Monday, 16 March 2015

What! My Child has to be Toilet Trained Before Starting School? We Aren’t Ready!

Toilet Training for Older Children

Why am I having so much trouble with toilet training?  My other child was toilet trained by the age of 3, but my youngest is about to start school and isn’t there yet?  I don’t know what I’m doing wrong?

Remember, every child is different.  There is no set age in which your child will be ready.  Sometimes there are other factors that are affecting their ability to use the toilet appropriately, such as developmental delays, food sensitivities, and anxiety. 

Our Story:

I have a 5-year-old son who constantly defecated in his pants and had frequent pee accidents.  It was driving me nuts.  Most of the time, I stayed calm and was patient and supportive, as I figured he would do it when he was ready and I knew that there were other factors lending to this toilet training delay (food sensitivities, anxiety, very mild developmental delay).  But every parent has their moments and I must say that I was starting to become extremely frustrated.  I knew he understood that he was supposed to go on the toilet and that he was capable of doing it, but he simply wouldn’t.

So, what changed?

I think that part of it was my perception of the situation.  I decided to trust in the experts (Pediatrician, Occupational Therapist) and succumb to the fact that it would happen when he was ready.  You can tell yourself all you want that they will do it when they are ready, but you need to really believe it.  Kids can pick up on your frustrations even when you are doing your best to hide them.

By really believing that he would do it when he was ready, I was able to truly exhibit patience and a supportive attitude.  When he was successful, my praise was genuine (Way to go!  I knew you could do it!  I’m so proud of you!).

White Board Toilet Training Chart
~ Customize this chart for your child! ~

As added incentive, I set up a visual sticker chart on the wall to track his progress.  I also made a very cool white board version.  We would regularly consult the chart and say things like, “Wow, look how many times you went pee on the toilet!  Good job!”

I don’t often use external rewards with my children, but at this point, I was willing to try anything.  I got a transparent container and filled it with little treats from the bulk store.  Every time he went pee on the toilet, he got one treat and when he went poo, he got 5 treats.  When the container is empty, we will talk about how, HE DID IT and that he’s officially a big boy now who knows how to use the toilet all by himself.  So far, this is working really well.  Because I know he won’t just help himself to the treats, he is allowed to count out his treats on his own when he uses the toilet.

I’m sure you are wondering what I do when he has an accident.  With confirmation from his pediatrician, I simply stay calm, take him to the bathroom, show him where the poo and pee goes (we literally put the poo in the toilet and flush it), and put him in the bathtub to get cleaned up (first he must try to clean himself, then I help with the rest).  I don’t scold him or get upset, I simply ask him where he needs to go the next time he has to poo or pee and encourage his ideas when they are appropriate.

Through this process, he is learning that the natural consequence of going to the washroom in his pants is to spend time getting cleaned up afterwards.  If he didn’t make it to the washroom because he was too busy playing, well now, he is learning that he loses more play time cleaning up his messes than he would have by just going to the washroom on his own.  Eventually, he will ask himself, is it really worth it?

As he got older and I realized that he understood that he needed to use the toilet, but was still choosing not to (often because he was too busy playing), I started a toileting schedule.  I talked to him about how it's unhealthy to go to the washroom in his pants.  I let him know that when he started making better choices (I asked him what some better choices might be to let him be a part of the process), he won't have to be on a schedule any longer.  Our schedule consisted of going to the washroom every hour and simply trying.  I slowly increased the time to allow him the opportunity to choose to use the bathroom on his own.

Another contributing factor was when he decided that he was a big boy and didn’t want to wear pull-ups any longer.  We had a talk about why he was wearing a pull-up.  I told him that we would try wearing underwear, but then he would have to use the toilet all the time.  When he had 3 accidents in a row, I switched him back to pull ups.  He was not impressed.  As he started showing me that he could use the toilet using a pull-up, we switched back to underwear.

So, did all of this work? 


Alex is now 5 years and 2 months old and for the past week, he has been using the toilet regularly on his own with no accidents.  I am one proud mother.

How Do I Help My Child Overcome Toileting Barriers?

Determine if they have a food sensitivity:

We were able to determine that our son had a sensitivity to dairy products by looking at:
  • Family History (I have a sensitivity, as well as my parents and sister)
  • Frequency of Bowel Movements (runny and frequent is definitely not good and neither is waiting 2 days or more – this causes strain on the bowels)
  • Looking at common food triggers and journaling their consumption and changes in bowel movements shortly after or the following day (common irritants: dairy, gluten, soy)
  • Cramping, smelly gas, bloating (I felt it was odd that a child would experience bloating)
  • Dry, rashy skin or swelling (we didn’t experience this, but my husband experiences this, which led me to think about family history and that irritants affect different people in different ways)
  • Constant congestion, runny nose, and/or cough
  • Fatigue (even with a healthy diet, he had unexplained lows throughout the day)
  • Change in mood (he definitely can’t have sugar, he turns into a grumpy maniac)
Are they having anxiety around using the toilet?

Using the toilet is foreign to children.  They don’t necessarily understand that their feces and urine are dirty.  They’ve been going in their diaper all along, so why change a good thing?  The toilet is scary; sitting doesn’t feel nearly as comfortable as squatting (and is actually unnatural to our physiology when expelling waste); and many children thrive off of routine, so changing that can be stressful for them.

For these reasons, it’s important that you avoid scolding, spanking, and forcing your child to use the toilet when they aren’t ready.  Some parents find that their child will hide their feces or try to clean it up on their own, ultimately making a much larger mess.  This is a sign that your child may have anxiety surrounding washroom routines and may feel uncomfortable to talk to you about it, especially if they fear reprimand.  Talk to your child about why they are behaving this way.  Ask them why they don’t want to use the toilet.  Reassure them that you won’t be upset with them and that you know it can be scary to talk about this stuff, but you love them no matter what.

When children are young, try to make using the toilet a fun thing.  Show your child that Mom and Dad use the toilet and then there’s no mess to clean up after (literally take them to the bathroom with you when you go).  Start a new routine where they sit on the toilet and read stories and have cuddle time (start with their pants up, then transition to pants down).  Part of your routine could include a treat that they enjoy at the end to associate a positive connotation with using the toilet.  Ultimately, your goal is to maintain patience and a supportive attitude.

Does your child have a developmental delay?

As a teacher, I knew from a very early age (7-8 months) that something wasn’t quite right, but I certainly wouldn’t expect that the average parent would be aware of the signs.  One thing you can do, is consult the Nipissing District Developmental Screen to determine if your child is meeting developmental milestones.  If you think there might be a problem, then talk to an expert, such as a Pediatrician or an Occupational Therapist.  These services are offered for free, but they often have wait lists, so try to be proactive and do some of your own research while you are waiting.  The Health Unit often offers home services to help parents who reach out to them.  There are definitely support groups that are willing to help you and it won’t cost you anything, so ask around.  Your local Early Year’s Center or School might be able to send you in the right direction or make a referral for you to receive services.

What do I do if my child is starting school and they aren’t toilet trained?

We encountered exactly this problem. 

Since our son did have a developmental delay, we were able to have his therapists and pediatrician collaborate with the school and determine a plan of action.  Our plan was for an educational assistant to take him to the washroom on a schedule and deal with any messes in a private room.  We started with pull-ups and transitioned to underwear as he improved. 

Parents who advocate for their children can receive services to help their children succeed.  The school can’t provide those extra services without the paperwork to back it up because they need a paper trail indicating a need in order to obtain funding to pay for the extra help.  Educational Assistants (EA) are allowed to help children who have an Individualized Education Plan (IEP) with their toileting needs, but teachers are legally not allowed to help your child (they can only talk your child through the process from outside the bathroom).  This is why you need to advocate for your child.  You need to make sure that an EA is assigned to your child for a portion of the day.  Talk to the principal and Kindergarten teacher to indicate that you would like to set up a meeting to discuss your child’s needs before school starts.  The process takes time, so try to get all of your ducks in a row at least a year in advance.

Good luck, I know you can do it too!

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