Tag Archives: potty training

Toilet Training For Preschool And Stuck in Neutral? Here’s Why…..

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Many of my clients are in a rush to get their kid trained in the next few weeks for school. They have been making some headway over the summer, but things can stall out half-way through.  Here are some common reasons (but probably not all of them) why kids hit a plateau:

  1. They lose that initial boost of excitement in achieving a “big kid” milestone.  Using the potty isn’t an accomplishment now, it is just a chore.
  2. Parents and caregivers aren’t able to keep up the emotional rewards they need.  It is hard to be as excited about the 10th poop in the potty as the first time.
  3. The rewards used aren’t rewarding anymore.  A sticker or a candy might not be enough to pull someone away from Paw Patrol.
  4. An episode of constipation or any other negative physical experience has them worried.  Even a little bit of difficulty can discourage a toddler.
  5. Too many accidents or not enough of a result when they are really trying can also discourage a child.
  6. Using the potty is now a power play.  Some kids need to feel in control, and foiling a parent’s goal of toileting gives them the feeling that they are the ones running the show.  “I won’t” feels so much better than “I did it” for these kids.
  7. Their clothes are a barrier.  When some families start training, it is in the buff or with just underwear.  Easy to make it to the potty in time.  With clothes on, especially with button-top pants or long shirts, it can be a race to get undressed before things “happen”.
  8. They haven’t been taught the whole process.  “Making” is so much more than eliminating.  Check out How To Teach Your Child To Wipe “Back There” and The Ten Most Common Mistakes Parents Make During Toilet Training for some ideas on how to teach the whole enchilada.

Should you pause training? The answer is not always to take a break.  I know it sounds appealing to both adults and kids, but saying that this isn’t important any longer has a serious downside.  If your child has had some success, you can keep going but change some of your approaches so that they don’t get discouraged or disinterested.  If your child really wasn’t physically or cognitively ready, those are good reasons to regroup.  But most typically-developing kids over 2 are neurologically OK for training.  They may need to develop some other skills to deal with the bumps in the road that come along for just about every child.

Sometimes addressing each one of these issues will move training to the next level quickly!  Take a look at this list and see if you can pick out a few that look like the biggest barriers, and hack away at them today!

For kids with low muscle tone, including kids with ASD and SPD, take a look at my e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone.  Read Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!) to understand why I wrote this book just for you!   

I give parents clear readiness guidelines and tips on everything from the best equipment, the best way to handle fading rewards, to using the potty outside of your home.  It also includes an entire chapter on overcoming these bumps in the road! To learn more about what my e-book can do for you, read The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

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How To Teach Your Child To Wipe “Back There”

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Potty training is a process.  For most kids, the final frontier is managing bowel movements.  Compared to learning to pee into the toilet, little kids are often more stressed by bowel movements and have less opportunities to practice.  Constipation or just the discomfort of normal elimination can make them wary, sometimes enough to convince some children that this is a process better done in a diaper.  In comparison, urination isn’t an uncomfortable experience for healthy children.  Bowel movements sometimes happen only a few times a week, instead of the multiple times a child needs to urinate per day.  Less practice and fewer opportunities for rewards (even if your reward is warm praise) make bowel training harder.

So when they finally make the leap and manage to do #2 in the toilet, a lot of parents decide to delay teaching their child how to wipe themselves.  After all, wiping can be messy and it has to be done well enough for good hygiene.  Here are my top suggestions to make “making” a complete success:

  1. Teaching should still be part of your narrative while you are the one doing the wiping.  In my book, The Practical Guide To Toilet Training Your Child With Low Tone, I teach parents how to transform daily diapering into pre-teaching.  While you are wiping, and even while you are waiting for them to finish on the toilet, your positive narrative about learning this skill doesn’t end.  You are telling your child how it’s done, in detail, as you are doing it. You convey with your words, your tone and your body language that this is a learn-able skill.
  2. Don’t forget the power of the “dry run”.  Practice with your child when he is in the bathroom, whether it is before bath time, before dressing, or during a special trip to the bathroom to practice.  Dry runs take away the mess but teach your child’s brain the motor planning needed to lean back, reach back and move that hand in the correct pattern.  The people that invented the Kandoo line of wipes have an amusing way to practice posted on their site:  spread peanut or sunflower butter on a smooth plate, and give your child some wipes or TP.  Tell him to clean the plate completely.  This is a visual and motor experience that teaches how much work it is to clean his tush well.  After this practice, your child will make a real effort, not just wave the paper around.  Brilliant!
  3. Will you have to reward him for this practice? Possibly.  It doesn’t have to be food or toys.  It could be the ability to choose tonight’s dessert for the family, or reading an extra two books at bedtime.  You decide on the reward based on your values and your child’s desires.
  4. Use good tools.  The adult-sized wet wipe is your friend.  The extra sensory information of a wet wipe versus a wad of dry paper is helpful when vision isn’t an option.  They are less likely to be dropped accidentally when clean, but having a good hold is especially important after it has been used. “Yucky”stuff  makes kids not want to hold on!  Wet wipes are more likely to wipe that little tush cleanly.  Don’t cut corners.  Allow your child to use more than one.
  5. Take turns.  Who wipes first and who bats “clean-up” (couldn’t resist that one!) is your decision.  Some children want you to make sure they are clean before they try, and some are insistent that they go first with anything.  This can change depending on mood and even time of day.  Be flexible, but don’t stand there like a foreman, ordering work but not willing to help out.  One of my favorite strategies is to always offer help, but be rather slow and inefficient.  This gives children the chance to rise to the occasion but still feel like you are always willing to support them.

 

Looking for more information on toilet training?  Take a look at my e-book, The Practical Guide To Toilet Training Your child With Low Muscle Tone to get a clear understanding of how to prepare for and execute your plan without tears on both sides.  Will it help you even if your child doesn’t have low muscle tone?  Of course!  Most of my techniques simply speed up the learning process for typically-developing children.  And who doesn’t want to make potty independence happen faster?

This e-book is available on my website tranquil babies, at Your Therapy Source (a great site for parents and therapists), and on Amazon.  Read more about my book with Amazon’s “look inside” section, or by reading The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

Teach Kids With EDS Or Low Tone: Don’t Hold It In!

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People who have read my blog are aware that I wrote a book on toilet training, The Practical Guide to Toilet Training Your Child With Low Muscle Tone. The issue of kids who “hold it in” didn’t make it into the book, but perhaps it should have. Children that have problems with muscle tone or connective tissue integrity (or both) risk current and future issues with incontinence and UITs if they overstretch their bladder or bowel too far. We teach little girls to wipe front-to-back to prevent UTIs. We need to teach all children to avoid “holding it in” in the same manner that we discourage them from w-sitting.

I am specifically speaking here about kids with Ehlers Danlos Syndrome, Down Syndrome and all the other conditions that create pelvic weakness and muscle control issues. But even if your child has idiopathic low tone (meaning that there is no identified cause) this can still become a problem.

The effects of low tone and poor tissue integrity on toilet training are legion. Many of them are sensory-based, a situation that gets very little acknowledgment from pediatricians. These children simply don’t feel the pressure of their full bladder or even a full rectum with the same intensity or discomfort that other children experience. This is known as poor interoception, a sensory-based issue that is rarely discussed, even by parents and occupational therapists that are well versed in other sensory processing issues.  For more on how sensory problems affect toilet training, see Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!).   Kids that don’t accurately perceive fullness can be “camels” sometimes, holding it in with no urge to go, and have to be reminded to void. It can be more convenient for the busy child to keep playing rather than go to the bathroom, or it can save a shy child from the embarrassment of public bathrooms; she prefers to wait until she returns home to “go”.

This is not a good idea at all! The bladder is a muscle that can be overstretched in the same way the hip muscles loosen in children who “W-sit”. Don’t overstretch muscles and then expect them to work well. In addition, the ligaments that support the bladder are subject to the same sensory-based issues that affect other ligaments in the body: once stretched, they don’t bounce back. Holding urine instead of eliminating just stretches vulnerable ligaments out.  A weak pelvic floor is nothing to ignore. Ask older women who have had a few pregnancies how that is working out for them.

For children with connective tissue disorders such as Ehlers-Danlos syndrome, another comorbidity (commonly occurring disorder) is interstitial cystitis (IC).  What does that feel like? The pain of a bad urinary tract infection without any bacterial infection.  Anything that irritates the walls of the bladder adds stress to tissue.  Regular elimination cannot prevent IC, but good bladder care could minimize problems.  Not holding it in is part of good bladder care.

The stretch receptors in both the abdominal wall and in the bladder wall that should be telling a child with low tone that it is time to tinkle just don’t get enough stretch stimulation to do so when they have been extended too far.

When should you teach a child not to hold it in?  Right from the start.  The time to prevent problems is when a child is developing toileting habits, not when problems have developed.

So….an essential part of toileting education for children is when to head to the bathroom. If your child has low muscle tone or a connective tissue disorder that creates less sensory-based information for them, the easiest solution is a routine or a schedule. They use the bathroom whether they feel they need to or not. The older ones can notice how much they are voiding, and that tells them that they really did need to “go”.   The little ones can be rewarded for good listening.

Understanding that the kidneys will fill up a child’s bladder after a large drink in about 35-45 minutes is helpful. But it can always be the right time to hit the bathroom shortly after a meal, before leaving the house, or when returning home. As long as it is routine and relatively frequent, it may not matter how a toileting schedule is created. Just make sure that as they grow up, they are told why this is important. A continent child may not believe that this is preventing accidents, but a child who has a history of embarrassing accidents in public may be your best student.

Many kids with hypermobility have bedwetting issues long after most kids are continent at night.  It helps to tell them why this may be an issue for them.  Without that discussion, kids often assume that there is something inherently wrong with them as people.  Don’t let your child’s self-esteem drop because they don’t understand why this is such a hard thing to accomplish.  Understanding also makes them more willing to follow a toileting schedule or to focus on developing interoceptive awareness.  If you are wondering if your child’s hypermobility has emotional and behavioral impact, read How Hypermobility Affects Self-Image, Behavior and Regulation in Children and Hypermobility and ADHD? Take Stability, Proprioception, Pain and Fatigue Into Account Before Labeling Behavior .

For little girls who are at a higher risk of UTIs, I tell parents to teach wiping after urination as a “pat-pat” rather than the standard recommendation of front-to-back wiping.  Why?  Because children aren’t really good at remember that awkward movement, and even if you are standing right their reminding her, she may just wipe back-to-front because that is easier and more natural.  “Pat-pat” is an easy movement and reduces her risk of fecal contamination.  I cannot tell you I have done hard research on this strategy reducing infections, but then, I have common sense.  This is the smarter way for her to wipe.  Want more info on wiping?  Check out How To Teach Your Toddler To Wipe “Back There”

The good news in all of this? Perceiving sensory feedback can be improved. There are higher-tech solutions like biofeedback, but children can also become more aware without tech. There are physical therapists that work on pelvic and core control, but some children will also do well with junior Kegel practice and education and building awareness of the internal sensations of fullness and urgency.  Many occupational therapists use the Wilbarger Protocol for general proprioceptive awareness.  If your child has Ehlers-Danlos Syndrome, please read Can You Use The Wilbarger Protocol With Kids That Have Ehlers-Danlos Syndrome? for information on how to use this treatment technique wisely.

Good luck, and please share your best strategies here for other parents!!

 

Looking for more toilet training information?

My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, has readiness checklists that help you decide what skills to work on right away, and detailed strategies for every stage of training.  I want children to become independent and confident, and for parents to feel good about their role in guiding kids to develop this important life skill.

If you are interested in purchasing The Practical Guide to Toilet Training Your Child With Low Muscle Tone, please visit my website, tranquil babies and click on “e-book” at the top ribbon. You can also buy it on Amazon and your therapy source

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!

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.

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.

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.

 

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!