As a pediatrician, I work with all children including those with disabilities. This blog shares tips for toilet training. Toilet training can be difficult for all families. It can be especially challenging for children with disabilities. They often need more time, directions, practice, and patience to learn these skills. Each family will need to change these tips to work in their home.

Strategies for Toilet Training:

Create a Schedule

1. Schedule toilet times, with a goal of 4-6 sits a day.
2. Use a visual schedule or pictures to help your child understand toileting.
   1. Pictures of your child doing each step: going into the bathroom, sitting on the toilet, reaching for the toilet paper, flushing, and washing hands.
3. Use first…then statements. First toilet then something your child enjoys doing. “First toilet then play with cars”.
   1. Create a picture board with simple pictures (see example)
4. Instead of asking if your child needs to go to the bathroom say, “Time for the toilet.”

Sitting on the Toilet

1. At first, the sits on the toilet are short (5 seconds per trip) with one long trip to practice having a bowel movement. Over time increase the sitting time (e.g., up to 5minutes).
   1. 1. Setting a visual timer lets your child know when the sitting ends.
2. Sits at first can be in clothes. Then underwear. Then without underwear.
   1. If your child uses the toilet then your child can get up right away.
   2. Boys are taught to sit on the toilet to urinate until regularly having bowel movements on the toilet.
3. Keep track of bowel habits to create your schedule. Watch for signs that your child needs the bathroom (crossing legs and dancing or going to a corner)
   1. 1. 20-30 minutes after dinner or a snack, your child should go to the bathroom and sit on the toilet.
4. Drinking more fluids and eating more fiber will help your child toilet more.

Make It Fun

1. Move to underwear. It helps your child realize when he/she is wet or soiled. If able, have your child pick out the underwear.
2. Bring a favorite book or sing a favorite song that is only read/sung in the bathroom.
3. If your child does to the bathroom, give IMMEDIATE praise. At the end of the timer, praise your child for sitting on the toilet.
4. Create rewards for toilet training, one for sitting and two for going. Can use sticker charts or small prizes only used for toileting. Give the reward IMMEDIATELY after the bathroom trip. Reward even small successes.
5. After sitting on the toilet, your child can do a preferred activity. Using first then statements (above).
6. Read fun books about toilet training with your child at bedtime.

Stick to It

1. 1. 1. Accidents happen. Let your child know it is no big deal. Change your child in the bathroom to learn the bathroom is for toileting.
      2. Work towards the same goal for 3 weeks.

Create a Team

1. 1. 1. Make toileting a team goal with school teachers, therapists, and your doctor.
      2. Working on toileting at home and school will increase learning.
      3. Watch for constipation and talk to your pediatrician. Constipation can slow toilet training progress

Additional Information and References:

1. 1. • Autism Speaks ATN/AIR-P Toilet Training Kit. AutismSpeaks.org
      • Create a Toileting Plan. HealthyChildren.org
      • Stadtler, et al. (1999) Toilet Training Methods, Clinical Interventions, and Recommendations. Pediatrics. 3: Supplemental 3.
      • Toileting Picture Cards. Do2Learn.com
      • Toilet Training. HealthyChildren.org