As an early intervention therapist, I have the privilege of seeing little ones in their home (natural environment) with their caregivers, for up to their first three years of life.
Over this time, the concept of “potty training” always comes up. This is a real and practical discussion to have, not only with your pediatrician, but even more so, with your physiotherapist.
A healthy bowel and bladder program is essential for life.
So, this life skill should ultimately carry over into a variety of settings, and technique should be the same and carried over as closely as possible by each caretaker.
It is helpful to wait for cues from your child that they are beginning to understand the correlation between this physiological need and the physical outcome that’s desired.
For a successful outcome, only begin potty training when your child begins to indicate via a gesture, behavior, verbally or by signing that they are wet or dirty.
This indicates that their sensory system is mature enough to recognize and interpret this feeling.
If your child is not able to interpret what this body function feels like, and understand what the expectation is, it may be too early for potty training.
Cognitively, if your child is developmentally delayed, this connection may take a bit longer.
If you feel they are ready, just like any other new habit, repetition and routine are both very helpful in mastering this activity of daily living (ADL).
Communicate with your child’s caregivers at school or at home in order to ensure consistency.
The physical set up of the room should ensure that your child can be safe and as independent as possible in this skill.
For children with mobility limitations, always try to provide adequate upper extremity support via guards, rails, or transfer bars to help with movement around the bathroom, and with the transition onto the toilet seat.
This will also be a very important component for children who are visually impaired.
They will benefit tremendously from tactile cues to give them information about where they are in this space relative to the placement of the toilet.
For a younger child, a smaller insert seat and a step stool will help them feel secure and be positioned correctly.
For boys, initially sitting during urination may be easier (and safer), without concomitantly working on static standing balance, a single hand task, and aim.
Feeling safe and secure in any setting maximizes cognition, motor planning and motor performance.
If your child requires assistance with sitting balance, there are numerous attachments that are portable, that can be attached to the seat to help stabilize their trunk.
Their natural toileting patterns may emerge over time, so just like with any other routine, be sensitive to their behavioral or verbal cues.
Signs, gestural prompts and visual aids may help your child communicate that they feel the need to go to the bathroom.
For children with developmental delays, this multistep task may take a lot of repetition, a lot of problem solving, with many failures before successes.
A picture card may be beneficial for breaking down the task into smaller steps, and also provide an opportunity for your child to communicate with you when they’re all done.
If your child has physical, cognitive, hearing or visual limitations please wait until they’re ready to conquer this skill.
Make sure the physical environment is void of obstacles and has adequate safe supportive bars for moving within that space, and then to safely transition onto the toilet.
Once on the toilet, make sure your child feels safe and secure.
Try to consistently imbed this activity into their daily routine/schedule.
It is best to use very short and succinct verbal cues to help your child tell or show you that they have the need to go or that they’re all done.
Make sure your child is wearing clothes that are easily removed.
If your child is not ready, concentrate on other more attainable skills, and revisit at a later date.
If over time, this remains a perplexing skill to acquire, speak with your therapist or your pediatrician for advice.
Dr. Sharon Galitzer, Pediatric Physical Therapist