcome such fears.
For most children it takes longer to master staying dry overnight. Your child may wear pants during the day but continue to wear a nappy or training pant at night.
Bedwetting, also known as nocturnal enuresis, is a common problem in children. Simple measures such as waking your child to use the potty or toilet and praising ‘dry nights’ can help. Your doctor or health visitor may also be able to offer further advice.
Occasionally some children will continue to soil their pants or defecate in inappropriate places even after mastering the skills necessary to use the toilet. This is known as encopresis, and the causes may be a physical problem or a psychological issue.
If after a reasonable period of time, you are making little progress, or there is evidence of persistent nocturnal enuresis or encopresis, you should seek professional help. Your family doctor is a good starting point. There is also a specialist organisation Education and Resources for Improving Childhood Continence (ERIC) that can advise and support you.
Even when a child is fully trained, it’s normal for accidents to happen especially if a child is excited, fearful, unwell or concentrating hard on something else. They may also occur if a child is feeling unsettled by a change to their normal routine, such as starting school. Try not to be critical or draw too much attention to what has happened, as this may make matters worse. However, if there are repeated and unexplained accidents, consult your doctor.
ERIC provides support and information to children, teenagers, parents and professionals on all continence issues. It also has an online shop for continence products.
Bladder and Bowel Foundation offers information, support and a nurse-run continence helpline.
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