Supporting Toileting for Children with Disabilities

Getting Started: Prepare for the Process

  1. Identify Signs of Readiness

    Every child develops at their own pace. Often, they will show you signs that they are ready to begin toilet training (Appendix A). These are some signs that your child might be ready to begin toilet training15:

    • Can stay dry for at least two hours at a time.
    • Aware of being wet or soiled (e.g. discomfort, tugging at clothing, aggravation, hiding).
    • Shows interest in the bathroom, toilet, or wearing underwear.
    • Follows simple directions (e.g., “sit down”, “pull pants up”).
    • Sits, stands, and/or walks with or without assistance to the bathroom.
  2. Track Toileting Habits

    It can be beneficial to observe and record the child's bathroom patterns for a few days to up to two weeks.16 This information can help with planning a toileting schedule that matches the child's natural body rhythms and current routine.

    • Note the times of day the child usually urinates or has a bowel movement (bm). This can be after meals, before or after naps, or during certain activities (Appendix B)
    • Watch for behavioral cues indicating the need for the bathroom or a clean-up. This may look like squatting, crossing legs, hiding, or running away.16
  3. Complete an Activity Analysis: Break Down the Task

    Activity analysis means breaking down a task into smaller, more manageable steps.3 Completing an activity analysis can help identify the physical, cognitive, sensory, emotional, and environmental demands of a task that are delaying a child's success.3

    • Complete an activity analysis by observing the child during their toileting routine and noting steps of the process that they need help with.
    • Steps of Toileting: Walk to the bathroom, pull down pants, sit on toilet, use bathroom, wipe, flush, pull up pants, wash hands, etc
    • Consider…
      • What steps are the most difficult for the child?
      • What skills are needed for each part?
  4. Set Up the Environment

    Creating a well-prepared environment is critical for success. Create a bathroom space that has all the necessities and supports the child's needs. Consider having the following15:

    • Supplies: Flushable wipes, extra pairs of underwear, a change of clothes easily accessible, etc
    • Positioning: A footstool so the child can sit with their feet flat and feel supported, a child potty seat or toilet cover, backrest or handrails for safety, etc.
    • Comfort Items: Fidgets, books, a favorite toy, etc.
    • Sensory Supports: Adjust lighting, reduce noise using headphones, nose plugs for smell, add a cushion if the seat feels cold or uncomfortable.
  5. Build a Team Plan
    • Collaboration is key. Don't be afraid to talk with others!
    • Share toilet training plans with the child's team. This may include teachers, therapists, caregivers, etc. Working as a team can help:
      • Recognize patterns and habits in different environments.
      • Identify helpful tools and strategies.
      • Keep strategies consistent.
      • Identify barriers or challenges across settings.
      • Prepare for adjustments ahead of time.