Hesperian Health Guides
Chapter 38: Toilet Training
By “toilet training” we mean helping a child learn to stay clean and dry. A child is toilet trained when:
- He knows when he needs to shit or pee (make stool or urinate) and has learned to “hold on” so he does not go in his clothing or on the floor (bowel and bladder control).
- He tells people when he needs to do his toilet, or (if he is physically able) ...
- He takes himself to a specific place (pot, toilet, latrine, or at least outside the house), removes necessary clothing, “goes,” cleans himself in the customary way, puts his clothing back on, and does whatever may be necessary to get rid of the waste.
Toilet training is important for the development of a child’s independence and dignity. Yet it is very often neglected in children with disabilities. Often we see children 5, 10, even 15 years old who are still in diapers (nappies) and who are still completely dependent on their family for being changed and cleaned. This situation is hard on both child and family. With a little instruction and encouragement, we have found that many of these children have become toilet trained in a few days or weeks. Many could have learned years earlier.
The age when children typically become toilet trained varies greatly from child to child. It also varies from place to place, according to local customs, what clothes children wear (if any), and how much the family helps. With training, many children can stay dry and clean by age 2 or 2½. With little or no training, most children learn to stay clean and dry by age 4.
Children with physical or cognitive disabilities are often late in learning to stay clean and dry. This may be partly due to their disabilities. But often it is because the parents have not provided the opportunity, training, and help that the child needs. For example, one 10-year-old boy with hearing loss and cognitive delay in Mexico still depended on his mother to change his diapers. His mother had never seriously tried to teach him and thought he could not learn. Yet with a little help from a village rehabilitation worker, he became completely toilet trained in 3 days!
Children with disabilities should be helped to become as independent as possible in their toileting. With help, most children with cognitive delay or disabilities can become completely toilet trained by ages 3 to 5.
Of course, children with severe physical disabilities may always need help with clothing or getting to the pot. But they can learn to tell you when they have to go, and do their best to “hold on” until they are on the pot.
Children who lack bladder and bowel control because of spina bifida or spinal cord injury have challenges specific to these conditions, but can often learn some control and become relatively or completely independent. The specific challenges and toilet training of these children are discussed in Chapter 25.