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Potty Training Kids with Special Needs 



Toilet training goes high tech

For countless generations, parents have been trying to get toddlers to use the toilet. Now, Belgian researchers think they have come up with a 21st century solution — electronics.

Researchers at the University of Antwerp are working with a diaper alarm that alerts grown-ups, especially day-care attendants, when tots wet their diapers. The alarm emits a pleasant musical sound when moist and does not harm the kids.

The theory behind the study comes straight out of the annals of behavioral and biofeedback psychology. By responding faster to wet diapers, attendants give appropriate encouragement and help children focus on bladder control more efficiently, said Jean-Jacques Wyndaele, study co-author and professor of urology at the University of Antwerp.

The technique had not been tested among healthy toddlers, although alarms have been used successfully to help older children overcome bedwetting problems and teach mentally handicapped children to use the toilet, Wyndaele said.

"There's overall very little research in this area," he said. "We wanted to see if this would work."

The team picked 39 healthy youngsters at several Belgian day-care centers. The kids, who were 18 to 30 months old, were chosen for their relative maturity and readiness to begin toilet training.

Training started as soon as the children arrived at day care and continued throughout the day for three weeks. Special diapers made by the researchers consisted of a light alarm box attached to a self-adhesive strip in the diaper. When the strip got wet, the diaper emitted a ringing sound, and the child was taken to the potty and encouraged to finish.

All children wore the same type diapers, but only about half wore diapers connected to the alarm box.

Positive results

The alarm plus positive reinforcement seemed to work. Children wearing the alarmed diapers achieved independent bladder control nearly 52 percent of the time, researchers said. That was significantly better than the others' 8.3 percent, according to the study, published in Neurology and Urodynamics. What's more, the effects seemed to last at least two weeks beyond the test period

One of the key advantages of the wetting alarm diaper-training method is that the child and the caregiver are informed of leakage, Wyndaele said. The alarm itself distracts the child and strengthens the awareness of bladder behavior. By bringing the child to a bathroom at that moment, further reinforcement is given.

Wyndaele said the technique could be especially useful in Europe and the United States, where a large percentage of children regularly attend day care.

"The participation in the toilet-training process of the day-care providers is thus valuable because they are often among the first to recognize when a child is developmentally ready to be toilet trained," he added.

Not so sure

And though intrigued by the study, two pediatricians in New York expressed some doubt that the Belgian method is better than the tried-and-true methods used by so many moms.

"I'm just not sure," said Dr. Marc Childs, who practices in Brewster, N.Y. "I usually find that toilet training works if you make the child think it's his need, not yours. My advice is, don't make diaper changing particularly enjoyable and reinforce others in your family when they go to the bathroom. He'll eventually get the message."


Potty training: How to get the job done

Potty training is a big deal. Here's what you need to know about timing, technique and handling the inevitable accidents.

By Mayo Clinic staff

"I've gotta go!" If you're looking forward to ditching your child's diapers for good, these words may be music to your ears.

Potty training is a big deal for parents and kids alike. The secret to success? Patience. Perhaps more patience than you ever imagined.

Is it time?

Potty training success hinges on physical and emotional readiness, not a specific age. Many kids show interest in potty training by age 2, but others may not be ready until age 2 1/2 or even older. And there's no rush. If you start potty training too early, it may only take longer.

So is your child ready? Ask yourself these questions:

§                          Does your child seem interested in the potty chair or toilet, or in wearing underwear?

§                          Can your child understand and follow basic directions?

§                          Can your child ask simple questions?

§                          Does your child stay dry for periods of two hours or longer during the day? Does he or she wake from naps dry?

§                          Does your child have fairly predictable bowel movements?

§                          Does your child tell you when he or she needs to potty or poop?

§                          Is your child uncomfortable in wet or dirty diapers?

§                          Can your child pull down his or her pants and pull them up again?

If you answered mostly yes, your child may be ready for potty training. If you answered mostly no, you may want to wait awhile — especially if your child is about to face a major change, such as a move or the arrival of a new sibling. A toddler who opposes potty training today may be open to the idea in a few months.

Ready, set, go!

When you decide it's time to begin potty training, set your child up for success. Start by maintaining a sense of humor and a positive attitude. Then:

§                          Pull out the equipment. Place a potty chair in the bathroom. You may want to try a model with a removable top that can be placed directly on the toilet when your child is ready. Encourage your child to sit on the potty chair — with or without a diaper. Make sure your child's feet rest firmly on the floor or a stool. As your child checks out the potty chair, help him or her learn how to talk about using the bathroom. Use simple, correct terms. Let your child see you and other family members using the toilet.

§                          Schedule potty breaks. If your child is interested, have him or her sit on the potty chair or toilet without a diaper for a few minutes several times a day. Read a potty-training book or give your child a special toy to use while getting used to the potty chair or toilet. Stay with your child when he or she is in the bathroom. Even if your child simply sits there, offer praise for trying — and remind your child that he or she can try again later.

§                          Get there — fast! When you notice signs that your child may need to use the toilet — such as squirming, squatting or holding the genital area — respond quickly. Help your child become familiar with these signals, stop what he or she is doing and head to the toilet. Praise your child for telling you when he or she has to go. When it's time to flush, let your child do the honors. Also remember the importance of good hygiene. Teach girls to wipe carefully from front to back to prevent bringing germs from the rectum to the vagina or bladder. Make sure both boys and girls learn to wash their hands after using the toilet.

§                          Consider incentives. Some kids respond to stickers or stars on a chart. For others, trips to the park or extra bedtime stories are effective. Experiment to find out what works best for your child. Reinforce your child's effort with verbal praise, such as, "How exciting! You're learning to use the toilet just like big kids do!" Be positive even if a trip to the toilet isn't successful.

§                          Be consistent. Make sure all of your child's caregivers — including babysitters, child care providers and grandparents — follow your potty-training routine.

§                          Ditch the diapers. After several weeks of successful potty breaks, your child may be ready to trade diapers for training pants or regular underwear. Take time to celebrate this transition. Go on a special "big kid" outing. Call close friends or loved ones and let your child spread the news. Once your child is wearing training pants or regular underwear, be careful to avoid overalls, belts, leotards or other items that could hinder quick undressing.

§                          Treat mistakes lightly. Accidents are inevitable — especially when your child is tired or upset. When it happens, stay calm. Simply say, "Uh-oh. You had an accident. Let's change you. Pretty soon you'll remember to use the potty chair every time you have to go."

§                          Sleep soundly. Most children master daytime bladder control within three to six months of starting potty training. Nighttime control may take months — or years — longer. In the meantime, you may want to use disposable training pants when your child sleeps.

§                          Know when to call it quits. If your child resists using the potty chair or toilet or simply doesn't get the hang of it, take a break. Chances are, he or she simply isn't ready yet. Try it again in a few months. If your child isn't interested in potty training by age 3, you might ask your child's doctor for suggestions.

Accidents will happen

You may breathe easier once your child learns how to use the toilet, but expect occasional accidents and near misses. Here's help handling — and preventing — wet pants.

§                          Stay calm. Kids don't have accidents to irritate their parents. Don't add to the embarrassment by scolding or disciplining your child. You may say, "You forgot this time. Next time you'll get to the bathroom sooner."

§                          Slow down. Remind your child to relax and take it slow. Completely emptying the bladder can help prevent accidents.

§               Offer reminders. Accidents often happen when kids are absorbed in activities that — for the moment — are more interesting than using the toilet. To fight this phenomenon, suggest regular bathroom trips, such as first thing in the morning, after each meal and snack, and before getting in the car or going to bed. Point out telltale signs of holding it, such as fidgeting or holding the genital area.

§                          Be prepared. If your child has frequent accidents, absorbent underwear may be best. Keep a change of underwear and clothing handy, especially at school or in child care.

When to seek medical advice

Occasional accidents are harmless, but they can lead to teasing, embarrassment and alienation from peers. If your potty-trained child reverts or loses ground — especially at age 4 or older — or you're concerned about your child's accidents, contact his or her doctor. Sometimes wetting problems indicate an underlying physical condition, such as a urinary tract infection or an overactive bladder. Prompt treatment can help your child become accident-free.


More Potty Training Ideas

Ideas that Worked in Other Families

The topic of toilet training comes up often among mothers of children with Down Syndrome. This article completes a series which began with a description of the One Day method, and continues  with a not-so-rosy scenario of one child’s potty training day. Finally, in this article, other moms (and one dad) chime in with their own ideas.

A mom with two boys writes:
A couple of things that I tried to keep in mind:

Some think that boys tend to want to achieve this task at a later age than girls, so I didn’t even start trying with Josh seriously until he was three.

What seemed to work best was taking him out off diapers and Pull-Ups altogether and putting him in regular underwear. Josh hated the urine running down his legs, so that pretty much took care of that part of the toilet training. Trying this in the summer is highly recommenmded (grin).

The bowel movement training was a little tougher.

What I wanted to accomplish too was to have him toilet trained, not me. I wanted Josh to do his thing independently. So, I had my hubby install a vertical bar next to the toilet that Josh could hold on to. He didn’t seem very comfortable on the pot, and was too short to stand to urinate. We got him a little stool to stand on, and the bar to hang on to, and then he was good to go (no pun intended).

I didn’t want to deal with cleaning up the potty chair, so instead we got one of those toilet seats that fit right on the toilet … the luxury padded model with Looney Tunes characters (got it at Lowes), and the tall urine guard (very helpful for those of you with sons—the low ones don’t work). I taught him how to climb up on the thing.

I was also paranoid that he would decide to finger paint with poop as this seems to be a common “kid” thing, so I started discussing with him very early in the process that “poopy—yucky—we only poop in the potty.” When he had an accident in his underwear, I would take him with me to flush the mess down the toilet. The flip side of this was that he would sometimes decide to poop somewhere else…on the stairs, under the bed…oh, such fun. We would have “the talk” again, and I had him help clean up the mess.

He got to the point that he would urinate consistently, but the bowel movements were tougher. He had all of the “pieces” of the puzzle, but had problems putting it all together consistently.

A couple of years ago, there was a discussion about serotonin deficiency in kids with Down Syndrome and the use of Prozac (an SSRI—selective serotonin reuptake inhibitor) in select patients (not for everyone—just for chronic constipation patients). I asked Dr. Leichtman if Josh would be a candidate, and he agreed. The Prozac was the addition that helped him put it all together. Within a couple of weeks, he was completely independent in toileting, day and night.

Oh, one other thing that helped along the way…this is going to sound gross, but it helped both of my boys. I would take them to the bathroom with me and encouage them to watch (yes, up close and personal) what I was doing and make a big deal out of it. Soon, they were both standing in line and cheering because it was their turn.

One of these days, I will have my privacy in the bathroom back. J

Hope some of these ideas help. I am so glad those days are over. Now that we aren’t buying diapers for two, I can almost afford a new car!

Another mom writes:
Got a man around the house? I hear that trying to “hit” Cheerios tossed in the toilet can be fun and make little guys more aware.

dad:
Having a joint session, peeing together, also seems to be a big encourager. You can play classic games like: Who finishes first? Who starts first? Playing tunes by alternating between the side of the bowl and the splashy middle. I’d explain this all to you, but, well, it’s a man thing. When one of you explains to me why grown women always go to use the facilities in pairs or groups, I’ll explain the total thrill of making two streams of urine hit mid-air…

Toilet Training Made Semi-Easy

   by Kent Moreno  

   (Note: Kent Moreno is a Behavior Analyst and father of a child with Down syndrome. He is employed by the West Virginia Austism Training Center at Marshall University as an education specialist. He can be reached at  knm@access.mountain.net.)

  The process of teaching a child to use the toilet can be a frustrating one. This is especially true if the child has a developmental disability. The protocol listed below has been used successfully, with individuals with developmental disabilities of all ages.

In addition to the protocol listed below, It can be helpful if a child is able to observe others using the toilet. This may be something which a family is not comfortable with or is not appropriate in certain settings. That's fine.

A major factor in the success of this program is based on the development of an effective toileting schedule. To determine the right schedule for the child, data needs to be taken for at least 2-3 days on how often the child goes to the bathroom. To do this, dry pants checks should be done every 20 - 30 min (20 minutes is preferable). If your lucky, you can find diapers which have a strip which changes color when the child voids otherwise, it will be necessary to feel for moisture. Take special care to write down the times of the day that the child defecates as most people defecate at approximately the same time each day. This procedure is called baseline data. Once 2-3 days of data has been gathered, it will be necessary figure out approximately how often the child goes to the bathroom. To do this, divide the number of waking minutes by the number of times the child went to the bathroom.

The toileting schedule can now be set up. As a rule of thumb, the child should be taken to the bathroom, twice as often as the child's average for urinating and defecating. So, for example, if the child goes to the bathroom an average of once an hour, the child would be taken to the bathroom every 1/2 hour. When setting up the toileting schedule, keep in mind the times of the day that the child is most likely to defecate and try to have the toileting schedule occur close to these times.

Prior to taking the child to the bathroom, give the child a cue that it is time to go to the bathroom. I recommend helping the child to make the sign for toilet until they can make it independently. Using the sign for toilet will not stop those children who are verbal from saying "toilet" and will give the child a way of communicating when they have to go to the bathroom once they have mastered the toileting procedure thus making a toileting schedule unnecessary.

It is important that the bathroom be a very fun place. Reserve a couple of the child's favorite toys or books which they can only have access to while they are seated on the toilet. Also, music can be very helpful. Mozart and Rockabilly seem to work well.

When having the child sit on the toilet, don't force it. The experience needs to be a positive one. If the child doesn't want to sit on the toilet, leave the bathroom and try again at the next scheduled time. Also, don't have the child sit on the toilet for more than 5-7 minutes. If the child is going to void in the toilet, they will usually do it within that time frame. If the child voids in the toilet, make a big deal out of it, praise the child verbally and tactilely (hugs, pats on the back...) and give them access to a small very preferred edible reinforcer (not always necessary). While it will be important to reduce the use of the edible reinforcers as quickly as possible but, in the early stages of acquiring toileting skills, it will be more important to make voiding in the toilet an extremely momentous and positive experience for the child.

One modification which can be made to the protocol which many times will increase the child's rate of success at voiding in the toilet is to give them something to drink 15-20 min prior to the scheduled toileting time.

 

Toilet Training Children With Down Syndrome
By Jane Orville 

Most parents wonder how their children with Down syndrome will learn to become toilet trained. This is understandably an anxious time for a parent, as you might be thinking about sending your child to a preschool program and wonder if he will ever be out of diapers. Teaching any child to use the toilet can be a frustrating time for parents, and the child, but if you relax and remember that you cannot “make” him learn before he is ready, he will leave those diapers behind someday.

One professional suggests taking a few days to document your child’s voiding schedule. Check his diaper every twenty to thirty minutes to see when he is going, and what (urine, bowel movement). When data is taken for a few days and you can see some semblance of a pattern, you will want to schedule toilet times for those specific times of the day.

One suggestion is to give your child some fluids to drink about 15 to 20 minutes before you plan on toileting him. Tell your child he is going to use the toilet, and if needed, use the sign for it and help him make the sign.

Make his toilet training experience pleasant. Have books available for looking at during this time, and keep the toileting time short, about 7 or 8 minutes at the most. If your child does not void during this time, don’t force it or use an unpleasant or frustrated tone. Have him get off and then try again at the next scheduled time.

A lot of praise is necessary when toilet training your child, especially for a child who has Down syndrome. Giving an edible reinforcement might be tried, but this can lead to the child expecting something to eat every time he has success on the toilet. Since children with Down syndrome already may struggle with weight issues, it is recommended that reinforcements such as verbal praise, hugs, high fives be used instead.

Some parents may have expectations for their child in the area of toilet training that are too high. Remember that not only is your child delayed mentally, he also may lack the proper muscle control at the average age that an “average” child is toilet trained. He will eventually learn this too; it will be on his own individual timetable.

Night training may be even further behind the average child’s schedule. Manufacturers are now making disposable underwear (commonly called “pull-ups”) in sizes large enough to accommodate a child up to 125 pounds. This does not mean that your child will be night trained so much later, but he just might not learn until he is that size, and you need to be aware of that fact.

“Megan was a few months older than four when she was toilet trained during the day, and in retrospect, I wish I had relaxed more with her in the preceding years in trying to get her trained. I felt a lot of pressure from other people, but you can’t “make” her learn something until she is ready to learn it. She wasn’t night trained until she was ten and a half. It just happened when it did, and that’s all there is to it,” says Valerie, mother of a 17 year old daughter with Down syndrome.

By Jane Orville

Jane Orville is the mother of a 17 year old Daughter with Down Syndrome and has spent years researching and compiling all the wisdom she has gained into a simple guide to assist parents deal with the concerns of raising a child with Down Syndrome. For more information see…

 

Doc note On Potty Training:

"When she'd have an accident and was wearing panties, she realized it," said Barbosa, who lives in Fort Myers, Fla.

While some experts and parents say kids learn faster when they're allowed to wet their pants, others say the training pants take some pressure off kids to navigate this milestone in their own time.

"The big problem isn't potty training. The problem is the emphasis we place on 'holding it'," said Steve Hodges, assistant professor of pediatric urology at Wake Forest University Baptist Medical Center.

By using disposable training pants, he said, children are more likely to emptytheir bladders when they have to. On the other hand, if toddlers are in underwear, they avoid the bathroom so that they can keep playing and having fun. If kids hold their urine, there's a bigger chance for infection, he said.

"Kids always say they don't have to go," he said, "but they always do."

Mom Note on Potty Training

I just wanted to add another suggestion for potty training.  I went to a workshop given by Gail Wayman of the Wayman Learning Center in Plano about a year ago.  This school is for children with special needs and they use this program with all of their students to get them potty-trained.
 
The brief version is this:  You potty train for urine first and when that is mastered, you work on bms.  Put the child in underwear and take them to the potty on a schedule.  If there is a urine accident, you take them through the motions of going from the spot of the accident (or scene of the crime!) to the toilet 5 times.  You quickly take them in there, pull down pants, sit on potty, pull up pants and go back to the spot.  You do this with the wet underwear still on (I know, gross).  On the last trip, you get them into dry pants.  Then you continue taking them on a schedule.  You also do a dry pants check every few minutes so you can praise them for staying dry.  At some point, the child will go on his own to the bathroom.  Once they do that, you no longer take them on schedule.  But you continue to do the "positive practice" (going 5 times to the potty) when there is an accident.  If there is a poop accident, you just go ahead and
change the diaper b/c you are only working on urine first.  When you do the positive practice, it is positive.  You don't have to really say anything to the child about having the accident, you just do the practice 5 times every time so they understand that they have to practice when they wet their pants.  It is a really intensive program, but they swear they have trained children of all abilities how to use the bathroom.
 
When they are going to the bathroom consistently for urine, you do the same thing for poop.  I have not tried this yet myself!  They say that it is gross pulling those dirty underwear up and down 5 times but it should only take a few times of doing that before the child won't have bm accidents anymore.


Down Syndrome Toilet Training

It is not always that children are born normal. One in a hundred cases can be a child with Down's syndrome. Down's syndrome or DS is a condition in which the child has extra genetic material, which causes delay in the child's growth, and this often leads to the child being mentally retarded. It is difficult enough and frustrating experience for a mother to toilet train a normal child but when it involves a Down's syndrome toilet training it requires more patience and love, comfort on the part of the mother to toilet train such a child with a disability.

Down's syndrome toilet training can start as early as six months. Take the child to a comfortable place like the bathroom and start by making sounds which sound like the child wants to pee. You can even leave the tap water running in the wash basin which will also encourage the child to pee.

The sound of running water always creates a desire in the child to want to pee. Slowly even a child with Down's syndrome will learn that when the mother takes him or her to the toilet and runs the water in the wash basin or makes a hissing sound it is time to pee. The mother should also be aware that within an hour of giving fluids to the child, the child will be ready to pee. So do make it appoint to take the child to the toilet every hour. Once the child is able to move freely you will find that the child automatically informs you if he or she wants to take a pee.

Before Down's syndrome toilet training make a note of schedule of the child like after how many hors he or she does her potty etc. Keep checking the diapers of the child regularly. Once you know when your child wants to take a pee, or do their potty encourage them by taking them to the toilet and being with tem all through while they finish their potty. It will certainly be a very frustrating experience for the mother in the beginning but as days go by the child will learn to trust the mother and also lose any fear they may have with regarding the use of the potty chair and will slowly yield to the love and reassurance of the mother.

Down's syndrome toilet training should never involve forcing a child to do their potty. Alternately, encourage them, as this is most important. Speak to them reassuring words and keep saying potty and toilet many times making them understand the meaning. Children are very quick to learn. They simply refuse to learn when you force things on them. With love and care, they will be willing to learn.

Keep some of the child's favourite toys I the toilet and allow the child to take it along when they go to the toilet for their potty. You can always have them washed and cleaned. You can also lay some soothing music to help them be more relaxed. Only if they are comfortable and relaxed will they do their potty.

Never ever force a child to sit on a potty and leave it screaming and kicking. This will only cause aversion to the child. Do it slowly and patiently in a playful manner and your down's syndrome toilet training can be as simple and easy as training any normal child.





<< Information >>

Concise Article Aids In Timing Potty-Training

Simple Clothing Important In Process

Last updated Monday, March 23, 2009 5:35 PM CDT in Your Family

By Tom McMahon
SPECIAL TO THE MORNING NEWS

There are many potty-training books on the market, but you don't need one. I recommend the concise two-page version provided by the American Academy of Pediatrics. It advises parents that children younger than 12 months have no control over bladder or bowel movements, and little control for six months or so after that. Children often start to show signs of being ready between 18 and 24 months, but some children may not be ready until 30 months or older. It is best to be relaxed about toilet training and avoid becoming upset. If your child strongly resists potty training, it is best to wait.

To determine if your child is ready for the potty, look for the following signs: Your child stays dry at least two hours at a time during the day or is dry after naps. Bowel movements become regular and predictable. Facial expressions, posture or words reveal that your child is about to urinate or have a bowel movement. Your child seems uncomfortable with soiled diapers and wants to be changed. Your child asks to use the toilet/potty chair or to wear Big Boy/Girl underwear.

When is the right time to start toilet training?

There is no set age at which toilet training should begin. The right time depends on your child's physical and psychological development. Children younger than 12 months have no control over bladder or bowel movements and little control for 6 months or so after that. Between 18 and 24 months, children often start to show signs of being ready, but some children may not be ready until 30 months or older.

Your child must also be emotionally ready. He needs to be willing, not fighting you or showing signs of fear. If your child resists strongly, it is best to wait for a while.

It is best to be relaxed about toilet training and avoid becoming upset. Remember that no one can control when and where a child urinates or has a bowel movement except the child. Try to avoid a power struggle. Children at the toilet-training age are becoming aware of their individuality. They look for ways to test their limits. Some children may do this by holding back bowel movements.

Look for any of the following signs that your child is ready:

  • Your child stays dry at least 2 hours at a time during the day or is dry after naps.
  • Bowel movements become regular and predictable.
  • Facial expressions, posture, or words reveal that your child is about to urinate or have a bowel movement.
  • Your child can follow simple instructions.
  • Your child can walk to and from the bathroom and help undress.
  • Your child seems uncomfortable with soiled diapers and wants to be changed.
  • Your child asks to use the toilet or potty chair.
  • Your child asks to wear grown-up underwear.

Stress in the home may make learning this important new skill more difficult. Sometimes it is a good idea to delay toilet training in the following situations:

  • Your family has just moved or will move in the near future.
  • You are expecting a baby or you have recently had a new baby.
  • There is a major illness, a recent death, or some other family crisis.

However, if your child is learning how to use the toilet without problems, there is no need to stop because of these situations.

How to teach your child to use the toilet

  • Decide what words to use. You should decide carefully what words you use to describe body parts, urine, and bowel movements. It is best to use proper terms that will not offend, confuse, or embarrass your child or others.
  • Pick a potty chair. A potty chair is easier for a small child to use, because there is no problem getting on to it and a child's feet can reach the floor.
  • Help your child recognize signs of needing to use the potty. Your child will often tell you about a wet diaper or a bowel movement after the fact. This is a sign that your child is beginning to recognize these bodily functions. Praise your child for telling you, and suggest that "next time" he let you know in advance.
  • Make trips to the potty routine. When your child seems to need to urinate or have a bowel movement, go to the potty. Explain what you want to happen. Encourage your child with lots of hugs and praise when success occurs.
  • Encourage the use of training pants. This moment will be special. Your child will feel proud of this sign of trust and growing up. However, be prepared for "accidents." It may take weeks, even months, before toilet training is completed.

If any concerns come up before, during, or after toilet training, talk with your pediatrician. Keep in mind, most children achieve bowel control and daytime urine control by 3 to 4 years of age. Even after your child is able to stay dry during the day, it may take months or years before he achieves the same success at night. Most girls and more than 75% of boys will be able to stay dry at night after 5 years of age.

Published online: 3/07
Source: Toilet Training (Copyright © 1993 American Academy of Pediatrics, Updated 4/03)

POSITIVE QUOTE OF THE DAY
-----------------------------

Far away in the sunshine are my highest aspirations. I may not reach
them, but I can look up and see the beauty, believe in them and try
to follow where they lead.

-- Louisa May Alcott (1832-1888) American Writer

MOM’s Note on Potty Training

My son wasen't crying on the potty, we rolled a tv up to the door and played his favorite videos (after not letting him see them for a week) we played games on the potty, He wasn't sitting there all by himself...I had to sit in claustrophbia bathroom with him...i swear it was harder on ME because I have a hard time sitting still!

You have to get creative with ways to make it 'fun' and we also never give him Cool-aid, but made sugar free cool-aid for him to drink on the potty and he guzzeled that down...we could see him holding it, holding it then he just couldn't hold it anymore....be sure you don't clap and go nuts till AFTER she's pee'd...in the middle they need to be focused on pee'ing.

Good luck!

MOM’s Note on Potty Training

I missed most of this thread except this last comment. But I do have
this advice to offer and it works for us. We give my son something
to drink wehn we tke him potty every hour. (What goes in must come
out, right?) taking him every hour is bound to catch him going potty
and then offering him a drink (or sometimes even something to eat!)
helps every time. After a while, they get the hang of it.

MOM’s Note on Potty Training

With my son, matthew, his dad or myself would take him into the restroom whenever we had to go. He had of course his potty chair, one in the bathroom and another in the front room. We would ask him after he would eat/drink if he needed to 'go' or not. Since most of our kiddos are visual learners I put pics on the bathroom wall just above his toilet and our toilet. I also put one up in the front room above his 'other' potty chair. He had reminders also in his room. The first time he used his potty he kept on using it. He threw away the pull ups and began using his Power Rangers, Turtles, etc., underwear.
You may want to try letting her pick out her own underwear and wear them around the house, either over a pull up or under whichever she prefers. I've noticed if we allow our kids just like our 'other' kids to sort of feel like they have control all will come to pass. They can't wait to sport their favorite character around! Sure hope this helps!!! good luck..


Published: October 11, 2007

For some people, potty training is a breeze. I once met a mom who told me that her daughter just decided at 20 months that she wanted to go on the potty and that was it.

I think I had a more typical experience. I had to hunker down for a full week until my eldest would go on the potty, and it took a couple more weeks to get her out of diapers during the day, followed by a month or two before she could wake up dry. For me, it was a lot of work.

I remember when I first heard the term "diaper-free baby." An old college acquaintance had decided to raise her son without ever using any kind of diaper, what's known as elimination communication. I thought she was crazy. I didn't want to potty train for weeks, let alone years.

I didn't think she would be able to keep it up, but I heard she is a mentor for other parents in Seattle who want to practice EC.

According to a recent Associated Press report, the diaper-free movement was founded on the belief that babies are born with the ability to signal when they have to relieve themselves. This can mean everything from watching a newborn's body language to teaching a pre-verbal child how to signal that he has to go.

The parents who practice EC look for these cues to tell them when they should run the baby over to the toilet, sink or nearest tree every time they think the baby has to go. When baby is in position, Mom or Dad mimics the hissing sound of a stream of urine to induce peeing. Eventually, the babies are able to get on somewhat of a schedule or show clear signs of when they want go.

Pictures on the Web site diaperfreebaby.org show smiling moms holding chubby little baby bums over the toilet. With other people's children, it looks pretty hygienic. But my little breastfed potato didn't have tiny little tinkles. To me it seemed like eight of the 10 newborn diapers she filled everyday could be characterized more as an explosion. Going diaper-free for me would have meant walking around looking like I just escaped from a bog of quicksand.

I can just imagine how my husband would handle the inevitable accidents, what ECers call "misses." I can hear him coughing and gagging now. He's already not a big fan of dirty diapers. Sometimes when he gets stuck changing a particularly foul load, I'll appear in the doorway just in time to exploit the situation.

"I'll change it …for five bucks."

Parents who have embraced EC as a lifestyle claim that it's a natural way to raise your child, because that's how they do it in parts of rural Africa and Asia. I think I'd rather walk 10 miles with a bucket on my head to fetch water than spend the day changing sheets, washing comforters and trying to get baby mess out of the carpet.

Still, with all of the perceivable drawbacks, EC is gaining in popularity. According to Elizabeth Parise, spokesperson for diaperfreebaby.org, the online EC support groups in the United States added 248 new members between March and July, bringing the total online membership number to 2,330. The Tampa support group currently has 25 members.

Parise was quick to point out that the actual number of people who practice EC is hard to gauge because there isn't a formal registry.

"Many areas hold DiaperFreeBaby meetings but don't run online groups," she explained. "Even in areas where there are online groups, many people attend the in-person meetings but don't join the online groups. We have grown so quickly that we are just now instituting a method for keeping track of attendees at in-person meetings better so that these figures will be more well-known in the future."

I didn't have the heart to tell Parise that we've recently started potty training our second child the traditional way. I've resurrected the Elmo doughnut, dusted off the Dora potty-time buzzer and purchased a bunch of fruit snacks for the occasion. While I'm not looking forward to spending an inordinate amount of time in the bathroom again, I am looking forward to getting rid of the diapers.

Help grandson understand his body before toilet training

Help grandson understand his body before toilet training 

First published in print: Wednesday, May 16, 2007

Q: Do you have any suggestions on how we can potty-train a "special" child?

Our 3-year-old grandson has had a lot of medical issues over the past two years. He doesn't talk yet, other than a few words.

Until he is potty-trained, he will be held back at day care.

We have not even tried because of all his other problems, but since he is more stable now, we would like to start.

A: Your question does not tell us about your grandson's medical conditions nor about your role in his care. Are you a supportive grandparent or are you raising the child yourself?

If you are supporting his parents, you might start by congratulating them on their ability to take one step at a time, waiting for signs of readiness in this little boy.

It is important that you all have waited for his other issues to stabilize, so he will have the energy he'll need to learn as complex a skill as this.

We'd need to know more about him to know what kind of program to suggest, but certainly many prolonged medical illnesses can interfere with a child's development -- motor, cognitive, language, social-emotional, and, for these, there is help.

We hope you all were able to get him into an early intervention program before he turned 3 to help you and him understand how to master his delays.

Even though early intervention programs are not covered after the age of 3, we hope that you can find a program that will continue to help you (and him).

Even at this age, it is important for him to begin to understand his delays -- in simple terms that make sense to him and that give him hope, and how to manage them

With the support of such a program and his medical doctors, you may be able to find a day care center that will respect his pace and join you in taking each step toward potty training -- on his timetable.

For a child who has struggled for control of his sick body, or who has lost it to doctors' and nurses' procedures, toilet training can all too easily become a new arena in which battles for control of his body are re-enacted.

For a 3-year-old who does not yet speak, handling frustration that cannot be expressed with words is already a challenge. Such a child may need extra opportunities to understand each step, to play out each one with his toys until he feels that the process has become his own. He's likely to need more help to understand how his body works as he tries to deposit his urine and bowel movements successfully where other people tell him to go.

It's not a simple command that you are giving him. And, as with other children, the goal is for him to want to imitate others, to want to put things where they belong, to feel that this is his accomplishment, not ours.

Here are a few steps to follow:

Put his potty chair on floor where he can sit, while you sit on yours. Leave diapers on. Read a story while you sit.

When he gives you permission, empty his dirty diaper into the potty. "That's where it will go when you are ready." Don't flush it away too soon.

When he's ready and interested, take off his diapers and put the potty in the yard (if you have one) or playroom for him to try to go, only for brief periods at first.

Staying dry at night is the hardest step. Don't rush it.

One step at a time, helping him understand his own body. Then it will be his achievement.

Dr. Joshua Sparrow contributed to this column. 


Potty Training Children with Special Needs

Potty Training Information

By Vincent Iannelli, M.D., About.com

Updated: December 08, 2004

About.com Health's Disease and Condition content is reviewed by the Medical Review Board

While parents often complain of difficulty potty training their children, for most families, potty training is a fairly easy experience. Even when there are problems or children show signs of potty training resistance, usually they will eventually become potty trained.

However, this is not always the case for children with developmental delays or disabilities, such as autism, Down syndrome, mental retardation, cerebral palsy, etc. Children with special needs can be more difficult to potty train.

Most children show signs of physical readiness to begin using the toilet as toddlers, usually between 18 months and 3 years of age, but not all children have the intellectual and/or psychological readiness to be potty trained at this age. It is more important to keep your child's developmental level, and not his chronological age in mind when you are considering starting potty training.

Signs of intellectual and psychological readiness includes being able to follow simple instructions and being cooperative, being uncomfortable with dirty diapers and wanting them to be changed, recognizing when he has a full bladder or needs to have a bowel movement, being able to tell you when he needs to urinate or have a bowel movement, asking to use the potty chair, or asking to wear regular underwear.

Signs of physical readiness can include your being able to tell when your child is about to urinate or have a bowel movement by his facial expressions, posture or by what he says, staying dry for at least 2 hours at a time, and having regular bowel movements. It is also helpful if he can at least partially dress and undress himself.

Children with physical disabilities may also have problems with potty training that often involve learning to get on the potty, and getting undressed. A special potty chair and other adaptations may need to be made for these children.

Things to avoid when toilet training your child, and help prevent resistance, are beginning during a stressful time or period of change in the family (moving, new baby, etc.), pushing your child too fast, and punishing mistakes. Instead, you should treat accidents and mistakes lightly. Be sure to go at your child's pace and show strong encouragement and praise when he is successful.

Since an important sign of readiness and a motivator to begin potty training involves being uncomfortable in a dirty diaper, if your child isn't bothered by a soiled or wet diaper, then you may need to change him into regular underware or training pants during daytime training. Other children can continue to wear a diaper or pullups if they are bothered, and you know when they are dirty.

Once you are ready to begin training, you can choose a potty chair. You can have your child decorate it with stickers and sit on it with his clothes on to watch TV, etc. to help him get used to it. Whenever your child shows signs of needing to urinate or have a bowel movement, you should take him to the potty chair and explain to him what you want him to do. Make a consistent routine of having him go to the potty, pull down his clothes, sit on the potty, and after he is finished, pulling up his clothes and washing his hands.

At first, you should only keep him seated for a few minutes at a time, don't insist and be prepared to delay training if he shows resistance. Until he is going in the potty, you can try to empty his dirty diapers into his potty chair to help demonstrate what you want him to do.

An important part of potty training children with special needs is using the potty frequently. This usually includes 'scheduled toileting' as outlined in the book 'Toilet Training Without Tears' by Dr. Charles E. Schaefer. This 'assures that your child has frequent opportunities to use the toilet.' Sitting on the potty should occur 'at least once or twice every hour' and after you first ask, 'Do you have to go potty?' Even if he says no, unless he is totally resistant, it is a good idea to take him to the potty anyway.

If this routine is too demanding on your child, then you can take him to the potty less frequently. It can help to keep a chart or diary of when he regularly wets or soils himself so that you will know the best times to have him sit on the potty and maximize your chances that he has to go. He is also most likely to go after meals and snacks and that is a good time to take him to the potty. Frequent visits during the times that he is likely to use the potty and fewer visits to the potty at other times of the day is another good alternative. Other good techniques include modeling, where you allow your child to see family members or other children using the toilet, and using observational remarks. This involves narrating what is happening and asking questions while potty training, such as 'did you just sit on the potty?' or 'did you just poop in the potty?'

Even after he begins to use the potty, it is normal to have accidents and for him to regress or relapse at times and refuse to use the potty. Being fully potty trained, with your child recognizing when he has to go to the potty, physically goes to the bathroom and pulls down his pants, urinates or has a bowel movement in the potty, and dresses himself, can take time, sometimes up to three to six months. Having accidents or occasionally refusing to use the potty is normal and not considered resistance.

Early on in the training, resistance should be treated by just discontinuing training for a few weeks or a month and then trying again. In addition to a lot of praise and encouragement when he uses or even just sits on the potty, material rewards can be a good motivator. This can include stickers that he can use to decorate his potty chair or a small toy, snack or treat. You can also consider using a reward chart and getting a special treat if he gets so many stickers on his chart.

You can also give treats or rewards for staying dry. It can help to check to make sure he hasn't had an accident between visits to the potty. If he is dry, then getting very excited and offering praise, encouragement, and maybe even a reward, can help to reinforce his not having accidents.

Another useful technique is 'positive practice for accidents.' Dr. Schaefer describes this as what you should do when your child has an accident and wets or soils himself. This technique involves firmly telling your child what he has done, taking him to the potty where he can clean and change himself (although you will likely need to help) and then having him practice using the potty. Dr. Schaefer recommends going through the usual steps of using the potty at least five times, starting when "the child walks to the toilet, lowers his pants, briefly sits on the toilet (3-5 seconds), stands up, raises his pants, washes his hands, and then returns to the place where the accident occurred." Again, although you are trying to teach him the consequences of having an accident, this should not take the form of punishment.

While it may take some time and require a lot of patience, many children with special needs can be potty trained by the age of 3-5 years. If you continue to have problems or your child is very resistant, then consider getting professional help.

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