Dr Eve FlemingDr Eve Fleming

ERIC trustee Dr Eve Fleming is a special needs expert and continence specialist. She has many years experience of helping children with additional needs and chronic health problems to get clean and dry. In this guest blog for ERIC, Eve shares her approach to assessing whether a child is ready to start toilet training and recalls the story of just one of the children she has helped to get clean and dry.

Children with additional needs can learn to get clean and dry just like all other children. Sometimes, it can be surprising to find that they can do it. Some other children can find it harder to learn and take longer. It can be a bit like snakes and ladders with setbacks and frustration, but also can have successes and rewards too. Nearly all children with special needs can be toilet trained.

Nearly all children with special needs can be toilet trained.

A valuable life skill

Learning to wee and poo in the toilet is one of the most important skills a child learns. It gives them independence and more time to learn other skills. For the child, there is more time to play and do the things they like. Parents and families have more freedom to do other things and there is a sense of achievement. It also saves the cost of nappies.

Learning to wee and poo in the toilet is one of the most important skills a child learns.

Key approaches for success:

  • Choose the right time for children and their carers
  • Be prepared for the task ahead
  • Make sure you have help and support
  • Don’t leave it too late or expect children to show signs of readiness for toilet training.
  • Make sure the bowels and bladder working well and are healthy
  • Break down the task into simple steps                                                                                                                                           

Boy with balloon                                                                      Moses has limited language                                                          

Moses’ story

Moses is five-years-old and likes playing with cars and Sonic the Hedgehog. He is a lively active little boy who doesn’t like sitting still. He doesn’t talk very well and can be difficult to understand at times. His parents tried to train him to use a potty a year ago, but he didn’t like sitting on it and everyone became stressed and Moses was upset. He is still in nappies but his mother has kept an eye regularly and noticed they can be dry for some time.

Sitting practice 

His parents discuss a programme with their health visitor and decide to focus on practising sitting on the downstairs toilet with a step and a well fitting toilet seat. They start with getting Moses to sit on his toilet seat with his nappy on at first after meals and counting to five, on his fingers. Afterwards they give him a new red Sonic to play with for a short time. They then gradually increase the number of fingers and then do this without a nappy.

Gentle steps 

After three weeks Moses is happy to sit for longer, and has occasionally done a wee. He now puts a Sonic sticker on his chart if he sits on the toilet and has a chocolate button if he does a wee in the toilet. At the end of the summer they talk to Moses’ teacher about continuing the programme, and they plan to give Moses the stickers for sitting on the toilet at school break times and for washing his hands.

Reward for effort not success

This programme starts by making  sure that Moses feels secure on the toilet, and can understand what he needs to do to get a reward. These should always be for effort, and not success. It gives a basis to build on and develop the other steps to become reliably toilet trained. It is good to avoid asking children if they want to go to the toilet, often they can’t anticipate this, and may not have enough time from feeling that the bladder needs to empty, and get to the toilet.

Avoid asking children if they want to go to the toilet

Good bladder and bowel health

Another thing that is important to consider for children with additional needs is a check that the bowels and bladder are working well. Children should have a good fluid intake, about six drinks of clear fluid a day. This makes sure that the urine is dilute, and this gives a better message. Many children do get constipated at times, and this can be uncomfortable for them to go to the toilet. This can cause longer term problems if they associate going to the toilet with pain, and can cause difficulties with toilet training. It is important to keep an eye on this and get help and treatment promptly if needed.

Further help and support:

Download ERIC's Guide for Children with Additional Needs

ERICs Guide for Children with Additional Needs

For health professionals:

Eve will be delivering a workshop on toileting children with additional needs at our first regional roadshow event in October. Using case studies, she will discuss preparation for toilet training, starting a programme, ensuring the bowels and bladder are working well and common toileting problems. Find out more and book your place.

A stock image has been used for the child's photo in this blog.