Toilet training children with sensory needs

Toilet training can take time and patience, and all the more so if your child has communication or sensory needs (including autism). The information and advice here will help you support children for whom toilet training is more of a challenge.

Children with sensory needs may show some of the following behaviours when it comes to using the toilet:

• Being frightened or reluctant to sit on the toilet, perhaps because of the open space beneath them or the splash sound in the toilet
• Feeling anxious about ‘letting go’ of their poo, which they may see as part of them
• Only doing a wee or poo in their nappy or pants, perhaps going to a certain place or hiding when they do this
• Liking the sensation of doing a poo in their pants or nappy

How you can help

Give your child lots of encouragement to use the toilet. Don’t get cross or let your child see your frustration or disappointment when they have accidents. Clean them with minimum eye contact and discussion. That way your child won’t be getting the contact or reaction from you they may be seeking or expecting. Give lots of praise when their pants or nappy are clean and dry.

If your child does soil themselves, change them in a bathroom area. This will help them learn where to poo. If the poo can be put in the toilet, do this to show them where it should go. If they’re able to, encourage them to clean themselves, flush the toilet and wash their hands.

If you feel comfortable doing so, let your child see family members using the toilet so they understand it is normal and nothing to be frightened of.

Using rewards can help massively when toilet training. Consider what your child will respond well to.

Your Health Visitor will be able to provide further support and advice.

Tips to deal with specific toileting problems

1. Your child doesn’t like sitting on the toilet

Start by encouraging your child to sit on the toilet fully clothed with the lid down to help them see that the toilet is a safe place to be. Encourage them to sit for brief periods to start off with, rewarding this. Once they’re accepting of this, repeat with the lid up, progressing to taking off trousers and eventually removing pants. Don’t worry if they don’t actually do a poo – just getting them to feel happy sitting on the toilet is a great start.

If they’re still in nappies, start by loosening the tabs first, before progressing to removing the nappy. Letting the nappy lie in the toilet bowl can help, as can putting toilet paper in the bowl first to fill the space and reduce any splash.

If your child’s going to feel ok about using the toilet, they need to be comfortable, so provide a step or stool to help them get onto the toilet. Have a reading book or toy which is always to hand for them to play with when they are sitting on the toilet. Some children benefit from having something weighted on their laps when sitting on the toilet, such as a hot water bottle or folded blanket.

2. Your child doesn’t want to let go of their poo, or finds it difficult to poo

Some children may previously have experienced pain when doing a poo, and so they now try hard to keep it in. They may also feel anxious about letting it go. Reassure them that it’s ok to poo. You can also try getting them to blow bubbles through a straw at the same time as this engages the correct muscles needed to do a poo.

3. Your child will only poo in their pants or nappy, and may hide when they need to do a poo

Try to identify the signs your child gives when they’re going to do a poo so that you know when you need to encourage them to go to the toilet. If they’re reluctant to go, it can help for them to stand on a carpet square which you can gradually move closer to the toilet. A chair also works well if they like something to hold on to.

If your child will only wee or poo in a nappy, try and work out when and where they’re likely to do this, and only put a nappy on at this point. When they’ve finished, remove the nappy in the bathroom area so they start to understand that this is where they should be going.

4. Your child has communication difficulties so is unable to tell you when they need to go to the toilet

Look out for the tell-tale signs that your child wants to, is doing or has done a wee or poo. For example, they may stop what they’re doing, change their facial expression, or become agitated or upset. If they’re wearing a nappy, try putting pants on underneath the nappy for a day to see if they recognise when they have done a wee or poo. Nappies are designed to keep children dry, so they often won’t know when they’ve done a wee unless they feel some discomfort.

Using picture exchange communication system, social stories or ‘now and next’ cards can also help.

5. Your child smears

You can prevent your child getting to their poo by dressing them in an all in one suit, putting a ‘onesie’ on back to front or using a belt. If the child successfully stops smearing, they may replace this behaviour with another, so seek advice from your Health Visitor.

6. Your child is constipated

Constipation can not only be very uncomfortable, but can also affect behaviour, sleep patterns, and eating and drinking. If you think your child may be constipated contact your Health Visitor or GP for advice and help.

7. Your child can’t or won’t use a public toilet

Public toilets or toilets in unfamiliar surroundings can cause anxiety and changes in behaviour for some children. Help your child by visiting public toilets more often so they start to get used to this different environment. You can get a radar key (a special key which opens more than 9,000 disabled toilets in the UK) online or from the local authority.

Useful links

Both the organisations below offer advice over the phone as well as providing information on their websites:

• The Children’s Bladder and Bowel charity (ERIC)
• Bladder and Bowel UK