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Ways to Make Toilet Training Easier

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HealthWiki > Disabled Village Children > Chapter 38: Toilet Training > Ways to Make Toilet Training Easier


Just as training should not be delayed, it also should not be started too early. If a child’s body is not yet able to control her bladder and bowel, trying to train her can lead to failure and frustration—both for the child and her parents. Normally a child is ‘ready’ by age 2 or 2½. But in some children, training may need to be delayed to age 3 or 4, or sometimes later.

Most children learn to keep clean a long time before they learn to stay dry. However, because a child pees much more often than she shits, if training aims at ‘staying dry’, ‘staying clean’ usually follows.

There are 3 simple tests to check if your child is ‘ready’ for toilet training. These are: bladder control, readiness to cooperate, and physical readiness. (These tests and many of these suggestions on toilet training are adapted from Toilet Training in Less Than a Day by Azrin and Foxx.)

DVC Ch38 Page 338-1.PNG
a woman speaking while holding her hands out toward a boy who holds a ball.
Now bring me the ball.
  • Bladder control. Does your child pee a lot at one time and not dribble every few minutes? Does he often stay dry for hours? Does he seem to know when he is about to pee? (The look on his face, holding himself between the legs, etc.) If the child does these 3 things (or at least the first 2) he probably has enough bladder control and awareness of peeing to make training possible.
  • Readiness to cooperate. To test whether the child has enough understanding and cooperation, ask her to do a few simple things: lie down, sit up, point to parts of her body, put a toy in a box, hand you an object, and imitate an action like hand clapping. If she does all these things willingly, she is probably mentally ready for toilet training.
  • Physical readiness. Can the child pick up small objects easily? Can she walk or move herself fairly well? Can she squat, or sit on a stool, and keep her balance? If so, she is probably physically able to do her toilet by herself. If not, she can probably still be trained but may need physical assistance.


Most children more than 2 years old can pass these 3 tests. If not, it is usually better to wait before trying toilet training, or to help the child become more ready.

SPECIAL PROBLEMS

If the child still does not have enough bladder control or awareness, it is best to wait until she is older. For example, some children with cerebral palsy are slow in developing bladder control.

If the child does not hear or understand simple language, or is mentally slow, more of the training needs to be done by showing and less with words. Special gestures or ‘signs’ need to be worked out for ‘wet’, ‘dry’, ‘dirty’, ‘clean’, and ‘pot’ or ‘latrine’. Instead of teaching by using a doll, it is more helpful to have another child demonstrate toilet use.

If the child is stubborn, refuses to cooperate when asked to do simple things, or often cries and screams whenever he does not get what he wants, toilet training will be more difficult. Stubbornness and refusal to do what they are told are common in many handicapped children—mainly because they are often overprotected or spoiled. Before trying to toilet train such children, it is wise to work first on improving their attitude and behavior. This is discussed in Chapter 40.

If a child’s physical disability makes it difficult for her to get to the toilet place, to lower her pants, to squat or sit, or to clean her butt, various aids or ways must be looked for to help her become as independent as possible. These will be discussed on the next pages.

2. Put the child on the pot at the times when she is most likely to use it

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Before beginning toilet training, for several days notice at what time of the day the child shits and pees. Usually there will be certain times when she usually does so—for example, soon after the first meal of the day.

Begin to put her on the pot or latrine at these times, encouraging her to make ‘poo’ or ‘pee’ (or whatever she calls it).

Leave her on the pot until she ‘goes’— or for no more than 10 minutes.

If the child ‘goes’, clap your hands, kiss her, show her what she has done, and let her know how pleased you are.

If she does not ‘go’, just ignore it. Do not scold or make her feel bad, or she may begin to fear or dislike the pot, and refuse to use it.

3. Reward and praise success

a woman and a girl speaking.
Are you dry?
Yes, dry.
What a big girl you are now!

In toilet training—as in any form of education—it works better to reward success than to punish failure. When the child shits or pees where she should, give her praise, hugs, kisses and other signs of approval. However, make sure that the child knows you are pleased with her, not because she shits and pees, but because she is staying dry or clean. When training, check the child often to see if she is ‘dry’ or ‘clean’. When she is, praise her. Also, teach her to check herself.

When the child has ‘an accident’ and wets or dirties herself do not punish or scold her. It is better to quietly clean up the mess or change her. At most, say something friendly (but not approving) like, “Too bad!—Better luck next time!”

CAUTION! As a general rule, do not offer a child candy, sweets or other food as a reward for doing something right. This can lead the child to associate food with love or approval—and therefore to make constant demands for sweets. Avoiding food rewards is especially important for children whose disability makes them less active, so that they easily get fat. Extra weight makes moving around harder for both child and parents. So ... DO NOT LET DISABLED CHILDREN GET OVERWEIGHT.
a very fat child speaking.
If you love me give me more sweets!
DO NOT GIVE FOOD AS A REWARD TO CHILDREN WHO ARE FAT
For children who are thin and active, it may make sense to sometimes give foods as rewards. But be sure to include healthful foods like nuts and fruits — not just sweets.
illustration of the below: a child lowering his pants.
Guiding the child's hands

4. Guide the child’s movements with your hands

When the child has difficulty carrying out a physical task—for example, lowering his pants—do not do it for him (if it is something he can learn to do for himself). And do not tell him his mistakes or how to correct them. Instead, gently guide his hands with yours so that he learns how to do it himself.

5. Use models, examples, and demonstrations

a woman speaking to a child as they watch another child using a latrine.
See how Kim poops into the hole! Do you want to be a big boy and do it next?

Setting an example is one of the best ways of teaching—especially if the example is set by persons the child loves, admires, and tries to copy. Even before children are old enough to be toilet trained, help prepare them by letting them watch their brothers and sisters use the pot or latrine. Tell them that when they are big enough they will be able to do it that way too.

Using a doll that wets is another good way to introduce toilet training. Dolls that ‘wet’ can be bought, or you can make one out of,

a gourd or a baby bottle inside a homemade rag doll
a gourd doll with a mouth to put water in and 2 plugs to remove for peeing and pooping.
open mouth (put water in here)
plug (pull to pee)
plug (pull to poop)
a bottle inside a doll; the nipple, with a large hole in it, is where the doll pees.
large hole in nipple of bottle
When lying down, no pee
the doll sitting on a pot.
When sitting up, doll pees

Show the child how the doll pees in the pot. Or better, ask your child to help you toilet train the doll. Be sure to include each step that will be needed for the child to become as self-reliant as possible. For example:

First have the child show the doll how to get to the latrine or pot — and then help the doll lower his pants. Next have the child teach the doll how to get onto the pot, and sit there until he pees. Try to make the situation as nearly like that of the child as you can—using the same pot in the same place that he will use it.
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Turn it into a game, but keep the focus always on toilet training.
a child speaking to a doll.
You're dry! Good boy!
After the doll has finished peeing, have the child pull up the doll’s pants. Ask him to feel the doll’s pants and check whether they are dry. If so, have him praise the doll.


To repeatedly see real persons (not just dolls) enjoy and be rewarded for using the pot or toilet is especially important for a child who is mentally slow or who has language difficulty.

6. Adapt toileting to the special needs of the child

Many handicapped children can be helped to become independent in their toileting if special aids or adaptations are made. Different children will require different adaptations. However, the following are often helpful:

    Correct position of hands,
    for lowering pants
    for raising pants
    Hook thumbs inside pants and push down. hand position for lowering pants. Put hand inside pants to pull over butt. hand position for raising pants. For training, pin shirt up out of the way — or do not wear one.
  • If the child has trouble pulling down pants or panties—use loose fitting clothing with elastic or ‘Velcro’ waist band.
  • DVC Ch38 Page 342-1.png
  • Use short ‘training pants’ made of towel-like material that will soak up urine.
  • DVC Ch38 Page 342-4.png
  • For a child with cerebral palsy or spina bifida, it may be easier lying down—you might provide a clean mat.
  • illustration of the below: girl on a potty seat.
    Some children, like this girl with cerebral palsy, need to sit. This potty seat was adapted from a child’s wood chair.
    DVC Ch38 Page 342-6.png DVC Ch38 Page 342-7.png
  • If people by custom squat to shit, and the child has trouble, a simple hand support can help.
  • Latrines can also be adapted.

  • a latrine with a hand rail. hand rail that can lift up arm or shoulder supports close to the toilet





    toilet seat and wheelchair seat on same level
    a girl in a wheelchair using a latrine that has a high hand rail, arm supports, and a toilet seat at the level of the wheelchair.
    high hand rail to make moving from wheelchair to toilet easier
    2-seater latrine with child-sized hole and step

    Make the outhouse (latrine) and its door big enough so that a wheelchair can fit inside. Position the door so that the wheelchair can enter right beside the latrine without having to turn around.

    Be sure the path to the latrine is level and easy to get to from the house.

  • A simple pot or ‘pottie’ is one of the best aids for toilet training of young children. It can be adapted in various ways for disabled children.
simple pot more complex pots sold in some countries ‘Baby Relax Toilette’ with removable pot — gives good back and side support.
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These give good back support. DVC Ch38 Page 343-3.png
DVC Ch38 Page 343-4.png
For the child severely disabled with cerebral palsy, the pot can be placed between mother’s knees. This provides good back support. Mother holds his shoulders forward, his hips bent and his knees separated. Later it may be possible to put the child on a corner seat like this— which also holds arms and shoulders forward and helps keep hips bent.
DVC Ch38 Page 343-5.PNG
illustration of the above: a corner seat.
2 posts may be needed to keep knees apart

bucket
A cardboard box can also make a good sitting frame. Use your imagination and whatever materials you can get to make it easier for your child to do it by herself.
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For severely disabled children, ‘toilet seats’ can be built into specially designed chairs.
illustration of the above: a chair with a shelf for a pot.
shelf for pot
DVC Ch38 Page 343-12.png
A cushion can be made to fit over the toilet seat for ordinary sitting. DVC Ch38 Page 343-13.PNG
Put a shelf for the pot.
Or leave the space under the seat open, so that the whole chair can be rolled over a toilet.
For the child who cannot sit up, you might make a wedge-shaped toilet box like this. illustration of the above: wedge-shaped box with a hole in the top.
DVC Ch38 Page 344-2.PNG
An old plastic bucket can be cut at the same angle as the bedpan so that it fits snugly under the hole. DVC Ch38 Page 344-3.png It works as a ‘bedpan’, or as a ‘floor pan’ for the child who can roll or scoot but cannot sit or lift himself without help. This way the child can learn to take care of his own toilet.
DVC Ch38 Page 344-4.PNG
For the child who has spasticity or poor balance, you can make a seat like this. The bar can be put in after the child has been seated. DVC Ch38 Page 344-5-a.png The seat can be made to fit over a bucket, over a floor-hole latrine, or over a standard toilet.
Tire potty seat — soft, safe, washable
(See from India — UPKARAN manual.)
Tire can be used alone, or over a ‘hole-in-the-floor’ toilet. or on a wood or metal frame over a toilet seat. DVC Ch38 Page 344-8.png
DVC Ch38 Page 344-6.png
DVC Ch38 Page 344-7.png
To keep urine from getting inside the tire, you can wrap long strips of inner tube tightly around the tire.
Cane or rattan toilet seat with climb up bars Enclosed wood or plywood toilet
Removable front bar can be added if needed. DVC Ch38 Page 344-9.png
DVC Ch38 Page 344-10.png
wood toilet with removable back, seat, and potty holder.
removable back to wash baby’s butt afterwards
removable seat
Or seat can be placed over a hole-in-the-floor toilet.
removable potty holder for easy emptying
DVC Ch38 Page 344-12.PNG

REMEMBER: As the disabled child grows, she will feel the same need of privacy as any child would for toileting and other personal acts. Help the child to obtain the privacy she needs.


This page was updated:19 Jan 2018