I’m Struggling to get my Child to use the Toilet, Now What?

The first thing caregivers need to ask themselves is: Am I concerned that there is something medically wrong? Are the barriers we are encountering possibly due to my child feeling unwell? How is this impacting my family relationships? Are the toileting issues impacting my child’s life, my life or the life of others outside of the home?

If you have asked yourself these questions and you know you want some support, connect with us now (link). We are happy to help by answering questions, providing guidance on next steps or initiating our services at any level. If you are still unsure, keep reading. Hopefully you will find this resource helpful.

Research tells us that the majority of neurotypical children acquire the skills to be considered daytime toilet trained (less than 4 accidents per week) by the age of 3 years (Blum, Taubman, & Nemeth, 2003). Girls tend to acquire these skills faster than boys (Schum et al., 2002) and learning to initiate using the washroom and remaining completely dry (no accidents) usually happens by the time the child is 4 years old (Perez et al., 2012).

Neurodivergent children typically take longer to acquire all the skills necessary to be daytime trained. Are they "just not ready?" The truth is...maybe. But maybe not. Some children do acquire the skills faster when they have had a bit more time to mature and develop. That being said, there are studies that indicate the long list of "readiness skills" (e.g., interested in the toilet, don't like being wet in their diaper, etc.) are not actually required to achieve daytime dryness. The most important readiness skill (and some might argue the only one needed) is that the child is physically able to sit on the toilet for 3 minutes and is cooperative with trusted adults when completing the bathroom routine.

Sometimes it can be difficult to know where to start if you're experiencing challenges around toilet training. Caregivers often wonder if they should just wait it out instead of calling a professional. Take a look at the chart below, if you or your child is experiencing any challenges mentioned below, we always recommend starting with a phone call to your doctor:

Question	Answer	Action
Is there any concern about the child peeing too often?	Yes	Call a family doctor, or walk-in clinic.
Is the child pooping less than once every 2 days?	Yes	Call a family doctor, or walk-in clinic.
Have you been attempting to teach toileting skills for 2 months or more with limited or no success?	Yes	Call a family doctor, or walk-in clinic.
Is the child holding their pee or poop for long periods of time?	Yes Examples: Holding until they get home from daycare/school or have a diaper on	Call a family doctor, or walk-in clinic.
Is the child showing signs of fear of the toilet?	Yes	Call a family doctor, or walk-in clinic.
Are there any other health concerns that coincide with the toileting issues?	Yes Examples: Change in appetite or diet, fatigue, pain or other illnesses	Call a family doctor, or walk-in clinic.
Are there any mental health or emotional implications for the child?	Yes Examples: Outbursts around toileting, increased stress around using the toilet at home or in other environments	Call a family doctor, or walk-in clinic.
Are there any mental health or emotional implications for the caregivers?	​Yes Examples: Increased stress around washroom routines, worry about the child’s wellbeing	Call a family doctor, or walk-in clinic.
Are there any social impacts on the caregiver, child or others?	​Yes Examples: Caregivers needing to go to school to change child/pick them up, exclusion from extracurricular activities (swimming, camps, etc.) or social events, interferes with daily life	Call a family doctor, or walk-in clinic.

Share all your concerns with your physician. Ask questions about the child’s gastrointestinal functions, share patterns of voiding (peeing or pooping), any signs of pain, avoiding using the toilet, fear and any behaviour outbursts or emotional reactions to using the toilet. If they have had UTI’s or constipation in the past, share these details and ask questions about this. If their diet has changed or their appetite has changed share that as well. Once the doctor has medically cleared the child and determines that there are no medical concerns that are the cause of the toileting issues you may want to seek assistance from an occupational therapist or board certified behaviour analyst.

Below is a general overview of what each professional can assist with. Please keep in mind this is not an exhaustive list and not every occupational therapist or board certified behaviour analyst has the experience or skills required to provide you with assistance in toileting or complex toileting needs so be sure to ask them about their experience and the approaches they like to use when working with children to develop skills needed to teach toileting.

Occupational Therapist (OT)

Board Certified Behaviour Analyst (BCBA)

Assessment of gross motor skills Assessment of environmental set up (e.g., toilet seats, stools, body positioning etc.) Strategies for increasing fine & gross motor skills associated with toileting (e.g., dressing, handwashing, wiping, getting up on the toilet, etc.) Strategies for children with sensory processing issues to build interoceptive awareness (the awareness of cues from inside their body) Other strategies for children with sensory processing challenges

​Washroom routines & environmental set up Structuring & scheduling of washroom trips Increasing cooperation with washroom routines & getting to the toilet Decreasing behaviours that interfere with using the toilet (e.g., refusing to sit, only pooping in a diaper, etc.) Decreasing challenging behaviour during the toileting routine (e.g., running away, aggression, self-injury, property destruction) Transitioning from diapers to using the toilet Teaching initiating and independently using the toilet Assisting with children who are neurodivergent Other strategies associated with increasing cooperation with using the toilet at home, school and in the community

In an ideal world a team would be built to incorporate both of these professionals, unfortunately there are not many teams currently available to provide that service. The good news is most OTs and BCBAs are VERY happy to collaborate and provide an interdisciplinary service that is organized by a parent or case worker.

If you have concerns hopefully this information has helped you determine the next step. If you are still unsure and want to speak to someone, please contact us. We are here to help!

Disclaimer:

We are not medical professionals, our chart and the information we provide is for educational purposes only. ALWAYS seek medical advice if you are concerned about the health of a child or youth.