Supporting Toileting for Children with Disabilities

Toileting Tools and Strategies

Every child's journey to toileting independence is different. When families and their team work together, children are more likely to succeed.17

Tools for a Strong Start

Strategies to help make the toilet training process successful from the start (Appendix C).

  • Create a Toileting Routine:

    Create a structured daily routine to help the child become more aware of the need for the bathroom. A predictable routine can be created by observing and documenting toileting habits.11,15-16

    • Benefits:
      • Increases self-awareness of body patterns and habits.
      • Builds comfort and consistency around bathroom use.
    • Tips/Considerations for Use:
      • Use a simple chart or notes to track when your child usually needs to go (Appendix B)
      • Start with the most common times (such as after meals or before naps).
      • Keep things positive! Make it part of the daily routine, not a chore.
      • Use a visual schedule to help make transitions smooth.
  • Conduct Scheduled Sits:

    Have the child sit on the toilet at regular times throughout the day (e.g., after meals, before leaving the house). Start with a goal of at least 6 toilet sits a day, for as little or long as the child will tolerate.16 This helps the child link bathroom trips with their body's natural patterns and takes away the “guessing” about when to go.14

    • Benefits:
      • Builds consistency and predictability.
      • Increases the chance of successful toileting.
    • Tips/Considerations for Use:
      • Use a timer, potty watch, or phone alarm to alert it is time for a bathroom trip.
      • Tell the child when it is time for the bathroom, don't ask. It is not optional!
      • Keep sit periods short at first (1-3 minutes), then gradually increase as the child is comfortable.
      • Celebrate for sitting on the toilet for any amount of time, even if nothing happens.
  • Use “Dry Checks”:

    Gently check the child's clothing for accidents at set times across the day to help build awareness. Offer praise for staying dry, even for short periods of time, to help build confidence with staying dry.14

    • Benefits:
      • Helps connect the feeling of being dry with a positive feeling.
      • Provides frequent opportunities for positive reinforcement.
      • Reduces skin irritation by decreasing the time a child sits wet.
      • May reduce behaviors by keeping a child comfortable.
    • Tips/Considerations for Use:
      • Keep checks lighthearted (e.g., “You're dry! Great job!”)
      • Avoid punishing the child when they are wet, instead, use simple and consistent. language to explain what has happened (e.g., “Your clothes are wet. Accidents happen sometimes. Let's go to the bathroom and get cleaned up.”)
      • Pair dry checks with a reward system, like a sticker chart or token economy.
  • Incorporate Visual Supports:

    Make toileting predictable by showing the child what to expect through visual supports (Appendix D). A picture chart, “first-then board”, visual schedule, or visual sequence (e.g., pull-down pants, sit, potty, flush, wash hands) can increase understanding and reduce anxiety, leading to more independence.13,18

    • Benefits:
      • Reduces anxiety by showing what to expect.
      • Encourages communication by offering visual tools.
    • Tips/Considerations for Use:
      • Place visuals at the child's eye level near the toilet.
      • Keep language simple and consistent.
      • Review the steps with the child each time before going to the bathroom.
  • Video Modeling - Learn by Watching:

    Some children learn by watching others complete a task first. Showing a short video of a child or adult completing a bathroom routine can make the steps easier to copy and remember.11,19

    • Benefits:
      • Provides a clear, consistent example of what to do.
      • Can be more engaging than verbal directions alone.
    • Tips/Considerations for Use:
      • Watch the video together and talk through each step.
      • Choose short, simple clips to avoid overwhelming the child.
      • Replay as often as needed before or during toilet practice.
      • Be mindful of sensory sensitivities within the video (bright colors, sounds, etc.)
  • Social Narratives for Support:

    Social stories are short, personalized stories that can explain toileting in simple terms. They can help show what is expected and why it's important.16

    • Benefits:
      • Helps children understand routines and expectations.
      • Can reduce fear or uncertainty about new skills.
    • Tips/Considerations for Use:
      • Use first person (“I sit on the toilet. I flush. I wash my hands.”).
      • Use real photos of the child and bathroom when possible.
      • Read before toileting or as part of a daily routine.
  • Encourage Communication:

    It is critical to ensure that the child has a way to communicate and express their needs.15 This may include using words or phrases, gestures or signs, pictures, or a communication device.

    • Benefits:
      • Provides a reliable way to communicate, increasing confidence.
      • Reduces confusion for caregivers, teachers, and family members.
    • Tips/Considerations for Use:
      • Teach a simple word, sign, or symbol for “toilet” early.
      • Use consistent language with everyone on the child's team to reduce confusion.
      • Reward communication attempts with positive reinforcement and praise.
  • Wear Underwear:

    Have the child wear underwear over their diaper or pull-ups, even if they are not toilet trained. This allows the child to feel the difference between being wet and dry while still containing accidents.9

    • Benefits:
      • Promotes awareness of accidents.
      • Provides a gentle step toward transitioning away from diapers.
    • Tips/Considerations for Use:
      • Allow the child to choose fun underwear with favorite characters.
      • Start at home when accidents are easier to manage.
      • Stay positive! Accidents are a normal part of the learning process!

Tools to Build on Progress:

Strategies for overcoming challenges once toilet training has started (Appendix C).

  • Address Sensory Sensitives:

    Bathrooms can be overwhelming. Adjust the space by making small changes to help children with sensory sensitivities feel more comfortable and safer when toileting.11,13

    • Benefits:
      • Reduces fear and stress tied to sensory overload.
      • Makes the bathroom a safer space.
    • Tips/Considerations for Use:
      • Use dimmer lighting or warmer bulbs.
      • Provide headphones or turn off loud fans.
        • Tip! Cover the automatic flush sensory on public toilets with a post-it note to to avoid unexpected flushes and loud noises while using the bathroom.
      • Offer a cushioned seat or step stool for positioning comfort.
  • Increase Fluid Intake:

    Encourage the child to drink more fluids. This may increase the frequency of bathroom trips, creating more natural toilet training opportunities.11

    • Benefits:
      • Helps the child feel the urge to use the bathroom
      • Creates natural opportunities for toilet training
      • Supports healthy hydration
    • Tips/Considerations for Use:
      • Offer small amounts of fluids (water, milk, juice, etc.) throughout the day, rather than large amounts at once.
      • Pair fluid intake with trips to the bathroom- help connect the two activities.
      • Avoid excessive fluid intake before bed to reduce the likelihood of nighttime accidents.
  • Prompt Trips to the Bathroom:

    Offer gentle and consistent reminders (e.g., “Let's use the potty!”) based on the child's needs and toileting schedule to initiate bathroom trips throughout the day.14

    • Benefits:
      • Prevents accidents by keeping toileting top-of-mind.
      • Builds awareness of the body's signals over time.
    • Tips/Considerations for Use:
      • Keep reminders positive, avoid punishing!
      • Pair with visual schedule or “first-then boards”.
      • Use fun cues like a potty watch alarm or visual timer.
      • Pair reminders with praise for cooperation.
  • Celebrate Wins:

    Positive reinforcements such as praise, high-fives, stickers, or small rewards help a child feel proud of their progress. Over time, rely more on natural reinforcement, like feeling clean and independent.13

    • Benefits:
      • Encourages motivation and progress.
      • Makes toileting a positive, rewarding experience.
    • Tips/Considerations for Use:
      • Start with frequent small rewards, then decrease over time.
      • Use both physical (stickers charts, token economies) and social rewards (cheers, or hugs).
      • Be consistent. Praise every effort, not just results!
  • Provide Step-by-Step Guidance:

    Some children may need extra support in learning each part of toileting. Try hand-over-hand help, verbal cues, or breaking the task into smaller steps.11,14

    • Benefits:
      • Makes a big skill feel more manageable.
      • Encourages independence over time.
    • Tips/Considerations for Use:
      • Focus on one new step at a time (e.g., pulling pants down).
      • Try using visual prompts with physical guidance.
      • Celebrate the completion of each step!