Tag Archives: toilet training

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

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Since writing my first e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, I have fielded a ton of questions about the later stages of potty training.  One stumbling block for most children appears to be “potty fatigue”.  They lose the early excitement of mastery, and they get wrapped up in whatever they are doing.  What happens when you combine the effects of low tone with the inability of a  young child to judge the consequences of delaying a bathroom run?  This can lead to delaying a visit to the bathroom until it is too late.  Oops.

Kids with low tone often have poor interoceptive processing.  What is that?  Well, interoception is how you perceive internal sensory information.  When it comes to toileting, you feel fullness in your bladder that presses on your abdominal wall, in the same way you feel a full stomach.  This is how any of us know that we have to “go”.  If you wait too long, pressure turns to a bit of pain.  Low muscle tone creates a situation in which the stretch receptors in the abdominal muscles and in the bladder wall itself don’t get triggered until there is a stronger stimulus.  There may be some difficulty in locating the source of pressure as coming from the bladder instead of bowel, or even feeling like it could be coming from their back or stomach.  This leads to bathroom accidents if the toilet is too far away,  if they can’t walk fast enough, or if they cannot pull down their pants fast enough.  You have to work on all those skills!

Add in a child’s unwillingness to recognize the importance of the weak sensory signals that he or she is receiving because they are having too much fun or are waiting for a turn in a game or on a swing.  Uh-oh.  Not being able to connect the dots is common in young children.  That is why we don’t let them cross a busy street alone until they are well over 3 or 4.  They are terrible at judging risk.  Again, this means there are skills to develop to avoid accidents.

What should parents do to help their children limit accidents arising from being “too busy to pee?”

  1. Involve kids in the process of planning and deciding.  A child that is brought to the potty without any explanations such as “I can see you wiggling and crossing your legs.  That tells me that you are ready to pee” isn’t being taught how to recognize more of their own signs of needing the potty.
  2. Allow kids to experience the consequences of poor choices.  If they refused to use the potty and had an accident, they can end up in the tub to wash up, put their wet clothes in the washer, and if they were watching a show, it is now over.  They don’t get to keep watching TV while an adult wipes them, changes them, and cleans up the mess!
  3. Create good routines.  Early.  Just as your mom insisted that you use the bathroom before leaving the house, kids with low tone need to understand that for them, there is a cost to overstretching their bladder by “holding it”  Read  Teach Kids With Ehlers-Danlos Syndrome Or Low Tone: Don’t Hold It In! to learn more about this.  The best strategy is to encourage a child to urinate before their bladder is too full, make potty routines a habit very early in life, and to develop the skills of patience stretching Stretch Your Toddler’s Patience, Starting Today!  from an early age.  Creating more patience in young children allows them to think clearly and plan better, within their expected cognitive level.

Looking for more information on managing daily life with your special needs child?

I wrote three e-books for you!

My e-book on toilet training, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, and my e-books on managing pediatric hypermobility, are available on Amazon as read-only downloads, and on Your Therapy Source as printable downloads.  The JointSmart Child:  Living and Thriving With Hypermobility  Volume   One:  The Early Years and Volume Two:  The School Years are filled with strategies that parents and therapists can use immediately to improve a child’s independence and safety.

Your Therapy Source has bundled my books together for a great value.  On their site, you can buy both the toilet training and the Early Years books together, or buy both hypermobility books together at a significant discount!

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Potty Training in the COVID-19 Age

 

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Parents are staying home with their toddlers and preschoolers now.  All day.  While this can be a challenge, it can also be the right time to do potty training.

Here’s how to make it work when you want to teach your toddler how to “make” in the potty:

  1. You don’t have to wait for readiness.  What you might get instead is a child that has lost the excitement of being praised by adults, and fears failure more than seeks praise or rewards.  If that sounds like your child,  quickly read Waiting for Toilet Training Readiness? Create It Instead!
  2. Have good equipment.  If you don’t have a potty seat that fits your child or a toilet insert and a footstool that is stable and safe, now is the time to go online shopping for one.  Without good equipment, you are already in trouble.  Children should be able to get on and off easily and not be fearful of falling off the toilet.  If you are training a preschooler and not a toddler, you really need good equipment.  They are bigger and move faster.  Safety and confidence go hand in hand.
  3. Have a plan for praise and rewards.  Not every child will want a tiny candy, but nobody should expect a new toy for every time they pee in the potty.  Know your kid and know what gets them to try a new skill.  Some children don’t do well with effusive praise Sensitive Child? Be Careful How You Deliver Praise , so don’t go over the top if this is your kid.
  4. Know how to set things up for success.  If your child is typically-developing, get Oh Crap Potty Training by Jamie Glowacki, because she is the best person to tell you how to help you be successful.  She even has a chapter just on poop!  If your child has hypotonia or hypermobility, consider my e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone.  It is inexpensive, available on Amazon and Your Therapy Source, and gives you checklists and explanations for why you need to think out-of-the-box to potty train these kids.  You don’t leave for vacation without a map.  Don’t wing this.  Just don’t.
  5. Build your ability to calm yourself first.  Exactly like on an airplane, (remember them?  We will get back on them eventually) you need to calm yourself down in the face of refusals, accidents and tantrums.  You are no good to anyone if you are upset.  Read Stress Relief in the Time of Coronavirus: Enter Quickshifts and Should the PARENTS of Kids With Sensory Issues Use Quickshifts? for some ideas.

Looking for more information on potty training?  I wrote an e-book for you!

The Practical Guide to Toilet Training Your Child With Low Muscle Tone was my first e-book.  It is still my best seller.  There is a reason:  it helps parents and kids succeed.  This unique book explains why learning this skill is so tricky, and it gives parents and therapists detailed strategies to set kids (and parents) up for success!  Understanding that the sensory and social-emotional impacts of low muscle tone are contributing to potty training deals is crucial to making this skill easier to learn.  I include a readiness guide, strategies to pick the best equipment and clothes (yes, you can dress them so that they struggle more!), and how to move from the potty seat onto the adult toilet.

It is available on Amazon and on Your Therapy Source, a great site for materials for therapists as well as parents looking for homeschooling ideas.

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Should You Install a Child-Sized Potty for Your Special Needs Child?

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Affordable accessibility and no institutional appearance!

I know that some of you don’t even realize that such a thing exists:  a toilet sized for preschoolers and kindergarteners!  Well, you won’t find it in Lowe’s or Home Depot on the showroom floor, but you can buy them online, and it is an option to consider.  Here are the reasons you might put one in your child’s main bathroom:

  1. You have the space already.  Some homes are large enough to allow each bedroom to have its own bathroom.   If you have the option, it might be worth it during renovations.  It shouldn’t add considerably to the overall cost, and it should not be that difficult to swap out when your child grows.  If you have a bathroom near the playroom, that might be another good location for this potty.  Most older kids and adults can make it to another half-bath on that floor, but it might be perfect for your younger child and his friends!
  2. Your child is terrified of the standard-height potty.  Some kids are unstable, some are afraid of heights, and some have such poor proprioception and/or visual skills that they really, really need their feet on the ground, not on a footstool.
  3. Your child was a preemie, and their growth pattern indicates that they will fit on this toilet comfortably for a while.  Some preemies catch up, and some stay on the petite size.  Those children will be able to use a preschool-right potty into early elementary school.  Even if your preemie is average in size, they may have issues such as vision or sensory sensitivity that will make this potty a great idea for a shorter time.

I am just beginning to build my materials to do in-home consultations as a CAPS, but I think that an underserved population are parents of special needs kids that would benefit from universal design and adaptive design.  This toilet would come under the category of adaptive design, and it is an easily affordable solution for some children.  Having more comfort on the toilet speeds up training for many kids.  It also decreases the aggravation of training and monitoring safety for parents.  I am very committed to helping the entire family have an easier time of things like toilet training.

Think about what your family’s needs and capabilities are, and if you are planning to remodel or build a new home, consider finding a CAPS professional in your area to help you make your home as welcoming for your special needs child as possible!  For more information, read How An Aging-In-Place Specialist Can Help You Design an Accessible Home for Your Child.

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For Kids Who Don’t Know They Need to “Go”? Tell Them to Stand Up

 

photo-1453342664588-b702c83fc822For children with either low muscle tone or spasticity, toilet training can be a real challenge.  If it isn’t clothing management or making it to the potty on time, they can have a hard time perceiving that NOW is the time to start heading to the toilet.

Why?  Often, their interoception isn’t terrific.  What is interoception?  Think of it like proprioception, but internal.  It’s the ability to identify and interpret sensory information coming from organs and internal tissues.  Among them, the pressure of a full bladder or a full colon.  If you can’t feel and interpret sensation correctly, your only clue that you need the potty is when your pants are soiled.  Uh-oh.  A child with muscle tone issues is almost certainly going to have sensory issues.  Tone will affect the amount and quality of sensory feedback from their body.

What can you do to help kids?  The simplest, and the fastest solution I have found, is to tell them to stand up and see if they have changed their mind.  Why?  Because in a sitting position, the force of a full bladder or colon on the abdominal wall and the pelvic floor isn’t as intense.  Gravity and intra-abdominal pressure increase those sensations in standing.  More sensation can lead to more awareness.

So the next time your child tells you they don’t have to “go”, ask them to stand up and reconsider their opinion.  Now, if they are trying to watch a show or play a game, you aren’t going to get very far.  So make sure that they don’t have any competition for their attention!

Looking for more information on toilet training?  Well, I wrote the (e) book!  The Practical Guide To Toilet Training Your Child With Low Muscle Tone gives you readiness checklists and ways to make readiness actually happen.  It has strategies you can use today to start making progress, regardless of your child’s level of communication and mobility.  Learn what occupational therapists know about how to teach this essential skill!  It is available on my website tranquil babies, on Amazon and on a terrific site for therapists and parents Your Therapy Source.  Read more about my unique book:The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

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Potty Training Boys: Do You Teach Standing Up Or Sitting Down?

 

darran-shen-477150.jpgTraining children for bladder control before bowel control is often easier for quite a few reasons:  More frequent bathroom trips = more opportunities for success, digestion and diet issues don’t stall success,  and urination is usually a painless, phobia-free, and quick experience.  In general, families that hire me as a consultant are encouraged to consider bladder training to be the first mountain to conquer.

But should little boys sit or stand to do the deal?  After a child has been sitting on the potty, understands it’s use, and has consistent success, I will encourage parents to have their sons stand to urinate.  But it isn’t as simple as that.  There are pros and cons.

First, the pros of standing to urinate:

  • little boys have probably seen their brothers, cousins and dad use the toilet, and most children want to copy their same-gender parent.  This is often more motivation to become independent in the bathroom.
  • young children may be a little more mindful of why they are standing in front of the toilet.  Children that are sitting have a harder time seeing what is happening and can get distracted. I know, I know, even the “big boys” can have terrible aim.  But children need all the help they can get to stay focused.
  • improving aim is motivation to use the toilet.  I wrote a blog post on using targets to teach boys to improve their accuracy and build interest in toileting.Piddlers Make Potty Training Fun!  These really work!

And now the cons:

  • See the item about distractibility under “pros”.  Some boys are so distracted that sitting on an toilet seat insert with a splash guard is the only way to prevent spraying the bathroom and any supervising adult.
  • Some children will start out urinating and begin to have a bowel movement concurrently.  Oops!  These children often have issues with low tone or digestive problems, and cannot “hold it” long enough to finish urinating and then sit on the toilet to have a bowel movement.  If they have an accident, it could be very upsetting to them and make them less eager to be fully trained.
  • Children with low muscle tone or postural stability issues may need to sit to achieve a safe and stable position.  No one can eliminate when they are unsteady or fearful.

Some children are vocal and clearly tell you what they want to do and why.  Some cannot or will not communicate, but you can figure out what they are thinking.  Some need to be encouraged to give standing a try.  If your son was initially interested and now has lost some of his enthusiasm and is still sitting to urinate, try telling him that it is time to stand like the big guys and see if you can regain some of your momentum in toilet training!

For more information on toilet training children with low muscle tone, check out my other posts such as  Should You Install a Child-Sized Potty for Your Special Needs Child?and  Low Tone and Toilet Training: The 4 Types of Training Readiness   as well as my useful e-book.  Here is a post that explains why this unique book will help you move forward with training right away! 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.  Most children don’t have more than one BM per day, but they urinate many times per day.  For an overview on wiping, even if your child doesn’t have low tone, read Low Tone and Toilet Training: Teaching Toddlers to Wipe

Constipation or just the discomfort of normal bowel 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 only 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 your child for practicing? 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.
  6. Teach them how to know when they are done wiping.  It’s kinda simple;  you wipe until the toilet paper is clean when you wipe.  This usually means little kids have to do at least two separate wipes, but they get the idea quicker.  Little hands are not that skilled, but dirty versus clean is something they can grasp.

 

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!

The Difference Between Special Needs and Typical Potty Training Approaches: Address Sensory/Behavioral Issues and Use Consistent Routines

tai-jyun-chang-270109.jpgAfter writing The Practical Guide to Toilet Training Your Child With Low Muscle Tone, I have been asked what was different about my book. There must be 100 books on potty training special needs kids. What did I do differently? Simple. I am an occupational therapist, so I have no choice but to use my 360 degree viewpoint to target all the skills needed to do the job. Seeing the path to independence in this way was second nature to me, but not to parents of kids with special needs. Time to offer some support!

The books I reviewed before I started writing were great, but every one lacked at least one important feature. If the authors were psychologists and teachers, they weren’t fully comprehending or directly addressing the sensory and motor aspects of a very physical skill. Oops.

OTs are always aware of the cognitive and social/behavioral components of activities of daily living, but we also have a solid background in physiology and neurology as well. That makes us your go-to folks for skills like toilet training. And that is a major reason why The Practical Guide is so helpful to the frustrated parents of children with SPD,autism, Down Syndrome, Ehlers-Danlos Syndrome, and a host of other diagnoses that result in delays or difficulties with muscle tone and potty training independence. It explains in detail how low tone creates sensory, motor, and social/behavioral problems, and how to address them. Knowledge is power, and knowledge leads to independence.

The other huge difference is that developing consistent sensory-motor-behavioral routines matter more for these kids. Tone isn’t a constant, as anyone with a child that has low tone knows all too well. Fatigue, illness, even a very warm day; these all make kids less stable and can even reduce their safety. Having a really solid routine makes movements easier to execute and more controlled when situations aren’t perfect. Kids with normal muscle tone can shift their behavior on the fly. They can quickly adjust and adapt movement in ways that children with low tone simply cannot. It isn’t a matter of being stubborn or lazy. Kids with low tone aren’t going to get the sensory feedback fast enough to adjust their motor output.

Good motor planning on a “bad day” occurs for these kids when they have well-practiced routines that support safe and smoothly executed movements. What makes the difference isn’t intelligence or attention. It is recalling a super-safe routine effortlessly. This is completely attainable for kids who have speech or cognitive issues as well as issue with low tone and instability. It may take them longer to learn the routine, but it pays them back with fewer accidents and fewer tears.

To learn more about my book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, visit my website, tranquil babies.com, or view it on Amazon.com!ferris-wheeltai-jyun-chang-270109

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!

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!

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: Parents And Children Need To Work Together

This one is simple to explain, but not so easy to achieve with some kids.  Children whose interactional pattern is defiance or whining are going to be much harder to train, regardless of whether or not they have significant issues with low muscle tone.  In fact,  I would rather coach a very physically unstable but cooperative child than a toddler with mildly low tone but a firm commitment to resist any adult request.   If both parties aren’t able to work together, things may not go well.  At all.

Toddlers and preschoolers are known for their tendency to love the word “no”.  Did you know that, developmentally, the high-water mark for hysteria and the reflexive “no” is between 18 and 24 months?  Yup, that’s when language skills haven’t emerged to support expressing feelings and comprehending adult reasons. It is when emotional fuses are neurologically short, as in that forebrain is still sooo immature.   They really can’t handle their emotions at all on a brain level.  They have just left that sweet-baby phase where they want to please you more than anything, and they can’t be quite as easily distracted from bad behavior now.  This is a generalization, and there are some parents reading this that are thinking “We never got that lovely baby phase.  He went from crabby infant to bossy toddler!”  Well, I sympathize,  and I still invite you to read on.  All is not lost.  As language, emotional and reasoning skills slowly grow, a child who still falls apart easily and rages constantly isn’t always at the mercy of neurology as much as not having some basic coping skills.  It’s time to work on them before you jump into potty training.

Toddlerhood is long, all the way up to 5 years-old, and I won’t minimize the tantrums and agitation that can emerge.  This extended path to greater maturity is why I bought, devoured and constantly use The Happiest Toddler on the Block, Dr. Harvey Karp’s great book on building toddler coping skills. Half of the benefit is learning to both listen to and talk to toddlers in a way that calms things down.  I could not do my work as a pediatric occupational therapist with as much joy and enthusiasm as I have without these strategies.  Thanks, Dr. Karp!

For parents of children with language, communication or cognitive issues that result in developmental delays, your child may be 4 years-old but their other skills that are closer to 18 months old.  You can still toilet train.  Has your child been diagnosed on the autistic spectrum?  You can still train them.  Really.  The process may take longer and you may have to be both very creative and very consistent, but it can be done.  Job #1 is still the same: building a cooperative and warm relationship.

If your days are defined by defiance and whining, you need to learn all of the Happiest Toddler techniques that reduce frustration, including Patience Stretching and the Fast Food Rule.  Stretch Your Toddler’s Patience, Starting Today! You need to use “time-ins” for shared fun and warmth without a goal in mind.  You could try some of the more language-based techniques such as Give It In Fantasy and Gossiping.  And of course, you need to look at your approach to setting limits. All that love is great, but if your child knows that there are no consequences to breaking family rules or aggression,  your plan is in trouble.  Dr. Karp’s techniques aren’t intended to be a toilet training plan, but they set the stage for learning and independence.  Those are the ultimate goals of toilet training!

If you would like a more detailed or more personal level of support, visit my website tranquil babies  and purchase a consultation (in the NY 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!

 

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: 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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Link

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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, available on Amazon and Your Therapy Source 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.