Toilet Training When Your Child Has Multiple Disabilities

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Toileting, or elimination, is something everyone does throughout the day, so helping your child achieve more independence in this area is likely to be a high priority for you and your family. If your child is consistently dry for 1-1/2 to 2 hours and can wake up from a nap without soiling, she may be ready to learn to use the toilet.

Although your child’s needs and abilities may vary from that of other children, what is important to consider is how to maximize their participation, privacy, and comfort when they use the bathroom. The more your child can do for themselves, the less dependent they will be on you and others for assistance.

Considerations Before Starting Toilet Training

• The use of a bathroom routine will give your child a framework for understanding what is going to happen and what is expected of her. You might begin the routine by giving a symbol that can become associated with using the bathroom, such as a card with a piece of soap on it that smells like the soap she uses to wash her hands or a washcloth that feels like the towel she uses to dry her hands.
• Select clothing for your child that is easy to remove and put on. For instance, pants with an elastic waistband will be easier to manipulate than pants with snaps and a zipper.

Bathroom Routine

• Use the hand-under-hand method when guiding your child to pull clothes up and down, tear off toilet paper, or wipe herself. Gradually over time, you will be able to decrease the amount of assistance you give her as she learns how to perform these tasks herself. Note that these techniques need to be used carefully and with sensitivity toward your child’s preferences, sensitivities, and abilities. Some children may be upset when they feel their hands are being controlled, especially if they have autism spectrum disorders that increase their sensitivity to sensory contact or stimulation. If this is the case, the hand-under-hand method may be better than hand-over-hand.
• Your child will be more successful in participating in using the toilet if she feels secure physically. Work with their occupational therapist or physical therapist to explore the best seating options for her, how to transfer her from her wheelchair to the toilet, or where in the bathroom handrails might be useful.
• Even if your child does not appear to recognize whether the bathroom door is open or closed, it is important to model privacy for her. Close the door to the bathroom when assisting her with using the toilet.

Use a Schedule

Some children with blindness or low vision and complex needs are not able to consistently communicate to you and others that they need to use the toilet. Using a schedule to indicate when your child is to use the toilet can help minimize accidents. With other members of your child’s educational team, keep track of when your child urinates and has a bowel movement. For example, if your child usually has a bowel movement approximately 30 minutes after a meal, then at 20 minutes after the meal, take them to the toilet and have them sit there. This routine will increase the probability that they will have the bowel movement in the toilet.

Despite the best efforts, however, accidents will inevitably happen. When they do, involve your child as much as possible in cleaning up, including the unpleasant parts such as removing wet clothing or wiping up the floor. This way they are more likely to make the association that when they use the toilet, and can avoid participating in these unpleasant tasks.

Incentive for Using the Toilet

Rewards can speed up toilet training and boost a child’s independence. First, ensure your child links using the toilet to the reward. If using rewards, choose special ones for this purpose only. Consider a favorite toy, a unique snack, or play a special song only after successful toilet use.