Toilet training : Activities of daily living for children with multiple disabilities-part 1
Children with disabilities face unique challenges when it comes to daily living activities (ADL). These challenges can vary depending on the specific disabilities that the child has, but in general, children with multiple disabilities require assistance with a wide range of daily living activities and toileting is a crucial one.
In this blog, I will discuss in detail about various toilet training steps and strategies that may be helpful for children with disabilities. I am focusing only on toileting in this blog. In my next blog, I shall be discussing 2 personal hygiene skills- Bathing and Brushing teeth.
Teaching Toileting Skills
Teaching toileting to kids is a significant milestone in their early childhood development.Toilet training can be a challenging and sometimes frustrating process for both children and parents. Its challenging process for any child, but it can be particularly difficult for children with disabilities. It is important to keep in mind that every child is different, and there is no one-size-fits-all approach to teaching toilet etiquette. Some children may be eager to learn and take to it quickly, while others may be resistant or require more time and guidance. Regardless of where your child falls on this, it is important to approach the subject with a positive attitude, patience, and a willingness to adapt your approach as needed. Hence, with the persistence, and a right structured approach and patience, it can be a successful and rewarding experience for everyone involved in the toilet training process.
In this blog, I will discuss how to prepare a child for toileting and make the process as smooth as possible.
I will share methods to teach toilet training step by step to these children.
Here are some practical tips and strategies for teaching toileting and personal hygiene skills to children with disabilities:
Step 1: Determine if your child is ready for toilet training
Before you start the toilet training process, it is important to determine whether your child is ready. Signs that your child may be ready include showing an interest in the toilet, being able to communicate their need to use the toilet, and having a dry diaper for a few hours at a time. If your child is not showing these signs, it may be too early to begin toilet training.
Step 2: Prepare for Toilet Training
Before starting toilet training, it is essential to prepare the child and their environment. Make sure the child is physically and emotionally ready for toilet training. It is important to create a consistent routine and schedule for the child, for this particular step only. Make sure their toilet is easily accessible. If possible, allot a seperate toilet/bathroom for your child who needs to be toilet trained. Label the toilet and all the toilet accessories alongwith their name. For example, “Siya’s Toilet”, “Siya’s potty seat”.
Here, use visual aids such as pictures or symbols to help the child understand only this part of the toilet training process. Use picture books and watching videos about toileting to help them identify what is a Toilet? What is a Toilet seat and all the important items in the toilet? Make them touch and feel if they want, make them stand there for a while; let them see and explore. Keep on repeating these processes for a while. If the child shows agitation during this process, it means child has issues connecting to this concept, hence, understanding of where exactly the child shows agitation could immensely help to timely resolve it.
Step 3: Make sure the child’s clothing is easy to remove
We always start with sitting on the toilet seat fully clothed, step. Gradually move to the next step of removed clothing. So, first have your child sit on the toilet fully clothed. Before your child starts using the toilet, it can be helpful to have them sit on the toilet fully clothed. This can help them get comfortable with the idea of sitting on the toilet and can help them get used to the sensation of sitting on it. And when we gradually do the transition to removed clothing we need to check the clothing is easy to remove.
Easy to remove clothing is crucial when teaching toileting to kids.
A.) Firstly, easy to remove clothing reduces stress for both the child and the parent. When a child is learning to use the toilet, accidents are common, and having to struggle with complicated clothing only adds to the frustration. If the child is wearing pants or shorts with buttons, zippers, or belts, it can be challenging to remove them quickly when an accident occurs. This can lead to a messy and stressful situation for both the child and the parent. By contrast, easy to remove clothing, such as elastic waist pants, or shorts, can be quickly pulled down, making the process less stressful for everyone involved.
B.) Secondly, easy to remove clothing promotes independence. The ultimate goal of teaching toileting to kids is to help them become independent in this area. Easy to remove clothing enables children to learn how to take care of themselves in the bathroom without requiring too much assistance from their parent. When children can easily pull down their pants or shorts, they are more likely to feel confident and in control of the toileting process. This can help them become more independent, which is a crucial aspect of their early childhood development.
C.) Thirdly, easy to remove clothing encourages consistency. When children are learning to use the toilet, consistency is essential. This means that they need to have the same routine every time they use the bathroom, including wearing the same type of clothing. Easy to remove clothing can help establish consistency in the toileting process. For example, if a child wears pants with buttons or zippers one day and elastic waist pants the next, they may become confused about what they need to do in the bathroom. By wearing the same type of clothing every time, children can focus on the toileting process rather than adjusting to different clothing.
So, easy to remove clothing reduces stress for both the child and the parent, promotes independence, and encourages consistency. When selecting clothing for your child, consider the ease of removal as a crucial factor in making the toileting process more comfortable and successful.
Step 4: Introduce the Concept of “When to Use the Toilet?“
Start by introducing the concept of when to use the toilet to the child by using Picture books and videos. Use simple language to explain what the toilet is used for and what is expected of them when should they indicate etc.
One of the best ways to introduce the concept of using the toilet to children is to start by talking about bodily functions in a matter-of-fact way. You can begin by explaining to your child what the toilet is for and how it works, using simple and age-appropriate language. For example, you might say something like, “When we eat and drink, our bodies make pee and poop. To get rid of pee and poop, we use the toilet.”
It can also be helpful to demonstrate the process yourself or show your child YouTube videos or picture books that explain how the toilet works. This can help to demystify the process and make it feel less scary or intimidating for your child.
Once your child understands the basics of toilet use, it’s important to establish a routine around when and how often they should use the toilet. Depending on your child’s age and level of development, they may need reminders or assistance with this. For younger children, you may need to set a schedule for bathroom breaks or ask them if they need to go at regular intervals ranging from every 30 minutes to 60 minutes initially. As your child gets older and more independent, you can gradually give them more responsibility for managing their own bathroom breaks as and when required.
Step 5: Use Modeling (Role- Modeling)
One approach to toilet training that has been effective for many families is the use of modeling. Modeling involves demonstrating and reinforcing positive behavior for a child, which can help them learn new skills and behaviors.
A.)Demonstrate the behavior: The first step in modeling is to demonstrate the desired behavior yourself. Show your child how to use the toilet, including how to sit on the toilet, wipe, and flush. Make sure to explain each step as you go, so your child can understand what you are doing. Allow the child to observe you using the toilet and talk them through the process. Use tactile cues to help the child understand what is happening.
B.)Encourage imitation: Encourage your child to imitate your behavior when using the toilet. This can help them feel more confident and comfortable with the process. You can also encourage them to practice on their own by providing a child-sized toilet or potty chair easily available online or in a retail shop.
C.)Be patient and consistent: learning through Modeling can take time and patience, so it’s important to be consistent with your approach. Stick to a regular routine and encourage your child to observe you and use the toilet at regular intervals throughout the day, like you. This will help them develop an understanding to it.
Step 6: Use Tactile cues:
Children with visual impairment rely on their sense of touch to navigate the world. One effective method of teaching toileting is by using tactile cues. Tactile cues are sensory prompts that help the child to understand when to use the toilet and how to do so independently. Use tactile cues to help them understand the steps involved in toileting and personal hygiene. For example, you could use a raised line or braille label to identify toiletry items, or provide a tactile map of the bathroom layout.
The Benefits of Tactile Cues
i. Tactile cues provide a physical reminder to the child of when it is time to use the toilet. Children with disabilities may struggle to understand social cues or verbal instructions, so tactile cues can be a useful alternative. Tactile cues can also be more reliable than verbal prompts, which can be missed or forgotten.
ii. Using tactile cues can increase a child’s confidence in their toileting abilities. By providing a physical prompt, the child can be more aware of their own body and its needs. This increased awareness can help the child to feel more in control and less anxious about toileting.
How to Incorporate Tactile Cues
There are many different types of tactile cues that can be used to teach toileting skills. Some examples include:
1.Placing the child’s hand on their bladder or stomach to help them feel when they need to use the toilet.
2. Providing a visual cue such as a picture or symbol that represents the toilet.
3. Using a phone reminder that rings or vibrates when it is time to use the toilet- really helpful for children with multiple disabilities.
4. Using a scent or fragrance that is associated with toileting, such as a scented soap or air freshener.
5. When incorporating tactile cues into a toileting routine, it is essential to be consistent.
6. Use the same tactile cue every time and provide lots of positive reinforcement when the child successfully uses the toilet. It may take some time for the child to get used to the cue, so be patient and persistent.
Step 7: Make it multisensory:
Using a multisensory approach can make the Toilet Training process easier and more effective. A multisensory approach involves using multiple senses, including sight, sound, touch, and smell, to teach new skills.
Use a variety of sensory cues to help children with multiple disabilities and visual impairment understand the concepts of toileting and hygiene. For example, you could use scented soap or lotion to help them identify different body parts, or play music or a recording of water running to help them understand the sound of flushing.
Benefits of a Multisensory Approach
A multisensory approach to toilet training can provide a range of benefits to children with multiple disabilities, including:
Improved engagement: Children are more likely to be engaged in the learning process when they can use multiple senses to learn. By providing a multisensory experience, children are more likely to be interested and motivated to participate.
Increased understanding: Using multiple senses can help children with multiple disabilities better understand the concept of toileting. For example, using visual aids, such as pictures or videos, can help children to understand the process of using the toilet.
Enhanced retention: When children use multiple senses to learn, they are more likely to remember what they have learned. This can lead to improved retention and faster progress in the toilet training process.
Here are some strategies that can be used:
1. Use tactile cues: Children with visual impairment rely heavily on their sense of touch, so incorporating tactile cues can be helpful. For example, use a textured toilet seat or a raised toilet seat that provides tactile feedback.
2. Use auditory cues: Auditory cues can help children with visual impairment understand when it is time to go to the bathroom. For example, use a timer or an alarm to signal when it is time to go to the bathroom.
3. Use olfactory cues: Using smell can also be helpful in toilet training. For example, use a specific scent, such as lavender or vanilla, in the bathroom to help the child associate that smell with going to the bathroom.
4. Use taste cues: Incorporating a specific food or drink into the child’s routine before going to the bathroom can also help them associate that activity with going to the bathroom. For example, giving the child a sip of water before heading to the bathroom.
5. Use visual aids: Even though if the child has visual impairment, visual aids can still be helpful. For example, using pictures or tactile symbols to represent the bathroom can help the child understand the concept.
6. Use a consistent routine: Children with multiple disabilities and visual impairment thrive on routines. Establishing a consistent routine for going to the bathroom can help the child understand what is expected of them.
Step 8: Reinforce Positive Behaviors
Children with disabilities may need extra encouragement and praise to feel motivated to learn new skills.
Use positive reinforcement strategies, such as verbal praise, high-fives, or small rewards, to celebrate their progress and accomplishments.Reinforce positive behaviors such as showing interest in the toilet, sitting on the toilet, and using the toilet. Use positive reinforcement such as praise, rewards, or tokens to encourage the child to continue with the process. Positive reinforcement can be a powerful motivator for these children. Praising the child for their efforts and progress can help build their confidence and encourage them to continue with the toilet training process.
Positive reinforcement: is a technique used to encourage desired behavior by rewarding it with praise, attention, or a small reward. When applied to toilet training, positive reinforcement can help motivate children to use the bathroom regularly and reinforce good habits.
Here are some tips on how to use positive reinforcement in toilet training:
1. Use praise and positive feedback:
When your child uses the toilet successfully, praise them immediately with positive feedback. Use phrases like “great job,” “well done,” or “you did it!” This kind of verbal reinforcement can be very encouraging and motivating for children.
2. Offer rewards:
Small rewards can also be a great way to reinforce good behavior. Consider using a sticker chart or a rewards system where your child earns a prize after successfully using the toilet several times. The reward can be something as simple as a favorite snack, a special toy, or a fun activity.
3. Be consistent
Consistency is key when it comes to positive reinforcement. Make sure to praise and reward your child every time they successfully use the toilet. This will help them develop good habits and reinforce their understanding of what behavior is expected.
4. Avoid negative reinforcement
Negative reinforcement, such as scolding or punishment, can be counterproductive and undermine your child’s confidence. Instead, focus on positive reinforcement to encourage and motivate your child.
5. Set realistic expectations
Toilet training can be a long process, and every child is different. Be patient and set realistic expectations for your child’s progress. Celebrate small successes along the way and focus on positive reinforcement to help them achieve their goals.
Step 9: Develop a consistent Toileting Routine
Here are some tips to help you establish a consistent toileting routine for these children.
1. Create a predictable schedule: Develop a consistent toileting schedule that is tailored to your child’s individual needs. Try to establish regular times for toileting, such as first thing in the morning, before and after meals, and before bed.
2. Use visual cues: Many children with multiple disabilities benefit from visual cues. Consider using picture schedules or visual prompts to help your child understand when it is time to use the toilet. Name it- Toilet time or potty time.
3. Address sensory issues: Some children with multiple disabilities may have sensory issues that make toileting difficult. If this is the case, work with an occupational therapist or other healthcare professional to address these issues and develop strategies to help your child feel more comfortable with toileting.
4. Be patient: Developing a consistent toileting routine can take time, especially for children with multiple disabilities. Be patient and continue to work with your child to establish a routine that works for them.
5. Use positive reinforcement: Reinforce your child’s toileting successes with praise, stickers, or other rewards. This can help encourage your child to continue using the toilet regularly.
6. Simplify the process by Task analysis: Simplify the toileting process as much as possible. Break down into simpler steps and parents can paste them on bathroom walls or parent can show them to the child as a visua cue.
7. Use adaptive equipment: such as grab bars, raised toilet seats, or commode chairs, to make toileting easier for your child.
Children with disabilities often thrive on routines and predictability. Establish a consistent toileting and hygiene routine that they can rely on. Use consistent language, gestures, and prompts to help them understand what is expected of them.Develop a toileting routine that is consistent and predictable. Create a schedule that includes regular times for using the toilet, such as after meals or before bedtime. Use visual aids to help the child understand the routine.
Step 10: Involve the child in the process:
Encourage the child to be an active participant in their own toileting and hygiene routine. For example, you could provide a visual schedule or checklist of the steps involved in toileting and hygiene, and encourage them to check off each step as they complete it. This can help them feel more in control of the process and build their confidence and independence. Involve your child in this process as much as possible. Encourage them to participate in the routine and provide opportunities for them to make choices about their toileting routine.
Remember, every child is unique, and it may take some trial and error to find a toileting routine that works best for your child. By working with your child and healthcare professionals, you can establish a consistent routine that can greatly improve your child’s quality of life.
Step 11: Use social stories, Videos of favorite cartoons and role-playing:
Social stories and role-playing can be effective tools for teaching toileting and hygiene skills to children with multiple disabilities and visual impairment. Use social stories to explain the steps involved in toileting and hygiene, and role-play different scenarios to help them practice these skills in a safe and supportive environment. Videos of favorite cartoons like peppa pig potty training video can be really helpful for the child to relate and understand easily.
Videos of favorite cartoons: Children with multiple disabilities and visual impairment may struggle to understand verbal instructions. Videos can be a helpful tool for these children because they provide a visual representation of the behavior that is expected. Using videos of favorite cartoons can be particularly effective because the child is likely to be engaged and motivated to watch them.
Role-playing: Role-playing is a technique where the child practices the desired behavior in a safe and controlled environment.This can help the child become more comfortable with the idea of using the bathroom and can also help them understand what is expected of them. For example, the child can practice sitting on the toilet, pulling down their pants, and wiping themselves. Moreover, parent can also show a demo of toilet routine by using child’s favourite toy in child’s place.
So, using social stories, videos of favorite cartoons, and role-playing can be effective ways to support children during toilet training. These tools can help to provide clear instructions, visual cues, and practice opportunities, which can increase the child’s comfort level and understanding of the desired behavior.
Step 12: Use Prompting and Cueing
Prompting and cueing are effective techniques and two strategies that can be used to assist children with disabilities during toileting. Here are some tips on how to use prompting and cueing for toilet training:
1. Use visual cues: Visual cues such as picture schedules, posters or signs can help remind the child when it’s time to use the toilet. You can also use pictures to demonstrate the steps involved in using the toilet, such as pulling down pants, sitting on the toilet, wiping, and washing hands.
2. Verbal prompting: Use simple, clear language to remind the child when it’s time to use the toilet. For example, you might say “It’s time to use the toilet now” or “Let’s go to the bathroom.” Customize verbal cues as per your child’s understanding for asking the child if they need to use the toilet.
3. Physical prompting: Physical prompting involves guiding the child through the steps involved in toileting. For example, you might gently guide their hand to pull down their pants or help them onto the toilet seat. Use prompts such as touching the child’s arm or hand to remind them to use the toilet.
4. Prompting during Positive reinforcement: Encourage the child to use the toilet independently and reward them for their efforts. You might offer praise, with some physical prompting like – pat on a back or head; high-five, or a high ten or simply a thumbs up.
Toileting for children with disabilities requires a patient, persistent and structured approach. Using prompting and cueing can be helpful in supporting the child to develop toileting skills. By creating a consistent routine, using visual and verbal cues, providing physical prompting and positive reinforcement, the child can successfully learn to use the toilet independently.
Step 13: Reinforce Independence
As the child becomes more comfortable with using the toilet, reinforce their independence. Allow them to initiate the process and encourage them to take ownership of their toileting routine. Use above mentioned positive reinforcements to praise them for their independence.
Step 14: Monitor Progress
Monitor the child’s progress and adjust the toileting routine as needed. Celebrate successes and be patient with setbacks. Keep a record of the child’s progress in a manual or a chart and use it to guide future steps in the toilet training process.
Step 15: Seek professional support:
If you are struggling to teach toileting and hygiene skills to a child with disabilities, do seek professional support. A occupational therapist or special education teacher may be able to provide additional strategies and resources to help you support the child’s learning and development.
Teaching toileting and personal hygiene skills to children can be a challenging process, but with patience, creativity, and support, it is possible to help them develop these essential skills and become more independent in their daily lives. By using a variety of strategies and involving the child in the process, you can help them build their confidence, self-esteem, and overall well-being.
In conclusion, children with disabilities require assistance with a wide range of daily living activities. Personal hygiene, eating and drinking, mobility, communication, and play and leisure are just a few examples of the ADLs that these children may need help with. By working with the child’s, parents, caregivers and healthcare providers, it is possible to develop a plan that meets the child’s specific needs and helps them to live a fulfilling life.
Teaching toilet training to children with disabilities requires a structured and patient approach. By using visual aids, positive reinforcement, and consistent routines, it is possible to teach these children the skills they need to use the toilet independently. Remember to celebrate successes and be patient with setbacks, and always seek the guidance of a healthcare professional if you have concerns about the child’s progress.
Creative representation for this blog is done by our supertalented CreativeSaathi associate Nikhil Thotam