Hello, my name is Debbie Atkins.
I am an occupational therapist and toilet training consultant
for children and young people with developmental disabilities.
Learning how to use the toilet and developing control of the bladder and bowel
is an important developmental skill for all children.
However, for many children with developmental challenges
there may be health, physical, emotional and learning difficulties
that can impact on the development of these continence skills.
Many of these children show difficulties with frequent wetting and soiling accidents,
toilet refusal or not being able to stay sitting on the toilet,
bed wetting, lack of independence with the routine,
as well as difficulties communicating a need to go.
In this video I will share some brief tips
to help you establish a positive and healthy daily toileting routine with your child.
An individualised and consistent daily routine will be the best approach to overcome toileting problems.
Firstly, managing toileting problems can be quite complex.
So it is recommended that you seek more comprehensive advice
from a health professional, such as:
a continence nurse advisor, occupational therapist, psychologist or physiotherapist
who has experience with the management of toileting difficulties
for children with a developmental disability.
Also it is most important to seek professional advice
from a doctor about any underlying health considerations
that may be impacting on your child's bladder or bowel health.
Not enough fluids and fibre in the daily diet is another common cause of toileting problems.
So do encourage healthy dietary pattern for your child
with a well balanced daily diet
and adequate daily fluid intake to maintain healthy bladder and bowel patterns.
See you doctor for further advice.
Consider the toilet and bathroom environment to set your child up for success.
Firstly, consider equipment that will support your child's independence,
stability and safety on the toilet.
A smaller insert seat and toilet step stool will be essential for younger and smaller children.
Many young people also still need a toilet step stool to ensure correct posture on the toilet.
With boys be aware that it is best to establish a toilet sitting routine first
before introducing standing for urination.
Also consider the sensory environment
and avoid or minimise any sounds, lights, touch, smell or movement
that may be distressing for your child.
For example, avoid using the toilet flush or bathroom fan if your child has an auditory sensitivity.
Or avoid room deodorisers or perfumes that may distress your child.
And choose toilet paper and underpants carefully
to suit your child's tactile preferences.
Lastly, create an interesting toilet environment that your child will want to go into.
Consider your child's particular interests.
Stay close and use conversation, background music, songs, storybook or a small toy
to encouraged a relaxed and sustained sitting time on the toilet.
Set daily toilet time routines with your child
that are predictable and consistent.
It is really helpful to keep a daily toilet record chart
to note your child's natural toileting patterns.
For example, there may be a regular time when a bowel motion is most likely to occur.
Your child may be waking up dry after a sleep.
Or your child may show certain periods of dryness during the daytime.
Be aware that natural urges to use the toilet
are most likely to occur soon after waking and after every meal and snack time.
So, plan prompted toilet time when your child is most likely to need to use the toilet.
However also watch for your child's verbal or behavioural cues
that may indicate a need to go with a full bladder or bowel.
You may observe your child moving to a quiet location or standing still,
or they may become more restless, fidgety or pull at their pants.
Be encouraging as you move your child quickly to the toilet at these times.
But be careful to avoid forcing your child as this can lead to strong resistance.
Choose teaching strategies and communication cues
to best suit the individual needs of your child.
Always use short and clear verbal language.
Avoid asking a question such as: 'Do you need to go to the toilet?'
Instead use a statement 'Toilet time'
that is short, clear and directive.
In addition sign language, gestural prompts and visual cues
can be very helpful in supporting your child's understanding.
Some children may also need physical guidance
to help then initially to participate in the routine.
However be aware to reduce your assistance and prompting
as your child shows spontaneous participation.
If wetting and soiling does occur then always move to the bathroom
and include a toilet sitting time as part of any clean up routines.
Keep your interactions calm and neutral.
There is no praise or rewards at these times but avoid any reprimands or punishment.
Instead, view this as a positive teaching opportunity
to practice the usual toileting routine with your child.
Talk to your child's other care providers or educators
at preschool, school or respite care,
to ensure there are consistent routines in all environments for your child.
Repetition and familiarity will best support your child's learning
Lastly, allow time for toileting
and always give your child lots of positive acknowledgment
for their participant in the routine.
Understand your child's specific developmental challenges
and keep realistic expectations.
Be persistent and patient as you support your child to become continent.
Do seek further professional advice from your child's doctor and health professionals.
For additional information you can contact
the National Continence Helpline on 1800 33 00 66.
This is a free telephone advisory service staffed by continence nurse advisors,
providing information and advice on continence management,
funding schemes, products and local services.
The Continence Helpline operates Monday to Friday,
from 8am to 8pm, Australian Eastern Standard Time.
You can also go to the Continence Foundation of Australia's website
I do hope you have found this short presentation helpful. Thank you.