Kids with low tone benefit significantly from supportive seating for eating, playing, and yes, toileting. Picking the right training potty can make all the difference for them, and their parents. My new favorites for smaller children (smaller than the average 3-4 year-old) are the Little Colorado Potty Chair and the Fisher Price Custom Comfort Potty seat. For older or larger children, I suggest that you take a look at my post on using the adult toilet for equipment ideas. Equipment matters, it really does. Why? Let me give you a short review of what potty seats need to provide for children, and why.
Low muscle tone makes children less stable, and when they are using a toilet, they are not sitting/standing passively. For little boys, you also have to consider standing to urinate. Although it can be easier to start teaching a boy to urinate in sitting, it seems to me that it quickly becomes natural and physically easier for all but the most unstable boys to shift to standing. This means that they may need to hold onto the raised seat for stability or hold onto the edge of the vanity cabinet or even a handrail.
Selecting a potty seat is seating them for action! They need to be able to sit straight, get on and off independently and safely, and feel stable enough to let go. The right seat will let them be slightly flexed forward with knees up above their hips a tiny bit. This allows them to use their abdominal muscles more effectively to perform a gentle Valsalva Maneuver.
This position is the way traditional cultures “make”; they squat and bend forward, increasing the intra-abdominal pressure to help empty their bowels without straining or holding their breath. Children with low tone almost always have weak abdominal musculature, and can even have poor smooth muscle contraction of the lower intestine. That slows the timely movement of feces, contributing to constipation and straining. Have you ever had the indignity and frustration of trying to have a bowel movement in a bedpan? Enough said.
Learning a new skill, a skill that is not visible and involves both motor, sensory and cognitive abilities, is best done with equipment that fully supports skill development. Children often have fears, including fears of falling in. They get frustrated and don’t want to bother to sit when they could be playing. The list goes on. Pick well and a child can learn faster and become more independent. Pick poorly and learning can be slower, more uncomfortable or embarrassing, or convince both of you to just give up for now. Want your OT or PT to help you decide? Read Low Tone and Toilet Training: How Can Your Child’s Therapists Help You ? and see all the things that therapists can do to help you train your child.
Here is a short review of what my favorite seats have to offer:
Fisher Price Custom Comfort Potty Seat
- This seat delivers a lot of support, with both a high back and armrests. A child can feel very supported and safe.
- Kids can use the armrests to re-position themselves independently and get on/off with less or without help.
- Small size helps the younger or smaller child get their feet flat and have a better sense of their body position. Even with the ability to raise the seat an inch or two, it is pretty short.
- All-plastic construction is easy to clean.
- A splash guard is molded into the bucket for those little boys who need some redirection.
- Compact size is easier for travel. Not if you have a Mini Cooper perhaps, but if you have larger car, you will be able to take your child’s comfortable potty with you on trips. Nothing ruins a good time like accidents or constipation because a child is too anxious or unstable to “go”.
- this is not one size fits all; the older and wider child could feel cramped or have their knees way too high for good posture or even comfort. A shallow seat makes it harder for larger boys to aim accurately when peeing, and doesn’t give taller children of both genders enough input through their thighs for postural control. Imagine sitting on a tiny little seat; you have to work extra hard to stabilize your body.
- The short curved armrests may be angled too much to help with standing/sitting if a child really needs support. They are not independent if they need help to get on and off the potty.
Little Colorado Potty Chair
This natural wood chair looks like what it is: a traditional commode-style potty. You can get it in a painted version, and I would opt for that, since the extra layers of finish should be the easiest to clean.
- You can get some add-ons that have benefits: a toilet paper holder and a book rack that attach on either side. The TP roll holder gives a child some independence with wiping (as long as they don’t think that rolling it out to the end is a fun game) . I would think twice about the book rack for a child that struggles to perceive sensation from the bowel or bladder. Lots of kids like to look at books while waiting, but for some kids any distractions hinder the ability to accurately perceive bladder/bowel information. Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!)
- This chair has a wide, straight back and straight armrests for extra stability and support.
- This chair is higher, wider and deeper than the FP chair above. For bigger kids or older children who are being trained later due to developmental delays, this is a big help. It is hundreds of dollars less than the adapted toilet chairs that kids with more severe or multiple delays really need. Most children with low tone are not going to need that level of stabilization, and getting more support than you need is not helpful, it slows down independence.
- The bucket insert doesn’t have a splash guard. That means that little boys especially must be positioned well. Kids with low tone often shift around more than the average toddler, so keep and eye on the position of everything while using this seat.
- This chair is not travel-friendly, unless you drive an Escalade or a Tahoe. It is affordable, so if you have a summer home or if you visit relatives regularly, you can pick up a pair and leave one there.
Neither chair plays music when you pee, has characters all over it, or does anything else but let your child sit there in peace, stable and ready to do the deal. If you truly need those other things, I guess you could sing a potty song and find some stickers. Hopefully your child will be able to train quickly and then advance to the next level: using the adult toilet.
If you have a tall toddler, or your child is over 3.5 years of age, you may not have much choice. The best system for very unsteady kids is shown in this post Low Tone and Toilet Training: Transition to Using The Adult Toilet , and I have also seen people use something call the Squatty Potty footstool for a bit higher support than the Baby Bjorn stool that I love. The area for foot placement is relatively small, so kids that pay no attention to where their feet are might not be ready for this one. The squatty folks make a foldaway one with a tote bag that you could take when you go out and use discreetly in public toilets. Genius.
Want more information about toilet training the child with low tone? I wrote a book for you! Visit my website tranquil babies and click on the e-book section in the top ribbon. This book gives you extensive readiness checklists that help you make a plan, it teaches you how to navigate problems like refusals and fears, and explains why low tone is such an issue with toilet training!