Tag Archives: low tone and toilet training

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!

 

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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.
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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.

And of course, my e-book, The Practical Guide to Toilet Training Your Child With /Low Muscle Tone will help you will all aspects of potty training.  Read more about this unique book here:The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

Here is a short review of what my favorite seats have to offer:

Fisher Price Custom Comfort Potty Seat

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Pros:

  • 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”.

Cons:

  •  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

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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.

Pros:

  • 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.

Cons:

  • 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.  And then there is the child-height toilet.  It isn’t difficult to find online, and even the big box stores like Home Depot and Lowe’s carry them online.  It can mean the difference between fear and confidence, so check out Should You Install a Child-Sized Potty for Your Special Needs Child?.

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. It is also available on Amazon.com and Your Therapy Source.  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!

Looking for seating that isn’t a potty seat?  Check out The Cube Chair: Your Special Needs Toddler’s New Favorite Seat! ,  Kids With Low Muscle Tone Can Sit For Dinner: A Multi-Course Strategy and A Simple Strategy To Improve Your Child’s Posture In A Stokke Tripp Trapp or Special Tomato Chair.