Toileting 

What is toileting? 

Toilet training is the process of training a child to use the toilet for bowel and bladder use (i.e. wees and poos). Toilet training may start with a potty (smaller toilet bowl-shaped device) or you may omit this and begin with the toilet. Most children will find it easier to control their bowel before their bladder and it usually takes longer to learn to stay dry throughout the night. A child is considered to be toilet trained when he or she initiates going to the bathroom and can adjust clothing necessary to urinate or have a bowel movement.

Why is toileting important? 

Many nursery have a policy that children attending their centres must be toilet trained, meaning that only if the child is toilet trained are they able to access an education*. Not being toilet trained may not only limit a child from accessing the academic setting, but also from other social scenes it may be difficult to take the child out when many of their friends are toilet trained and they are not. As children become more aware of the lack of toilet training, there may be some bullying or public ridicule by other children. 

*This is not always a hard and fast rule but toileting independently is the desired goal. 

What are the underlying skills required for toilet training?

1. Physical skills 

• Control of sphincters / muscles responsible for controlling the evacuation process. 
• Physical ability to sit upright on toilet/potty and not fall off. 
• Ability to undress/dress as needed (including managing buttons/zips and knowing how to plan and sequence dressing/undressing). 

2. Sensory Processing 

• Awareness of soiled/wet nappy (i.e. body awareness, tactile discrimination). 
• Awareness of need to toilet (with enough time to get there). 
• Ability to cope with the sensory environment of toileting. 
• Internal (i.e. reading the body’s signals and managing the feelings of toileting). 
• External (including toilet seat, toilet paper, smell, noise, clothing on skin). 
• Attention to task, to sit still long enough to toilet (more than 5 mins without you needing to help them stay sitting). 

3. Concept understanding 

• Comprehension of the sequential steps of toileting and dressing (e.g. pull pants down beforesitting). 
• Attempts to remove clothing in readiness for toileting. 
• Attempts to request or communicate needs to others (e.g. I need to go to the toilet). 
• Awareness of the routine of toileting. 
• Awareness of the task that is required of you in the bathroom. 

4. Communication 

• The ability to follow simple adult-directed routines (i.e. doesn’t demonstrate avoidance behaviours where the child simply doesn’t want to do it because an adult is telling them to do it and interrupting what they were doing). 

You can if the child has difficulties with toileting skills when: 

• The child is not alerting an adult when they have wet or soiled their nappy. 
• The child struggles to undress independently. 
• The child is fearful to sit on the toilet/potty. 

When you see difficulties with toileting skills, you may also see difficulties with: 

• Following instructions
• Receptive language (understanding
• Self-care
• Sensory processing
•  Planning and sequencing. 
• Self-regulation

What can be done to improve toileting skills? 

Building blocks: Develop each of the four steps outlined above. 

Visual schedule: Including the steps involved in toileting. 

Reward chart: For independent toileting (whether successful or not initially) or telling an adult of the need to go. 

Activities that can help improve toileting skills include: 

• Physical setup: Be prepared with the right equipment. If the child is using the toilet it will be helpful to get a step for the child to stand on as well as a smaller seat that fits securely inside the existing toilet seat, as some children may be nervous about falling in. 

• Role play: Role play toileting with teddy bears. 

• Read books: Buy one of the many children’s books that serve as a social story about toileting (many books have the flushing noise maker in them!).