Once the potty seat has been mastered, the question soon becomes: How is she going to use a regular toilet? Most younger children use a step stool and an insert to sit securely on an adult toilet. Kids with low tone often need a little more assistance to get up there and stay stable.
Here is what your child needs to be able to do in order for her to climb up and use a regular toilet with an insert:
- Have enough sphincter control to “hold it” while getting clothing and positioning right.
- Be able to manage easy clothing independently and have awareness of their needs for clothing management. This means that if you have to tell them what to do or how to fix their clothes, they are not that independent yet. Will you still help them? Maybe, but if your child is able to know when her panties are down low enough, and a boy knows that he picked up his shirt before he pees, then your child can be a responsive participant if they find themselves unstable and need to think on their feet ( pun intended).
- Be stable while momentarily standing, either to manage clothing, while turning around, or for boys, to pee standing up. Some little boys will pee in sitting for a long time, others (usually the ones with big brothers) demand the right to stand. Aim is a lot harder if you are not standing in a stable position. The handles on the following item give young children something to hold onto. Just like seniors, grabbing a towel bar or the paper holder is a risk. Every time they reach too far, their balance is altered. That can be a huge help, compared to just a step stool.
The best support with a step that I could find anywhere is the Mommy’s Helper Cushie Step Up Potty Seat. There are a few available models with this basic design, but this one gets the best reviews for stability and ease of use. If a set-up is wobbly with a typically-developing child, a child that has issues with safety and control in other situations is going to be in trouble as they climb up to use the toilet. It doesn’t do as well with an elongated seat as a rounder one. The contoured seat grips that tushie a bit more, and the texture and softness of the seat prevents accidental sliding as well. This is not permission not to supervise for a while. Kids are unpredictable, so a wobbly child might need your eyes just to see what will throw them off their focus and put them at risk of falling.
The Baby Bjorn footstool is an amazingly stable choice. The legs have rubber grips all the way around, and the top is super-grippy. Even when wet! It is hard to tip, and it is so sturdy that adults can stand on it without any problems at all. Easy to clean too! If your child can use a step stool instead of a ladder, this is the one. Little boys that pee standing up will stand on this and hold the top of the tank or the back of the adult seat to steady themselves to aim. The biggest problem for some kids is that sometimes it isn’t wide enough for the kids that normally stand with their feet very far apart (your OT or PT will call that a wide base of support in their progress note). Their feet might go to the edges, seeking that same wide stance. Not safe. Practice having them standing on it without using the toilet, so that there are no surprises about how to climb and turn in a small space.
Remember, they have to get up there first, then pull down underwear and clothes. Trying to climb stairs with pants around your ankles is asking for trouble. Just try it yourself some day! That means that clothing choice still matters. Nothing with belts, long tunics or long skirts, tight leggings or skinny jeans. Unless you want to do all the work and slow down their learning curve.
Hint: Having kids develop independent dressing skills when they are off the potty, i.e. getting ready for bed, dressing to go to daycare, etc. is essential. I started writing “important”, but that is not accurate. It is essential.
These kids need chances to build smooth and fast movements under pressure. The only way to get there is practice and learning from repeated opportunities. Good teaching is nice, experience is better. The more automatic and controlled a skill is, the less difficult it will be to execute it when rushing to make it to the potty. Being able to manage clothing without even trying to toilet train is important. If your low-toned child is miles away from getting on the big toilet, and you are reading this for future reference, then today’s goal might be for her to to help more with getting dressed.
If your child is still struggling, you may want to install a child-height potty temporarily. they are available online through big box stores and easy to swap out when your child grows. Read more about how using the right height potty can help your child in Should You Install a Child-Sized Potty for Your Special Needs Child?.
Looking for more information on low tone and daily life skills? Check out Low Tone and Toilet Training: Teaching Toddlers to Wipe and Low Muscle Tone and Dressing: Easy Solutions to Teach Independence.
My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is finally done! You can buy it at Your Therapy Source (a great site for parents and therapists), Amazon.com or on my website, tranquil babies. I cover all the prep you need to do for success, help you address issues like constipation and language delays, and even deal with the inevitable setbacks that arise along the path to independence. Read more about this unique book at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!
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