Category Archives: toilet training

Low Tone and Toilet Training: Learning to Hold It In Long Enough to Make It to The Potty

 

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If your child can’t stay dry at night after 5, or can’t make it to the potty on time, there are a number of things that could be going wrong.  I won’t list them all, but your pediatrician may send you to a pediatric urologist to evaluate whether there are any functional (kidney issues, thyroid issues, adrenal issues etc.) or structural issues ( nerve, tissue malformations).  If testing results are negative, some parents actually feel worse rather than better.

Why?  Because they may be facing a situation that is harder to evaluate and treat:  low tone reducing sensory awareness and pelvic floor control.

Yes, the same problem that causes a child to fall off their chair without notice can give them potty problems.  When their bladder ( which is another muscle, after all) isn’t well toned, it isn’t sending sensory information back to the brain.  The sensors that respond to stretch aren’t firing and thus do not give a child accurate and timely feedback.  It may not let them know it is stretched until it is ready to overflow.  If the pelvic floor muscles are also lax, similar problems.  Older women who have been pregnant know all about what happens when you have a weak pelvic floor.  They feel like they have to “go”  but can’t hold it long enough to get to the bathroom!   Your mom and your daughter could be having the same problems!!

What can you do to help your child?  Some people simply have their kids pee every few hours, and this could work with some kids in some situations.  Not every kid is willing to wear a potty watch (they do make them) and the younger ones may not even be willing to go.  The older ones may be so self-conscious that they restrict fluids all day, but that is not a great idea.  Dehydration can create medical issues that they can’t fathom.  Things like fainting and kidney stones.

Believe it or not, many pediatric urologists don’t want kids to empty their bladder before bedtime.  They want kids to gradually expand the bladder’s ability to hold urine for a full 8-10 hours.  I think this is easier to do during the day, with a fully awake kid and a potty close at hand.  Too many accidents make children and adults discouraged.  Feeling like a failure isn’t good for anyone, and children with low tone already have had frustrating and embarrassing experiences.  They don’t need more of them.

There are a few ideas that can work, but they do take effort and skill on the part of parents:

First, practice letting that bladder fill up just enough for some awareness to arise.  You need to know how much a child is drinking to figure out what the right amount is, and your child has to be able to communicate what they feel.  This is going to be more successful with children with at least a 5-6 year-old cognitive/speech level.  Once they notice what they are feeling down there right before they pee, you impress on them that when they feel this way that they can avoid an accident by voiding as soon as they can.  Try to get them to create their own words to describe the sensation they are noticing.  That fullness/pressure/distention may feel ticklish, it may be felt more in their belly than lower down; all that matters is that you have helped your child identify it and name it.

You have to start with an empty bladder, and measure out what they are drinking so you know approximately how much fluid it takes them to perceive some bladder stretching.    It helps if you can measure it in a way that has meaning for them.  For me, it would be how many mugs of coffee.  For a child it might be how many mini water bottles or small sport bottles until they feel the need to “go”.  You also need to know how long it takes their kidneys to produce that amount of urine.  A potty watch that is set to go off before they feel any sensation isn’t teaching them anything.

The second strategy I like involves building the pelvic floor with Kegels and other moves.  Yup, the same moves that you do to recover after you deliver a baby.  The pelvic floor muscles are mostly the muscles that you contract to stop your urine stream.  Some kids aren’t mentally ready to concentrate on a  stop/start exercise, and some are so shy that they can’t do it with you watching.  But it is the easiest way to build that pelvic floor.  There are other core muscle exercises that can help, like transverse abdominal exercises and pelvic tilt exercises.  Boring for us, and more boring for kids.  But they really do work to build lower abdominal strength.  If you have to create a reward system for them to practice, do it.  If you have to exercise  with them, all the better.  A strong core and a strong pelvic floor is good for all of us!

Tell your child to stand up and check again to see if he “has to go”.  Why? Because the extra force of gravity on that full bladder will add sensory information.  Many children with low muscle tone sit or lie down while playing.  The force of a full bladder isn’t felt as intensely, and young children aren’t always able to parse the small cues.  Stand up, and there should be more force on the internal sphincter and more of a sense that it’s time to use the toilet.

Finally, don’t forget that the same things that make adult bladders edgy will affect kids.  Caffeine in sodas, for example.  Spicy foods.  Some medications for other issues irritate bladders or increase urine production.  Don’t forget constipation.  A full colon can press on a full bladder and create accidents.

Interested in learning more about toilet training?  My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone is available on my website, tranquil babies.  Just click ‘e-book” on the ribbon at the top of the home page, and learn about my readiness checklists, and how to deal with everything from pre-training all the way up to using the potty in public!

 

 

 

 

Why is Staying Dry at Night So Challenging For Some Children?

I have received a few questions on this subject since publishing my e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone.  Parents are wondering how to expand daytime success through the night.  Here is what I know about getting through the night high and dry:  it is as much a physical milestone as a behavioral accomplishment.  The pituitary gland is involved in hormonal secretions to diminish urine production, and the nerves for sphincter control may not be fully developed in younger children.  The bladder has to expand to hold a quantity of urine at night, so tiny children really cannot accomplish this feat, regardless of motivation.

Typical children who are dry all day can need another 2-4 years (yes, years!) to stay dry at night and/or wake themselves and use the potty independently.  The child who is a “potty master”, getting there on time and managing all the skills at school, may still need a pull-up style training pant as an insurance policy.

What can you do to improve the odds of dryness at night?

  • Limit drinks right before bed.  As you know from my book, children will generate enough urine to “go” about 45 minutes after a big drink.  The kidneys are also responding to hormone and salt levels in the blood, so some urine will be generated at night, even if nothing has been taken in by mouth for 2 hours before bed.  Deny that late night sippy cup or that last swig of juice, and come up with a better bedtime routine in it’s place.
  • Insist on the bathroom being a last stop before bedtime.  Empty that bladder, even if your child insists that they don’t feel that they need to “go”.
  • Make sure your child is well hydrated during the day.  A thirsty child is going to beg for that drink, and then fail to stay dry.  The bladder gets it’s exercise during the day, as it fills and empties.  Constantly running to the bathroom, or never making it to the bathroom can both contribute to late preschool bedwetting.  Be encouraging but firm with children that tend to dry out during the day.  They don’t realize the part their refusal plays in bedwetting, they just feel like a failure, and maybe worry that they are a failure in your eyes as well.
  • Recognize the role of constipation can play in bedwetting.  The pressure of stool on a bladder can be enough to create problems.  My book has many ideas to address constipation, and this is another reason to address this problem instead of hoping it will go away.
  • Accept that brain maturation is a key driver of night dryness.  A child with brain differences, from ASD to ADHD to SPD, may need more time to achieve this milestone.  Criticism and harshness isn’t going to make that brain develop any faster.
  • Ask your pediatrician’s advice if your typical child isn’t dry at night by 7, or if you suspect that there is another issue.  Never ignore your gut feelings about your child.  You know more than you think!

Take a look at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! to learn more about my e-book and how it can help you toilet train your child!  Visit my website tranquil babies to purchase the book and buy a phone consultation to get your specific questions answered personally!

Toilet Training Older Kids: Equipment Matters as Much as Approach

Is potty training after the toddler years different?  Yes, and no.  Here is what you need to consider when you are looking at the equipment for an older child that is still in a diaper or a pull-up.  Whether they have language or not, whether they have rigid or stereotyped behaviors or not, your set-up when training the older child is very important.

  1. Your child probably won’t fit correctly on a toddler potty seat.  Unless your child is significantly shorter and thinner than her peers, she won’t fit.  Children that are nonverbal or very compliant may not complain about sitting so low or so tightly.  They just won’t do well.  They may only sit for a short time, get agitated, or withhold.   They may cling to you when transferring on and off because they are sitting so low.  It can look like they either don’t understand what to do, or won’t comply.  Both can be wrong.  The defiant ones will cry and refuse to use a seat that doesn’t fit them.  Some crafty parents have adapted the smaller seats for their slim little ones, but not everybody can do that.  Look at my posts on the adult toilet Low Tone and Toilet Training: Transition to Using The Adult Toilet  or on a child-friendly size Should You Install a Child-Sized Potty for Your Special Needs Child? for help to reconfigure your set-up ,giving your child a better chance at success and comfort.
  2. The right environment for toileting is not in front of the TV.  After all these years of using diapers or pull-ups (which is developmentally really a diaper that you wear, not absorbent underwear), using the toilet can seem as silly to them as going into a restaurant and cooking our own dinner would be to us!  If you have the room, use the bathroom for training.  Bring them into the fold by requiring them to assist you with all aspects of diapering, turn off the TV so you have their attention, and when you do watch potty videos, make sure you are there reminding/encouraging them.  Your demonstrated interest has more power than you think!
  3. You are gonna need a bigger boat (wipe).  Nod to one of my favorite movies, Jaws.  But seriously, using those tiny little toddler wipes from the cute dispenser might not do the job on a 5 year-old heine.  Not enough wiping with a tiny one, and if they aren’t clean down there, it is not only messy, it is a hygeine issue.  Use the grown-up wipes and put Paw Patrol stickers on it if you have to sell them as appealing.

Good news!  My e-book, The Practical Guide to Toilet Training Your child With Low Muscle Tone, is up on my website, tranquil babies .  For a sense of what it includes, take a look at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!  I took all the requests from my consultation clients, and my years of experience as a pediatric OTR, and wrapped it into a book that gives you real help, not just charts or encouragement that it takes time.  If you want a hard copy, go to my website and send me an e-mail to find out how to get one!

Piddlers Make Potty Training Fun!

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Your son will eagerly run for potty time!

I laughed out loud the first time I saw a toddler pee onto one of these circles.  Then he asked for more juice so that he could come back later and try again!

Piddlers aren’t a new concept.  Parents have been tossing cereal circles into a potty for “aiming practice” for a long time.  These commercially-made circles are just easier to aim for, dissolve more, and clean up easily.  Cereal has a funny way of bouncing around in the toilet, making it more frustrating, not as successful and not as much fun.

Getting children motivated to use the toilet can be a big headache.  For every totally cooperative toddler, there are 5 more that are defiant or simply uninterested.  They just won’t “go”.  Piddlers may not be a total answer, but they can get your son over these barriers to skill development.  Once a child is successful and has a routine, things are so much better!

Little boys have to control their aim if they are going to urinate standing up.  This is a totally new concept for them, and a skill.  Yes, a skill.  Since they have been using a diaper for elimination from the day they came home from the hospital, toilet training is a completely foreign concept, from beginning to end.  It’s a little bit funny: mostly the mommies are in control of toilet training, but only brothers, cousins and daddies can demo this particular skill.   Read Low Tone and Toilet Training: Kids Need To See How It’s Done to understand why a live performance can jump-start your child’s comprehension of toilet use.

Piddlers are made of starch and food coloring, and won’t turn anything blue or orange.  You may not even need the whole package!  Once a child has success and has developed a routine, explain that you need to go to the store later to buy more (not really), but he can use the potty right now anyway without one or two Piddlers in the potty.  Eventually you won’t need Piddlers any more, but you will have a little boy that is paying attention to what he is doing in the bathroom!

Great News!  My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is now available as an e-book on my website, tranquil babies .  Just click the “e-book” section on the top ribbon to get your copy.  

Don’t think your child is ready for toilet training?  You need this book more than the parents of kids that are struggling with training!  Knowing how to prepare your child and yourself before you start training can make all the difference.  My book will explain in detail what you need to know and how you can start developing potty skills…today!

The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

photo-1445800363697-51e91a1edc73  Toilet Training Help Has Arrived!             

My most popular post,  Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!) inspired me to write a manual to help parents with potty training.  There was nothing in books or online that really helped families, just a few lines about being patient and not pushing children….which is no help at all! Families deserve good strategies and an explanation for all the frustration they experience.

What makes this book so unique?  Media specialists say that you have to be able to explain your product in the time it takes for the average elevator ride.  OK, here is my elevator speech on The Practical Guide to Toilet Training Your Child With Low Muscle Tone:

My book provides a complete explanation of the motor, sensory, and social/emotional effects that low muscle tone has on toilet training.  It does so without being preachy or clinical.  Parents understand whether their child is ready to train, and how to start creating readiness immediately.  They learn how to pick the right potty seat, the right clothes, and how to decide between the “boot camp” or gradual method of training.  A child’s speech delays, defiance or disinterest in potty training are addressed in ways that support families instead of criticizing them.

  • Each readiness quiz helps parents figure out what issues need to be addressed for successful training and reminds them of their child’s strengths.
  • Chapter summaries give a quick review of each section.  Parents decide which chapter they need to read next to get more information.
  • Clinical information is explained in layman’s terminology, so parents don’t have to Google “interoception” to understand the neurology that causes a child not to recognize that they have a full bladder.

Here’s what parents are saying about The Practical Guide”:

The Practical Guide has truly been heaven sent!  Although my globally delayed 5-year old daughter understood the idea of toileting, this skill was certainly not mastered.  Our consultations with Cathy and her guide on how to toilet train have given me the knowledge I’ve needed to understand low tone as a symptom that can be tackled.  Morgan has made visible advances, and I am so encouraged and empowered because I know what piece we need to work on next.  Thank you, Cathy, for writing this book!”      Trish C, mother of Morgan, 5 years old

“I would often say to myself “Cathy has to put all of her accumulated wisdom down into a book”.  I am happy to say-here it is!  You will find no one with more creative and practical  solutions.  Her insights and ideas get the job done!”     Laura D. H., mother of M., 4 years old 

Cathy has been a “go-to’ in every area imaginable, from professional referrals to toilet training.  I can’t say enough positive things about her.  She has been so insightful and helpful on this journey.”  Colleen S. mother of two special needs children

Want a bit of a preview?  Here is a small section from Chapter One: Are You Ready For Toilet Training?  Is Your Child?

Parents decide to start toilet training for three primary reasons.  Some families train in anticipation of an outside event, such as enrolling their toddler in a preschool that doesn’t change diapers.  Another example would be the impeding birth of a sibling  Parents who want to train their older child hope that they can avoid having two children in diapers, They do not expect to have the time and attention for training after their new baby arrives.

The second common reason to begin training is when their child achieves a skill that parents believe to be a precursor to successful toileting.  For example, when children learn a word or a sign for urination, adults may thing that they may finally be able to train them.  The final reason is when school staff or their pediatrician recommends that they start training.  whatever your reason, you are reading this book because you are wondering if you and/or your child could be ready for toilet training.

These are the eight types of toileting readiness: 

  1. Financial
  2. Physiological
  3. Communication 
  4. Cognitive 
  5. Social/emotional 
  6. Clothing Management
  7. Time and Attention
  8. Appropriate Equipment

How can you find my book?

Three ways:  Visit my website  tranquil babies and click on “e-book” at the top of the homepage, buy it on Amazon, or visit  Your Therapy Source, a wonderful site for parents and therapists.  Just search for The Practical Guide to Toilet Training Your Child With Low Muscle Tone!

 

Need more than toilet training strategies?

 My new e-book, The JointSmart Child:  Living and Thriving With Hypermobility Volume One:  The Early Years is for you!  Like The Practical Guide, it has solutions to everyday problems, but this book also gives you strategies to make your child and your home safer, have mealtime and dressing successes, and even learn how to communicate better with your family, babysitter, teacher and doctor!  Find it on Amazon.com.  It is also available as a printable download on Your Therapy Source.

HELP HAS ARRIVED!

The Ten Most Common Mistakes Parents Make During Toilet Training

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Since writing The Practical Guide To Toilet Training Your Child With Low Muscle Tone, I have been asked for a list of missteps that happen on the way to success.  Here they are:

  1. Ignoring their own readiness issues.  Parents who are unaware of their own lack of readiness will not be able to be the effective coach and teacher that their child needs.  Training requires extra laundry, cash outlays and can create lots of frustration for adults.  If you don’t know how you will handle all of these issues, your reactions could make potty training harder.  Even if you have trained older children, life situations change.  A parent with a more demanding job or simply more “irons in the fire” will have to figure out how to devote the necessary time and attention to toilet training this child.  Learn more about readiness by reading Low Tone and Toilet Training: The 4 Types of Training Readiness
  2. Assuming that defiant children will be LESS defiant in toilet training.  Older toddlers and preschool children that are still in diapers can be the most difficult to train.  Developmentally, they are at the stage in which they are learning about their ability to assert control over situations and people and handling the consequences.  Some children have temperaments that make toilet training harder any age.  The shy child can be overwhelmed by accidents and expectations, and the spirited child can balk at being told when to sit on the potty and resists following a routine.
  3. Using equipment that doesn’t fit the child.  The wide range of equipment available doesn’t mean that parents will pick the one that has the best chance of success.  Children with motor or sensory issues are especially vulnerable to failure when the equipment doesn’t meet their needs.  Typically-developing children can respond negatively to poor equipment as well.  A seat insert that is wiggly can seem frighteningly unsafe to them, and a potty on another floor can result in so many accidents that they insist on a diaper for security.
  4. Ignoring the sensory processing component of low muscle tone.  Many children have low muscle tone, including children with ASD, sensory processing issues, and syndromes such as Down and Prader-Willi.  Parents are aware of the balance and stability components of low tone, but don’t recognize any of the sensory components.  The one that derails training the most frequently is a lack of interoceptive awareness, which is limited perception of internal sensory experiences .
  5. Assuming that speech delays mean training delays.  Children can learn to use the toilet without any verbal abilities at all.  They do need some receptive language skills, but the level of comprehension to master a toileting schedule isn’t as high as parents think.  Creating a good plan is the challenge.
  6. Interpreting accidents as failures.  No one likes to have an accident or clean one up.  But accidents are signals that learning is happening and/or changes in the training plan are needed.  If you or your child react dramatically to accidents or interpret their meaning incorrectly, this can create training resistance or refusal.  For some more ideas on addressing accidents with your special needs child, read Not Making It To the Potty In Time? Three Reasons Why Special Needs Kids Have Accidents.
  7. Not knowing how to anticipate bladder fullness or bowel routines.  What goes in must come out.  If a child wanders around with a sippy cup, it will be nearly impossible to anticipate when that bladder will be full, and when sitting on the potty will be a success.  Understanding how to make early training successful by guiding a child the the toilet at the right time is key.
  8. Minimizing the importance of clothing choice for independence.  Children have the cutest clothes, but during toilet training, cute styles can spell disaster.  “Dressing for success” means clothes that can be slid on and off easily, and don’t get in the way of seeing and feeling the call of nature.
  9. Ignoring fears and withholding behaviors until they derail training.  Some children are truly afraid of the sounds, feelings and even the smells of elimination.  They can even think that they will be flushed away!  Avoiding addressing  withholding issues can create behavioral but also medical problems.  Ignore them at your own peril.
  10. Waiting until the last minute to train.  After a few years of diapers, children can assume that this is how their parents want them to eliminate.  Not using pre-training strategies that inspire and prepare children, even children with special needs, makes training harder than it has to be.  Take a look at How Early Can You Start Toilet Training?  to understand more about training readiness at any age.

For kids without special needs, the best book for them is Oh Crap Potty Training.  Read A Great Toilet Training Book for Neurotypical Kids: Oh Crap Potty Training! to learn why this is going to help you get it right, even if you have failed before.  But what if your child has low muscle tone?

  My book, The Practical Guide to Toilet Training Your child With Low Muscle Tone, helps parents through all the complexities of potty training .  The e-book is available on my website tranquil babies.  It is also available on Amazon and at Your Therapy Source.

There is nothing out there that does as complete a job of helping parents succeed with toilet training children who have low muscle tone.  I looked.  All the other books on special needs potty training shrug their shoulders when they discuss neuromuscular issues, because teachers and psychologists don’t truly understand the ways neurophysiology contributes to the struggle.  I have provided readiness checklists and chapter summaries for quick answers to your questions.  Medical and therapy terms are fully explained so that you don’t have to run to Google to figure out what each term really means.  

My book provides parents with ideas they can use today to move forward with potty training!

 Help has arrived!

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Waiting for Toilet Training Readiness? Create It Instead!

 

 

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Fall has arrived in New York, and toddlers know the best way to enjoy it!

I just watched a therapist on YouTube tell parents how to look for toilet training readiness signs.  From her limited description, you would have a better chance of finding truffles in France!

The signs of readiness in special needs children can be subtle, so do not ignore moves such as going behind the couch before having a bowel movement (if they can anticipate it, they can do it in the potty, too) and jumping around a bit before urinating into a diaper.   A lot of signs are not that hard to see.  Low Tone and Toilet Training: The 4 Types of Training Readiness  Other than the physiological ability to keep a diaper dry for 1.5-2 hours, which is reached around 18-24 months, most of the other types of readiness can be facilitated.  Even in special needs kids.    And I am not taking about forcing any child to use the toilet.  Ever.

The good news is that you can create more readiness without force.  You shift their awareness, give them vocabulary, engage them in elimination events, and through it all, you inspire them.  Sounds simple, but it takes some thought and effort.  It is totally worth it, from the savings on diapers to the decreased stress on you and your child when you do start training.  Jamie Glowacki, the author of a terrific book “Oh Crap Potty Training” takes a risk and challenges the idea that children will naturally be ready.  She thinks that there are children that will really never be “ready”, as in eager to train.  You probably know if your kid is in this category.  They weren’t ready for a sippy cup, or to let go of the pacifier, or switch from a crib to a toddler bed.  They hate change and they enjoy controlling situations much more than they care about consequences or praise.  Admit it:  you know if this is your kid.  They need your help to be ready.  Give it to them.

Not every child needs your help to become ready for toilet training.  I know plenty of parents who say that at least one of their children really self-trained.  Sounds hard to believe, but a motivated and attentive toddler that has been watching an older sibling…well, they have been taking notes!  They just need a little bit of encouragement, and off they go.  “Go” as in go to the bathroom.

Creating more readiness in toddlers that aren’t self-starters isn’t hard.  When you diaper them, you narrate and explain.  It sounds silly at first to do so, but children are sponges and absorb more than you think.  You are inviting them to attend, not encouraging them to watch the TV while you wipe them off and strap a diaper on them in standing.  Have them participate by holding wipes or clean clothes, go get a clean diaper for you, and when they are ready, have them toss out a well-wrapped dirty diaper.

Let them see how it’s done.  I wrote a post on this, Low Tone and Toilet Training: Kids Need To See How It’s Done  so I am not going to go into the details here.  Let’s just say that a picture is worth a thousand words.  The less language a child has, the more your demo helps them to understand the process.

Read those potty books, watch those potty videos.  Not just your child, but you too.  If you are watching and reading with them, you are communicating that you value the idea of their participation. Speak about their eventual independence in terms that inspire.  Not pressuring them, inspiring.  We talk about how they will go to school one day, be a mommy or a daddy one day.  This is something closer to the horizon, but if it is spoken about as a far-away event, well, it will be.

Help has arrived!  My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is available on my website, tranquil babies, and as a clothbound hard copy when you contact me through the site.  Read The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived! to learn why my innovative book design and detailed information on toilet training will help you make immediate progress, regardless of your child’s current abilities.

Can You Toilet Train a Non-Verbal Child?

Parents of non-verbal children often delay toilet training, assuming that these kids need more communication skills to be successful.  I disagree.  I think children and their parents need other skills more.  Here are my thoughts about what really matters for these kids:

  • Their parents need excellent observation skills.  A child that cannot easily communicate their needs and concerns is still showing you signs that they have already eliminated or that they are ready to eliminate.  Children have familiar facial and postural changes such as grimacing, grunting, and crouching.  They often go to their “poopy place”, a location in the house where they prefer to have bowel movements. Behind the sofa is a common spot.  Just like typically-developing kids, parents who know when to anticipate elimination can guide their child to the potty so that kids make the connection between sitting and successfully eliminating.  This may mean that grazing and sipping all day long is over.  If drinks and meals are served generously but not continuously, it is easier to predict when a child will have a full bladder.  The act of eating often stimulates colon activity, so bowel moments are more regular and therefore predictable as well.  This is easier when meals are larger and eating is not happening in small snacks through the day.
  • Children need familiar routines.  When non-verbal children can anticipate a toileting routine, they don’t need to rely as much on receptive or expressive language skills.   For example, ending a meal and getting dressed will remind them that they now go to the toilet.  Lack of a routine will mean that they have to work harder on communication.  Being caught out of their routine and in need of a toilet could be so stressful that they resist giving up their diaper.  Create and carefully maintain  routines that support success and calmness around elimination.
  • Families need good toileting equipment.  A child that cannot describe in detail why they are uncomfortable is going to be less cooperative with toileting.  Beyond an appropriate potty or toilet insert/footstool set-up, a non-verbal child needs clothing that is easy to manage and wet wipes that really clean them.  My strategy of “dry runs”, in which children pretend and get a chance to practice, helps everyone see if they have prepared well for toilet training.

Help has arrived!  My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is now available on my website, tranquil babies and in a clothbound hard copy by contacting me through my site.  Read   The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived!  to learn how my innovative book is designed to be parent-friendly and help you move forward with toilet training today!

Toilet Training Has It’s Costs: Don’t Be Shocked

 

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In speaking with families about their worries in anticipation of toilet training, one of the issues that rarely comes up are it’s costs.  Sure, everyone laughs about the vacation they will take when they no longer buy diapers or pull-ups.  Those huge boxes from Costco don’t come cheap.  But there are costs during the training process that are only vaguely anticipated.  Be sure that you are ready for them too!

Clothes and Underwear.  Children may need a new wardrobe.  The first reason is that a child will not be able to get those teeny hipster jeans off fast enough to pee or poop.  They move faster in wide-waisted sweats.  The second reason is that you will need multiple pairs of underwear and possibly even other clothes.  The teddy bear may wear one pair as a motivator, you may use two pair as thick training pants down the road, and then there are all the small accidents that leave your child smelling less-than-fresh.  Time to change.  The last reason is that accidents happen anyway, and some clothing is going to be so soiled that “Super-Tide” or whatever you are using just cannot handle the stains.  Into the trash they go.

Wipes, flushable and not.  One of my oldest friends says that flushable wet wipes saved her life during training.  They aren’t cheap, and kids start out taking a handful, as if they were going to wipe down the whole bathroom, not just their little tushie.  You will need to stock your go-bag with wipes as well, for trips outside the home.  And of course you may still need the non-flushable ones to help them clean things up.

Carpets, etc.  If you do a Training Intensive, sometimes known as Potty Boot Camp, there will be accidents, guaranteed.  Even with a Gradual Start approach, accidents happen.  Sometimes on a tile floor (good), and sometimes on the carpet or the couch (bad).  Some things can be cleaned and some will need professional help.  Or replacement.  Be prepared.

Time and Attention.  The most precious commodities of all to parents are their time and attention.  Developing an awareness of when your child is most likely to eliminate, making it a priority to get them to the toilet for a successful attempt, and even making sure they “go” before you leave for the store is a completely different use of time from the days when you slapped a fresh diaper on them and ran out the door.  Kids take a while on the potty, and this process will consume your time and attention until they are completely trained.  Some trained preschoolers still need you to wipe them effectively, well past 4!  Again, your time and attention is required.

If this list has you backpedaling on the idea of training, thinking that it is better to delay it until they are so old that they learn in a few days, I might mention that if you miss the wonderful window of physical readiness combined with cooperation/response to praise and rewards, you may have to wait a long time.  Kids that aren’t trained, but now get stuck in the power struggle common to the 2.5-4 year-old range, realize what power withholding wields over adults.  So much less attractive than a 24 month-old who sweetly accepts their treat for a job well done!

Looking for more information?  Take a look at some of my other posts on toilet training, such as  Is Slow Progress In Toilet Training A Failure?    If your child has special needs, this might be of interest Why Do Some Kids With ASD and SPD Refuse Toilet Training?.

Want more personal support or have specific questions?  Please visit my website tranquil babies  and purchase a in-home consultation (in the NYC metro area) or a phone/video consult.

 

Is Slow Progress In Toilet Training A Failure?

Children that are slow to learn independent toileting come in many flavors.  There are the children who resist training; they just don’t want to sit on the potty and rewards haven’t made them excited to train.  Then there are the kids who develop fear of painful bowel movements.  And also the children with language and/or cognitive delays, who learn everything at their own pace.

Some kids in the last group spend a lot of time at the stage of scheduled toileting.  They can get to the potty, manage clothing independently or with only a few hints, and wipe, and some can even recognize that they need to “go” without being asked.  They just don’t put the whole thing together.  Is that a failure?

I don’t think so.  I believe that some kids stay at one stage for a reason, and sometimes their reason isn’t clear.  The kids with fears or lack of motivation need an adult to rethink these situations and take action.  A diet change, the use of probiotics or more fluids can make a huge difference.  Finding out that social reinforcers like an older cousin’s comments about the importance of using the toilet can be the key to motivate a toddler.  The biggest mistake, I think, is thinking that there is nothing that can be done. For a child that has fears or avoidance that aren’t addressed , he can assume that this situation is OK with his parents, or that no one is able to help him move forward.

What about the children that learn at their own pace, who take a long time to learn independence in most skills?  I think that being independent but needing to use a scheduled toileting plan is still a big accomplishment, and the need for a schedule can be phased out over time.  Firm routines help, so does pairing toileting with another regularly occurring event like getting dressed, and fading the prompts away one at a time.  If you think about your own behavior, didn’t your mom tell you to “go” before you left the house, regardless of how many times you told her that you had just gone?  Toileting schedule.  Or looking at the clock and using the bathroom before you board a plane to avoid being locked in that nasty in-flight potty?  Scheduled toileting again.

So take another look at your child’s progress and reconsider how you characterize the situation.  It may not be as bad as you think.

 

Why Do Some Kids With ASD and SPD Refuse Toilet Training?

Toilet training is one of the few self-care skills that fall primarily on special needs parents.  Speech therapists, feeding therapists, occupational therapists and ABA instructors all do assessments and create plans.  Hints on toilet training from your therapy team are often very helpful, but “the boots on the ground” are yours as a parent.  You are the one that deals with it when *&%$ happens, as it most certainly will!

Many parents find themselves with children that do not cooperate or become defiant to the entire process of training, regardless of their level of cognitive, sensory or motor involvement.  A child with profound issues can cooperate well, and a child that is in a integrated class can be steadfast in not participating.  What gives?

  1. Sensitivity to multi-sensory input:  The noises, smells, even the lights in a bathroom can be mildly to very irritating to sensitive children.  They may not verbalize it, even if they have lots of language; they just want out.  Try to minimize what you can, and use the sensory calming techniques your OT has shared.  Ask for all her good ideas!
  2. Sensory seekers that aren’t motivated to remove wet or smelly diapers, don’t register the experience, or actually want to explore what is in that diaper.  Some children are at the other end of the sensory spectrum, and may not find the odor and feeling of a soiled diaper offensive or even that noticeable.   See Pull-ups do a wonderful job of reducing the sensory input, so try training pants with a leak-resistant cover. Just like a younger typically-developing toddler, some ASD and SPD kids “smear”, which is exactly what it sounds like: decorating the room and/or themselves with their feces.  This is a behavioral issue with older children, but it also suggests that the motivation to get trained isn’t going to include wanting to be rid of the diaper and it’s contents.
  3. They dislike being exposed to room-temperature air, and wiping/being wiped.  These kids probably have always dislike diapering.  They might avoid you after they have had a bowel movement to avoid being changed.  You may have had to become an expert in the “fast change” so that they are not totally hysterical.  Well, sitting on the pot with their pants off for a while and learning to wipe might be even harder than being diapered.  Try warming the room, get a warmer for the wipes (these exist) and make sure that you communicate that this doesn’t mean they have to sit there for a long, long time.
  4. They hate the feeling of the clothing sliding over their legs.  Time to work on reducing their tactile sensitivity.  It can be done; ask your OT.  And find some super-soft clothes for the toilet-training period.  Fleece shorts, anyone?
  5. Sitting on the toilet seat feels like they are perched over a big scary hole.  Children with poor spatial awareness or poor proprioception aren’t good at judging how large the opening is or how deep.  Add some instability with low tone, and you have a recipe for fear.  Then flush the toilet while they are still sitting, or standing nearby, and that potty seems like it could suck them down!  Try a potty seat and gradually move them over to a toilet once they are confident and independent there. Do more homework exercises on core stability and postural control, and don’t forget vestibular activities from OT.  And consider a child-sized toilet in the bathroom they use most Should You Install a Child-Sized Potty for Your Special Needs Child?.
  6. Without a clear sense of time, sitting there seems like it takes forever.  Kids can have no sense of how long something they don’t enjoy will take.  Use a visual timer, the microwave timer, or your smartphone timer.  My iPad has a visual countdown clock to see when time is up.

These are the most common that I have encountered.  Some of my posts on toilet training children with low muscle tone will also apply to kids with ASD and SPD, so check out  Low Tone and Toilet Training: How Your Child’s Therapists Can Help You  and Low Tone and Toilet Training: The 4 Types of Training Readiness.

The Practical Guide to Toilet Training Your Child With Low Muscle Tone is finally available! My 50-page e-book is for sale on my website  tranquil babies  (or buy a clothbound hard copy if you live in the U.S.) to help you with training.  Check out  The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived!  to learn more about my book and how I can help you navigate potty training without tears!

 

 

Low Tone and Constipation: Why This Issue Delays Toilet Training Progress

Kids with low tone and sensory processing disorders are not the only children who struggle with constipation, but it is more common for them.  The reasons are many:  low abdominal and oral tone, less use of available musculature because they use compensatory sitting and standing (the schlump, the lean, the swayback) patterns, and even food choices that have less fiber.  If you struggle to chew and swallow, you probably aren’t drinking enough and eating those fruits and veggies that have fiber.  Sucking applesauce packets may get you Vitamin C, but it has pulverized all that fiber.  Now add discomfort with the sensory experience: the smells, feelings, sounds of bathrooms and using the potty.  It can all be too much!

Without fluids, fiber and intra-abdominal pressure to support peristalsis (the automatic contraction of the intestines), children with low tone are at a huge risk for constipation.  And constipation makes pooping harder and even painful.  Sensory overload makes kids agitated, distracted, and sometimes even aggressive.  Not good for learning or letting it go into the toilet.  Hence, resistance and even fear of pooping, and therefore more stress and withholding of stool.  A really big problem, one that you may have to get your pediatrician’s assistance to solve.

It can change.  Here is your secret weapon: your child’s occupational therapist.  If you haven’t been involved in your child’s therapy before, this might be the time.  Research has shown that sensory-based issues can contribute to toileting problems, and OTs are capable of evaluating all the sensory and motor-based contributors.  While  your pediatrician gives you recommendations on diet, laxatives and more, your OT can help your child stay in the alert-but-calm zone where digestion is relaxed, get better core stability to help push that poop along, and adapt the toileting experience for minimal sensory aversion and maximal sensory perception.  Take a look at Low Tone and Toilet Training: How Your Child’s Therapists Can Help You and Low Tone and Toilet Training: The Importance of Dry Runs (Pun Totally Intended).

Update:  Many of my clients have been successful with a creative combo approach:  they use stool softeners, they limit refined carbs (sorry, Goldfish crackers are cheese plus refined carbs!), ensure lots of fluids and then add some tasty fiber.  Prunes covered with chocolate have been popular, but beware the results of too much of a good thing!  They use abdominal massage and make sure that their physical and occupational therapists are working those core stabilizers.

There are medications that improve gastric motility, but they aren’t always tolerated or even prescribed for small children.  Pediatricians are very hesitant to be aggressive with a small child that could dehydrate in a few hours of diarrhea.  Find a doctor that listens to you and is creative.  My suggestion?  Think outside the box and consider an osteopath.  They are “real” doctors, but they have more training in alternative and manual treatment approaches.

Think constipation is only going to affect pooping?  Wrong!  Read Is Your Constipated Toddler Also Having Bladder Accidents? Here Are Three Possible Reasons Why to understand more about how this problem can contribute to other toilet training struggles.

Good news!

My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is done and available at  Your Therapy Source ( a terrific site for parents and therapists!), on Amazon as well as on my website, tranquil babies !!  Just click on the “e-book” section, and start making progress with your child today!

I include detailed readiness checklists and a full explanation of how to train your child in all aspects of toilet training.  You will know how to get the right equipment, what clothes to use so that dressing doesn’t derail your child’s best efforts, and how to deal with defiance and distress.  And yes, constipation is addressed in more detail than in this blog post.  It may turn out to be only one of the issues that you have to confront.  Don’t worry, help has arrived!

If you want a hard copy, contact me through my site and request a mailing address for your payment.

            As I say in my book:  be prepared, be consistent, expect to practice, and be positive that you and your child can do this!

 

 

 

 

Low Tone and Toilet Training: How Your Child’s Therapists Can Help You

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Over the years as an occupational therapist, I have been giving parents hints here and there.  Writing my e-book  this fall, and preparing an e-course (coming soon) to support families makes me realize that some clients did not ask me very many questions while they were toilet training their child.

So….Are there aspects of therapy that can help you with toilet training?  Yes indeed!  Does getting more therapy mean that your child will automatically be trained earlier and more easily?  Unfortunately, not really.

When it comes to potty training, you can bring a child to the potty, but you can’t make him “make”.  Toilet training is a complex skill, and even the best therapy will still only prepare all of you and develop important skills needed for this skill.  Bringing it all together is still the job of the parent or the full-time caregiver that creates and executes the plan. Waiting for readiness?  Read Waiting for Toilet Training Readiness? Create It Instead!  to understand what you can do today to inspire interest and build skills. Thinking that it’s too soon?   How Early Can You Start Toilet Training?  will shad some light on what is really important when you are wondering if your child is old enough.  If you are wondering if your child’s diagnosis is part of the issue, take a look at Why Do Some Kids With ASD and SPD Refuse Toilet Training?  And finally, if you are eager to move into night-time training, read Why is Staying Dry at Night So Challenging For Some Children? for support at the finish line of toilet training.

Here is a list of what therapy can do to support you and your child for toilet training.  If you haven’t heard your therapists discussing these treatment goals/approaches, you might want to share this post with them.  They may be more focused on other very important skills right now, but always keep your discussions open and inform them that you are planning on training.  Most therapists are very eager to support families whenever they can with whatever goals the family has.

  1. Core stability for balance, abdominal strength and safety on the toilet.  Most kids with low tone do not have great core stability, and this is where the rubber meets the road.  A weak core will put a child at greater risk of falling or feeling like he will fall.  It is harder to relax and pee/poop if you are afraid you will land on the floor.
  2. Clothing management and hand washing.  No child is really independent in using the toilet if someone else has to pull clothing up and down.  Washing hands is a hygiene essential.  Time to learn.
  3.   Good abdominal tone.  See #1.  Helps with intestinal motility as well.  That is the contraction of smooth muscle that moves the poop through the colon and on out.  My favorite hack is the use of kineseotape in the classic abdominal facilitation pattern.  All but one of my clients have had a nice big bowel movement the next day after taping; no pain, no fuss.  Regular taping along with strengthening can improve proprioceptive awareness internally (interoception, for those of you who need a new word for the week!)
  4. Transfers and equipment assessment/recommendations.  Therapists can teach your child how to get on/off, up and down safely from a toilet or potty seat.  They can teach you what to say and do to practice transfers and how to guard them while they practice.  They can also take a look at what you already own and what you might need to obtain.  Children with significant motor issues may need an adaptive toileting seat, but most mildly to moderately low-toned kids do not need that level of support.  What they do need is safe and correctly-sized equipment.
  5. Proprioceptive awareness for balance and stability.  Some therapists use balance discs or boards, some use other equipment.  Swings, climbing, jumping, etc.  More body awareness= more independence.
  6. Sensory tolerance for the feeling of clothing, using wipes/TP, the smells and the small enclosure of a bathroom.  If your child has sensory sensitivity issues in daily life, you have to know that they are going to be issues with toilet training.
  7. Effective vestibular processing.  Children that have to turn around, bend and look down then behind their bodies to get TP or pull up their pants need efficient vestibular systems.  Vestibular processing isn’t just for walking and sitting at a table for school.
  8. Practicing working as a team and following directions.  Your child needs to be responsive to either your praise, your rewards or both.  Therapists that support independence (all of us!) and develop in your child the sense that the she is a part of the therapy plan will make it easier for your child to work with you on toileting!

Want more information on potty training?  Read my first book or call me for a consult!

 My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone is now available at Amazon.com as well as Your Therapy Source ( a terrific site for parents and therapists)  and on my website,  tranquil babies .  Families are telling me that they have made progress in potty training right away after reading my book!

Read The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived!  to learn how my book will help you and your child move forward today!

Want 30 minutes of my time to problem-solve things?  Visit my website  Tranquil Babies and buy a Happiest Toddler on the Block session.  We don’t have to do HTOTB; we talk about whatever you need!  I can’t do OT with you, but I can give you potty training advice an behavior strategies that really work!

Low Tone and Toilet Training: What You Can Learn From Elimination Communication Theory

Yes, those folks who hold a 6 month-old over the toilet and let her defecate directly into the potty, not into a Pamper.  Elimination Communication (EC) has committed fans, as well as people who think it is both useless and even punishing to kids.  I am not taking sides here, but there is one thing that should get even the skeptics thinking:  a large portion of the developing world deals with babies and elimination this way.  It is very hard to buy a disposable diaper in Nepal, and it is a problem finding water to wash cloth diapers in the Sahara.  I know there are a bunch of parents who roll their eyes whenever EC comes up, but some aspects of the process could help you train your child to use the toilet.  Why not consider what you could learn from EC that will help your child?

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First, parents who practice EC become very very good at anticipating when their kids are going to need the toilet.  Signs such as grunting, flexing the trunk forward, even facial expressions are quickly noted.  If you spend a lot of time watching your child then you probably know some of the signs.  This makes it easier to tell them to sit on the potty when their attempts will actually be successful.  You can also help them connect the physical feelings they are reacting to with language.  Telling them that when they get that feeling in their belly, they need to go use the toilet sounds so obvious to us.  But if you are little, you need help connecting the dots.  If you are little and have learning issues, you need to hear it more often and stated clearly.

Secondly, EC counts on knowing that reflexive intestinal movement happens about 30 minutes after food enters the stomach, and kidneys dump urine into the bladder about 30-45 minutes after a big drink.  Unless your child has digestive issues, this is a good start to create your initial potty schedule plan.  Kids with constipation or slow stomach emptying may take longer, but you already know that you have to work on those issues as well to be successful in toilet training.  Remember, if your child is roaming the house with a sippy cup, it is going to be a lot harder to time a pee break so that they have a full bladder (remember the issue with poor proprioception of pressure in low tone?).  If not, check out  Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!)  Toilet training is a good time to limit drinking to larger amounts at meals and snacks.  This will work for preschool preparation as well.  Most programs would not allow your child to wander with a cup for hygiene reasons, and you are helping them get off the “sippy cup syndrome”, in which children trade bottle chewing for sippy cup slurping.

Think that embracing EC fully will fast-track your kid?  Not necessarily.  In fact, some EC kids struggle to become more separated from a parent as they are not cradled any longer while “making”.  Taking responsibility for their own hygiene and awareness can be harder for some very attached children than if they were using diapers and used them independently.  But EC concepts are something to think about carefully when you are making your plan to help your child with low muscle tone.

 

 

Low Tone and Toilet Training: Kids Need To See How It’s Done

Low muscle tone creates more challenges for toilet training, but that means parents need to focus on getting all the parts of teaching and practicing down right.  If your child is unfocused or inattentive when you speak about potty training, you can try books and videos. Sometimes the use of media will spark interest and generate excitement.   If you don’t see an immediate boost in interest and cooperation, then your child might need a front row seat for a live demo.  By you (or your partner).

I know, most of us want privacy for this activity, even between couples.  Most women I know aren’t enthusiastic about the idea of demonstrations.  But many kids, and almost all kids whose communication and attention skills are delayed, really need to see what’s going on when you use the toilet.  Kids that have issues like ASD may have been present for your bathroom routine but they were paying attention to something else.  It is time to make a point of having them watch this very personal but important skill.

Sometimes you pick the moment, and sometimes it picks you.  If your child happens to be around and nature calls, bring them along.  If they wander in while you are using the bathroom, don’t send them out.   You may also have to make this “appointment viewing”.  Plan for it, so that you aren’t tearing them away from an activity they have chosen.  Being dragged away from fun to stand there watching isn’t going to work.

Be descriptive, use nouns and verbs.  Saying what you are doing provides them with more language about these activities.  They need to know how to describe to you what they are feeling before and during.  If your child signs, it is time to learn the relevant signs and teach them.  Here is the place where the signs make sense, in the bathroom.

If your son thinks that peeing into the shrubs/snow outside with daddy is the best thing in the world, take the show outside, neighbors permitting. Not everyone is so open to this idea.   I know a family that said that this game was so much fun that her son begged for more juice so that he would have more urine available for the game!!

 

 

Great news!  My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is done and available!  Visit my website tranquil babies and click “e-book” on the top ribbon.  I will proudly say that there is nothing out there that explains exactly why low tone makes training so much harder, then gives you readiness checklists and real-life strategies that work!

 

Low Tone and Toilet Training: The 4 Types of Training Readiness

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When clients ask me if I think their child is ready to potty train, my answer is usually “Tell me more about the readiness signs you believe you are seeing.”  There are numerous factors to consider when assessing toilet training readiness if a child has low muscle tone.

Here are the four types of readiness that every parent needs to look at to determine whether their child with low muscle tone is ready to start potty training:

Physical Readiness

After about 18 months, most children can keep a diaper dry for an hour or more.  Their sphincter control increases, and their bladder size does too.  This isn’t conscious control; it is physical development.  Kids with low tone can take a little longer, but without additional neurological issues, by 24 months many of them will be able to achieve this level of physical skill needed to accomplish daytime urinary continence.  Bowel control is usually later, and nighttime control is later still.

Achievement of the OTHER physical readiness skills are less predictable.  These skills include:

You will notice that children need enough skill, not amazing or even good skills.  They just need enough ability to get the job done.

I need to mention that issues such as constipation can derail a parent’s best plans.  Kids with low tone are more likely to have this problem.   Read my post Constipation and Toilet Training  for some ideas on how to manage this issue and who can help you.  The best time to manage constipation is before you start training.

Cognitive/Communication/Social Readiness

The trifecta for toilet training readiness in typical children is a child who is at the 16-20 month level of cognitive/communication/social skills.  This child has the ability to follow simple routines and directions, can understand and communicate the need to use the toilet and express their basic concerns, and is responsive to praise or reward plus interested in learning a skill.  If your child has receptive language issues (difficulty understanding what you are saying) then read Targeted Toilet Training Strategies to Help The Child With A Receptive Language Delay for some specific strategies for this situation.

What about children with global developmental delays?  They absolutely can be toilet trained.  I have worked with children who have no verbal skills and perform tasks like dressing and self-feeding only by being prompted, but they can use the toilet with very little help.  Do they always know when to “go”, or do they simply follow a schedule?  Well, to be honest, sometimes they toilet on a schedule for quite a while before they connect the physical impulse with the action by themselves.  But they are dry all day.  The essential abilities are these:  they know what they need to do when they sit on the potty, and they know that they are being praised or rewarded in some other way for that action.  That’s it.  Have faith; children with developmental delays can do this!!

Some children with low tone have no delays in any of these areas, but many have delays in one or more.  The most difficult situation with cognitive/communication or social readiness?  A child who has developed a pattern of defiance or avoidance, and is more committed to resisting parental directions than working together.  Toddlers are notoriously defiant at times, but some will spend all their energy defying any directive, must have everything their way or else, and can even enjoy being dependent.

If this is your child, job #1 is to turn this ship around.  Toilet training will never succeed if it is a battle of wills.  And no adult wants it to go that way.  Repair this relationship before you train, and both of you will be happier.  You don’t need a child psychologist consult to do it, either.  Read my posts on the Happiest Toddler on the Block methods for ideas on how to use “Gossiping” Let Your Toddler Hear You Gossiping (About Him!)and  Turn Around Toddler Defiance Using “Feed the Meter” Strategies to build a more cooperative relationship with your child.

Family Readiness

Research suggests to me that the number one indicator for training is when the parents are ready.  Sounds off, right?  Isn’t it all about the child’s abilities?  But if the family isn’t really ready, it isn’t likely to work.  I worked with a family that had their first 3 children in rural Russia.  Boiling dirty diapers on a wood stove makes you ready ASAP! Their son born in America was trained much later than his sisters because Pull-ups made it easier to wait, not because he wasn’t ready. Families need the time to train, time to observe voiding/elimination patterns, and time to identify rewards that work for their child.

They need to be prepared to be calm, not angry, when inevitable accidents happen and to avoid harsh punishments when a child’s intentional avoidance creates an accident.  They have to be ready to respond to fears and defiance, and then handle the new independence that could bring a child freedom from diapers, but more insistence on control in other areas.  Many of my clients have nannies, and most parents have partners. Every adult that is part of the training process has to be in agreement about how to train.  Even if they are more cheerleader than “chief potty coach”, it is either a team effort or it is going to be a confusing and slower process.  Check out Toilet Training Has It’s (Seen and Unseen) Costs for more information about how the process of training has  demands on you that are not always obvious.

Equipment Readiness

Do you have a stable and comfortable potty seat or toilet insert?  How will your child get on and off safely?  Do you need a bench or a stair-like device?  Grab bars?  Do you have wipes or thick TP? Enough clothing that is easy to manage?  Underwear or pull-ups that also do the job?  One of my clients just texted me that having a mirror in front of her daughter seemed to help her manage her clothing more independently.   A few weeks ago we placed the potty seat against a wall and in the corner of the room so that if she sat down too fast or hit the edge of the seat with her legs while backing up or standing, it wouldn’t tip and scare her.  No rugs or mats around, so she won’t have to deal with uneven or changing surfaces as she gets to the potty.

Really think out the whole experience for safety, simplicity, and focus. You might want to install a child-sized potty in your child’s main bathroom Should You Install a Child-Sized Potty for Your Special Needs Child?.   If you want to learn what your child’s occupational and physical therapists know to assist you with toilet training, ask them Low Tone and Toilet Training: How Can Your Child’s Therapists Help You ?

You can now see why parents rarely get a simple answer when they ask me if their child is ready to train.  I will say that since they are asking the question, they may be ready, and that is one of the four types of readiness!

Need more help with toilet training?  I wrote an e-book on toilet training for you!

The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is available as an e-book on my website, tranquil babies, on Amazon  or at Your Therapy Source ( a terrific site for parents and therapists!).  If you want more guidance to evaluate your child’s toilet training readiness and learn how to prepare them well, this is your book!  It includes readiness checklists and very specific strategies to build readiness.  Think you are ready to jump in and start training?  My book will guide you to choose between the gradual and the “boot camp” approach, and it addresses the most common stumbling blocks children experience on the road to independence.

Read my post The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived! , to learn more about this unique book and see what it can do for you today!

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Low Tone and Toilet Training: The Importance of Dry Runs (Pun Totally Intended)

In my posts about choosing a potty seat, How To Pick The Best Potty Seat For Toilet Training A Child With Low Tone  then picking clothes and learning to wipe, Low Tone and Toilet Training: Teaching Toddlers to Wipe,  planning and preparation for potty use was emphasized.  Kids who are unsteady and struggle with coordinating actions need to have really good skills under pressure to use the toilet successfully.  I am going to give you my best strategy yet for potty success:  dry runs.

It is exactly what it sounds like.  Nobody has to “go”.  It is practice managing the clothes, the toilet paper, and the movement transitions (sit, stand, turn around) of toileting.  Some kids are old enough to understand the concept of pretending, and some may be a little confused.  Even if they are uncertain about it, you should still work on these skills at times when they don’t have to toilet.  You can say explicitly that we are pretending, practicing, or phrase it however you wish.  In my private practice, I use “work clothes” for dressing practice.  Kids change their clothes at the beginning of our session, and then change back into their original outfit at the end of the session.  Once it is our routine, kids don’t complain much.  It doesn’t hurt that the activity I offer right after putting on “work clothes” is one of their favorites, and so is the activity we do after taking them off at the end of our session.  Twice the practice, but also no stress to get out the door to daycare, no fatigue at the end of the day.

Dry runs do not have to be a full dress rehearsal.  You can break it up into just practicing pulling pants down/up, or standing up and sitting down smoothly.   For kids that cannot handle changing routines but aren’t ready to do a full dress rehearsal, perform some of the steps for them at first, rather than leaving them out.  Talk about what you are doing, and try to keep their attention on you as you perform some of the actions.  Children at all levels of skill need to be at least aware of each step.

Each child will have their own specific challenges, but there are some aspects of toileting that can challenge kids with low tone:

  • Where to grasp clothing, how to place fingers for a stable grip, and how far to pull pants down need to be clear.
  • Where to place their feet for a stable stance.  Kids that have poor proprioception won’t automatically place their feet in the right spot, and splints/braces can give them stability but remove even more proprioceptive and tactile input.  They might need a marked spot for foot placement on the floor or on the step stool.
  • If they are standing up to wipe or pee, they may need to hold on to something with one hand.  Be very clear where that spot is and what objects are bad choices to hold onto.
  • Children who also have language, memory, modulation and attention issues may need very specific, very short and very familiar verbal cues.  The same cue that is said  in the same way helps them to stay calm and focused.  Figure out what prompts are understood quickly and use them every time.

Dressing skills in general are important to learn for all children, even kids with global and profound delays.  Independence changes a person’s self-image, and kids with low tone often stay dependent in many skills long after toddlerhood.  Make it clear that you are proud of them and value their emerging abilities.  Children want to please, even the defiant ones, even the kids with cognitive and behavioral issues.  They all want to please adults in their lives.  Even when they don’t seem to, they do.  They also want to be independent and control aspects of their daily lives.

Go have some “dry runs” and see if it moves your child’s toilet training forward this week!

 

Want more assistance than just reading blog posts?  Visit my website tranquil babies and purchase a video or phone session!   You can ask questions, get a review of your set-up and your equipment, and learn new techniques.

 

Low Tone And Toilet Training: Pull-Ups or Cloth Training Pants?

My post on clothing choice when toilet training a child with low muscle tone  Low Tone and Toilet Training: Teaching Toddlers to Wipe covered a lot, but it did not include a very important garment:  underwear.  I am putting pull-ups and their generic equivalents in the underwear category.  Many would not, as they are as absorbent as a diaper, disposable, and most children themselves do not think of pull-ups as step toward being a big boy or girl.  Apparently they do not watch or believe the ads.

Here is why it is worth thinking about your choice of undergarment:

  1. Kids with low tone often aren’t as aware of touch input as other children, and aren’t bothered by the very mild warmth and wetness of an absorbent undergarment.  Sometimes they don’t even notice it at all.  That will make it harder to recognize when they have had an accident, or when they need to get to the toilet right now.  This sensory-based issue is one of the two big issues with teaching low-toned kids Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!).  Being able to dash to the potty and successfully avoid an accident is a big deal for them.  This is an accomplishment, and wearing a garment that prevents them from experiencing success reduces training progress.
  2. I understand that having an accident is not fun for either the child or the parent, but it is memorable.  No one learns unless the lessons are memorable.  Understanding what those body signals mean and respecting them is the cornerstone of training, and for kids that need to listen to their bodies, it is essential that they not ignore them.  The Baby Whisperer even encourages parents with children that refuse to sit on the potty and intentionally make in their pants (not exactly an accident, but a mess nevertheless) to take off their clothes themselves and jump in the tub, then wash themselves off.  They get some help, but this isn’t playtime.  There is no quick wipe-off as they stand in front of the TV, watching the show they refused to leave to go potty.  Her thinking is that it is not done as a punishment at all, it is a natural consequence of intentionally not answering the call of nature.  No harsh words, no threats, but no continued watching of that show either.
  3. These children are often unsteady when they are calmly standing still, so being in a rush to pull their underpants down to use the potty is not likely to make them more stable and coordinated. Picking a garment that they can pull up and down easily under pressure is the only kind way to go.   You may have to try both to see what your unique child can manage, and do dry runs Low Tone and Toilet Training: The Importance of Dry Runs (Pun Totally Intended).  I explained it to a stylish mom this way:  if you have to use the toilet really badly and you have spanx and stockings on, think about how embarrassed you would be not to make it in time.  That is what many kids feel every time they need to go.  Dads, if you do not know what spanx are, ask!  Imagine wearing bike shorts under your khakis. Then add thin long underwear over the bike shorts.  Got it?
  4. Some kids are mature enough to care about the graphics on their clothing, and it’s enough to motivate them to commit to toilet training in the first place.  If you can only find the specific superhero that your son adores on a pull-up, you may have to use it, at least at first, to get him excited about learning.
  5. The companies that manufacture pull-ups would like you to believe that they are the only way to get out of diapers.  They are not. You can use cloth training pants, which have a thick crotch area to absorb small accidents.  Some parents have their kids wear 2 pair at a time for extra protection.  They aren’t that bulky.  You can also buy breathable waterproof covers for these pants.  The quality and comfort of these covers has improved over time.  But they do not have a princess on them…
  6. If you go for the cotton pant/waterproof liner combo, you will have to be more vigilant and have kids change out of them more often.  Some kids have more sensitive skin, so make sure you are giving them a little diaper cream as a barrier if you know that your child has had some diaper rash as an infant. As your child stays dry for longer periods, you can even take off the cover for more breathability.
  7. Pull-ups are one-and-done, no way to decrease the level of absorbency and safety.  There is one strategy that “kinda” works for the younger kids:  a pair of underwear and then the pull-up.  They get wet/soiled and kids have a modified experience of an accident without as much mess.  But even this solution limits the real-life experience of really, really having to get to the toilet on time.  This is one reason why children do not want to give up the pull-up.  The older toddlers understand all too well that it is a huge leap from diapers or pull-ups to a thin pair of underwear.  That seems to me to put a lot of pressure on a small child.  I think that this is one reason that toilet training all children has moved later and later.  It has nothing to do with less pressure on them to train or more freedom of children to choose.  They are afraid to fail at something that their parents clearly value.  They want to please us and succeed for themselves.   We should do absolutely everything we can to help them feel good about themselves while learning this important life skill.  Having an accident can be an opportunity to learn and not be judged.

Low Tone and Toilet Training: Transition to Using The Adult Toilet

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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:

  1. Have enough sphincter control to “hold it” while getting clothing and positioning right.
  2. 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).
  3. 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.

41lLLbRbbkL._AC_US160_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.

52733343312610pThe 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 , Is Your Child With Low Tone “Too Busy” to Make it to the Potty?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 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!

Wish you had someone to ask about toilet training a child with low muscle tone?  You do now!  Visit my website,  tranquil babies , and purchase a phone consultation to get personalized attention, and a chance to ask all your questions!

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Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!)

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Most parents assume that toilet training a child with low tone (also called hypotonia) isn’t going to be easy. A child with low muscle tone often crawls later, walks later, and may speak later.  But  low tone can affect toilet training in ways both obvious and subtle.  As an occupational therapist, I want to share an explanation of why one of the consequences of low muscle tone can make teaching this skill just as hard as teaching your child to walk independently.  Hint:  it isn’t something you can see, and it isn’t balance or stability. (both very important, but quite visible, consequences of low tone).

When muscles are not “sitting at the ready” for use as they are in normal tone, it takes more time, more stimulation, more effort or all three to get them to contract and tighten.  But it also means that the receptors inside the muscles of the bladder, the rectum, and the abdomen are not firing as frequently or as strongly.  The brain’s interpretation of a change from resting state to the stimulation of stretched receptors is known as proprioception.  The special ed teachers I work with in Early intervention would call it “body awareness”.  This internal awareness of a change in pressure within your bladder wall, in your rectum and against your pelvic wall is what compels you and I to get up and go to the bathroom.  This is “interoception“, proprioception’s internal version.  With low muscle tone, your toddler is honestly stating the truth when they tell you that they don’t feel like they have to “go” and then they pee on the floor right in front of you.  They may have only a very weak sensation of fullness, or it may only be perceived a few moments before they really have to go.  That is what lower proprioceptive registration is like.  All of a sudden, the level of muscle receptor firing has reached a point where it is perceived.  And now there is a puddle on your floor.

What can you do?  

There may never have been a better time to get this going Potty Training in the COVID-19 Age .  In previous posts I have mentioned that all the strategies to develop cooperation and frustration tolerance are keys to teaching a toddler anything at all. I go into more details about readiness in Low Tone and Toilet Training: The 4 Types of Toileting Readiness .  When you are facing an issue where the feelings that you are trying to sensitize them to are fleeting and invisible, you are going to need them to be very highly motivated indeed.  That means that you work on Happiest Toddler on the Block techniques such as patience stretching and “feeding the meter”.  These create positive parenting interactions that help your toddler listen to you when you tell them it is potty time and then keep them on the toilet long enough to make things happen.  If your toddler ignores your directions unless it is something he wants to do, and engages you in defiance games constantly just to see your reaction, you have some work to do regarding his behavior before toilet training is going to be successful.

Here are specific suggestions for toilet training the child with low muscle tone:

  • They need stronger physical sensations at the time when you sit them down on the potty. A full bladder stretches, and that stretch of the muscle wall is what they don’t feel unless it is a profound stretch. That means that they should drink a larger amount of liquid at specific times, so that bladder is really full at a predictable time. Yes, it means that roaming the house with a sippy cup will not work for toilet training.  A half-full bladder isn’t going to give enough sensory input but it will empty when they bend forward or squat.   If you have done the patience stretching and feeding the meter techniques from Happiest Toddler on the Block, your toddler can handle the change in beverage scheduling and they will be fully hydrated at all times.  They are just not drinking all day long.  The same thing can be done with meals, allowing for small snacks but having real toddler-sized meals, not grazing throughout the day.  Full colon= more contractions and more sensations.  A diet with fiber makes the poop firmer, and therefore sensations in the colon are more obvious.  A higher-fiber diet is a good way to prevent constipation as well.   This is a summary of a recent comment from a parent that used these methods:  She told me that using this strategy made her life so much less stressful when taking her daughter out of the house for preschool or appointments.  She knew that her child had fully emptied her bladder and wouldn’t be taking a big drink again until lunch.  She didn’t have to scout out bathrooms constantly and keep watching her daughter for little signs that she needed to “go”.  Makes sense to me!
  • Watch your child closely, and see what their current voiding/defecating schedule seems to be.  Not every person is like clockwork, but you need to know when they are likely to go once you have the drinking and eating schedule down.  What goes in will come out.  Kidneys are more reliable than intestines.  About 30-45 minutes after a big drink, that bladder should be filling up.  For some children it can be 20-25 minutes. Then you know when to get them on the potty.  There is no point in sitting there when they are close to empty.  Everyone gets irritated.  Is your child unwilling to drink enough?  You may need to offer a better beverage, such as a yogurt drink or chocolate milk.  Serve them with a “silly straw” and watch that drink disappear!
  • These children just don’t have that much abdominal muscle tension to help with voiding, so the physical position they are in can help or hurt their efforts.  Sitting with your knees lower than your hips and your body leaning back reduces the intra-abdominal pressure.  You want to increase their ability to push gently, so sitting on a floor potty in a slightly flexed position can help them contract their abdominal muscles and push with their feet to get some pressure going.  Heavy straining is not recommended and so do not demonstrate or encourage superhero-sized force. Read my post on selecting potty seats that help your child do the deal. Picking A Potty Seat For Toilet Training A Child With Low Tone
  • Don’t distract them from the job at hand.  You might not be comfortable with a long conversation about toilet activities, but if they are chatting about Thomas the Tank Engine while that pee is coming out, they have no idea how it happened or what it felt like just before the stream started.  They missed out on becoming more aware of the sensory experience, and low muscle tone can make that sensation very fleeting and vague for them to begin with.  If they arrived on the potty full and ready to do their thing, this doesn’t have to be an extended bathroom visit.  This bathroom trip is all about the process of using the toilet, not a rehash of what they did at school that day.
  • Last, and probably obvious to most parents, is that you cannot shame a child for not recognizing a sensation that is not easily perceived because of low muscle tone.  They didn’t cause this issue, and once they are motivated to use the toilet, they would like to please you and feel proud of themselves too.

For more information about managing toilet training with low tone, take a look at these posts:      Is Your Constipated Toddler Also Having Bladder Accidents? Here Are Three Possible Reasons Why  and Should You Install a Child-Sized Potty for Your Special Needs Child?

If your child has mastered the potty seat but isn’t ready for the “big time”, read Low Tone and Toilet Training: Using The Adult Toilet for two pieces of equipment that can raise their game, and a few other strategies to help them make the switch to using an adult toilet.

Want a guide to toilet training?

 I wrote an e-book for you!

I am so excited to offer parents a comprehensive manual that prepares them well and explains so many of the confusing situations that they encounter.  Don’t be afraid to train….be prepared!  Learn more how my e-book can help you make changes in your child’s skills today by reading The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived!

Here’s what parents are saying about The Practical Guide”:

The Practical Guide has truly been heaven sent!  Although my globally delayed 5-year old daughter understood the idea of toileting, this skill was certainly not mastered.  Our consultations with Cathy and her guide on how to toilet train have given me the knowledge I’ve needed to understand low tone as a symptom that can be tackled.  Morgan has made visible advances, and I am so encouraged and empowered because I know what piece we need to work on next.  Thank you, Cathy, for writing this book!”      Trish C, mother of Morgan, 5 years old

“I would often say to myself “Cathy has to put all of her accumulated wisdom down into a book”.  I am happy to say-here it is!  You will find no one with more creative and practical  solutions.  Her insights and ideas get the job done!”     Laura D. H., mother of M., 4 years old 

Cathy has been a “go-to’ in every area imaginable, from professional referrals to toilet training.  I can’t say enough positive things about her.  She has been so insightful and helpful on this journey.”  Colleen S. mother of two special needs children

How do you buy my book?  Three ways:  Buy it at my website tranquil babies, on Amazon.com, or visit your therapy source, a wonderful site for parents and therapists.

 

Need more than toilet training advice?  

I wrote a more comprehensive e-book for the parents and therapists of young children with hypermobility!

Read my post The JointSmart Child Series: Parents of Young Hypermobile Children Can Feel More Empowered and Confident Today! to learn how my new book, The JointSmart Child:  Living and Thriving With Hypermobility will help you with all aspects of raising a hypermobile child, from selecting the best equipment to communicating with your child’s doctors!  It is currently available on Amazon.com as a digital download, and it is a printable download with a clickable table of contents on Your Therapy Source!

 

For even more support with your toddler, visit my website tranquil babies and speak with me directly by purchasing a phone/video consultation.  You will be able to ask your specific questions and get up-to-date equipment recommendations and more!

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