Toilet Training When Your Child Has Multiple Disabilities
Toileting, or elimination, is something everyone does throughout the day, so helping your child achieve more independence in this area is likely to be a high priority for you and your family. If your child is consistently dry for 1 1/2 to 2 hours at a time and can wake up from a nap without being soiled, she may be ready to learn to use the toilet.
Although your child's needs and abilities may vary from that of other children, what is important to consider is how to maximize her participation, privacy, and comfort when she uses the bathroom. The more she can do for herself, the less dependent she will be on you and others for assistance. Here are some suggestions for helping your child to be as independent as possible in using the toilet:
- The use of a bathroom routine will give your child a framework for understanding what is going to happen and what is expected of her. You might begin the routine by giving her a symbol that can become associated with using the bathroom, such as a card with a piece of soap on it that smells like the soap she uses to wash her hands, or a washcloth that feels like the towel she uses to dry her hands.
- Use the hand-under-hand or hand-over-hand method when guiding your child to pull clothes up and down, tear off toilet paper, or wipe herself. Gradually over time you will be able to decrease the amount of assistance you give her as she learns how to perform these tasks herself. Note that these techniques need to be used carefully and with sensitivity toward your child's preferences, sensitivities, and abilities. Some children may be upset when they feel their hands are being controlled, especially if they have conditions such as autism spectrum disorders that increase their sensitivity to sensory contact or stimulation. If this is the case, the hand-under-hand method may be a better choice than hand-over-hand.
- Your child will be more successful in participating in using the toilet if she feels secure physically. Work with her occupational therapist or physical therapist to explore the best seating options for her, how to transfer her from her wheelchair to the toilet, or where in the bathroom handrails might be useful.
- Select clothing for your child that is easy to take off and put on. Pants with an elastic waist band will be easier for her to manipulate than pants with snaps and a zipper, for instance.
- Even if your child does not appear to recognize whether the bathroom door is open or closed, it is important to model privacy for her. Close the door to the bathroom when assisting her with using the toilet.
Some children with visual impairments and multiple disabilities are not able to consistently communicate to you and others that they need to use the toilet. Using a schedule to indicate when your child is to use the toilet can help minimize accidents. With other members of your child's educational team keep track of when your child urinates and has a bowel movement. For example, if she usually has a bowel movement approximately 30 minutes after a meal, then at 20 minutes after the meal take her to the toilet and have her sit there. This routine will increase the probability that she will have the bowel movement in the toilet.
Despite the best efforts, however, accidents will inevitably happen. When they do, involve your child as much as possible in cleaning up, including the unpleasant parts such as removing wet clothing or wiping up the floor. This way she is more likely to make the association that when she uses the toilet she can avoid participating in these unpleasant tasks.
Many children learn to use the toilet more quickly and become more independent if they are given rewards for doing so. Before embarking on such a program, it is important to determine whether your child is able to make the connection between using the toilet and the reward. If you do decide to use rewards for potty training, select rewards that are only given at this time, such as a favorite toy, special snack, or music CD that your child is given only after she successfully uses the toilet.