How do you know when your child is ready to toilet train?Things to look for:

• Child is staying dry for longer periods of time (i.e. 3-4 hours). Also, staying dry during naps.

• Child indicates that they have a dirty diaper. May do this verbally, through body language , taking off diaper, etc.

•Shows interest in others' bathroom habits (likes to watch you go to the bathroom, wants to wear underwear, etc.)

•Dislikes the feeling of being dirty

•Able to follow simple instructions, such as “Go get the toy”

• Has demonstrated the desire to be independent

How do you know if you are ready to toilet train?

•Desire

•Willing to do what it takes

•Putting the time and effort in

•Patience

•Staying calm

•Making it worth it to your child

•Being consistent with yourself, child, family, and whoever else interacts with your child.

What may interfere with your child’s toileting•Has no clue what you are

trying to get he/she to do

•Fear of the bathroom or toilet due to sensory sensitivities

•No structure

•Your reactions and inconsistency

•The use of diapers or pull-ups other than during the night time or the bus/car ride

•Doesn’t like change But all can be overcome if you are willing to make the effort…

How we usually toilet train at school

•We have you, the parent, send your child in a diaper/pull-up with underwear over it along with their other clothes they should be wearing. We also request 6 changes of clothing (shirts, pants/shorts, underwear, and socks which should be replaced daily if used), small treats for when they are dry (i.e. skittles, M&Ms, etc), and slightly bigger treats for when they have a success in the toilet (i.e. mini candy bars, cookies, etc). These treats should only be used for toilet training.

•We start by setting a kitchen timer for 5 minutes. When it goes off we ask the child if they are wet or dry. We have them feel to see if they are wet or dry. If they are dry we give them a small treat. Then we repeat with the same routine.

•Roughly every 30 minutes we take them to sit on the toilet for 5 minutes. We record all the toileting data.

•As improvement continues the time is adjusted to be longer time periods. When ready, the timer and treats will be discontinued.

Urination before the BM

• Obviously working on urinary training comes first

• When urinary training has been successfully accomplished we can concentrate on the bowel movement

• The bowel movement will often take more time to achieve

• You can still encourage your child to sit on the toilet especially if you notice them needing or starting to have a bowel movement

Bowel Training

•Initial success is crucial

•Track child’s bm and look for patterns

•Once patterns are found, sit your child on the toilet accordingly

•It may take several weeks or months to achieve full success

•Make sure you reward them after a success

•Also, remember to remain neutral when accidents occur

Toilet TrainingName: __________________ Begin: ____________________

Criteria: _________________ Completed: __________________________________________________________________

Date Time Urination BowelMovement

Accident Initiated Comments

2/8 3:15 X X

2/9 9:15 x pull-up dry

2/9 9:50 X X went a little in the toilet too

2/9 10:20 didn’t go

What you can do at home•Once started only use diapers/pull-ups at night time, during rides, activities without access to a bathroom, and when sick (i.e. diarrhea)

•Set up a schedule that can fit in with your lifestyle within reason

•Decide and be consistent with your reward system including the time you decide to check for dryness and when sitting on the toilet

•Make sitting on the toilet a pleasant experience for your child. Books, games, activities, and much more can help your child have a pleasant experience to encourage progress with toileting

•Use lots of praise and positive feedback (i.e. act excited )

•If child has an accident stay calm and neutral

•Show child where it should go and have them help clean up the mess within reason

Options where help is needed

• If no success, start pushing liquids such as juices, water, etc. (this is often referred to as “flooding”), but just encourage it and not force it

• Change reinforcers

• Use a visual schedule for your child to know what to do

• Use a calendar as a visual for showing when changes are coming and when they will be

• Be more positive

•Break down the task by using pictures to visually show exactly how to use the bathroom or to just teach step by step

i.e. 1. Enter the bathroom (does not do fasteners)

2. Pull clothes downa. Allows adult to pullb. Pull from calvesc. Pull from kneesd. Pull from thighse. Pull from hipsf. Pull from waist

And continue so forth

•Write a social story and use it with every opportunity to teach

i.e. A Place for Poo

Hi, my name is Bob.There is a toilet at my house and at my

school.People go poo in the toilet.My mommy is happy when I go poo in the

toilet.My Daddy is happy when I go poo in the

toilet.I will try to go poo in the toilet.This is a good idea to go poo in the toilet.

• Overcorrection: 1. Tell the child he/she is wet, and

have him/her feel his pants. 2. Prompt child to say, sign, or

identify bathroom with picture or PEC symbol.

3. Fully prompt the child to the bathroom and physically prompt through:

Pants downSit downStand up

Pants upRepeat 10 times, 10 different

locations4. Have child change and clean self

• First, establish a visually supported transition and sequencing system

• Second, be sure to do normal steps in toileting before using these approaches and use when needed

• Third, use these two questions when your child has any problem with any steps of the process of toileting

1. What is my child’s perspective during this process?

2. How can I simplify and/or clarify through visual structure or in any other area the process?

Examples of situations that may occur and ideas to use if you find yourself in this situation with your

child:1. RESISTS SITTING ON THE TOILET

• Allow to sit without removing clothes

• Allow to sit with toilet covered (cardboard under the seat, gradually cutting larger hole, or towel under the seat, gradually remove)

• Use potty seat on the floor rather than up high

• If strategies are helpful for sitting in other places, use in this setting also (timers, screens, picture cues, etc.)

• Take turns sitting, or use a doll for model

• Sit together

• Add physical support

• Help them understand how long to sit (sing potty song, length of one song on tape player, set timer one minute, etc.)

• As they gradually begin to tolerate sitting, provide them with some form of entertainment

2. AFRAID OF FLUSHING

• Don’t flush until there is something to flush

• Start flush with child away from the toilet, perhaps standing at the door (might mark the spot with a carpet square and gradually get closer to the toilet)

• Give advance warning of flush, setting up a flushing cue system, such as “Ready, Set, Go”

• Allow them to flush the toilet

3. OVERLY INTERESTED IN FLUSHING

• Physically cover toilet handle to remove from sight

• Give something else to hold and manipulate

• Use visual sequence to show when to flush (i.e. after replacing clothing)

• When time to flush, give child a sticker that matches to a sticker on the toilet handle

4. PLAYING IN THE WATER

• Give a toy with a water feature as a distraction (i.e. tornado tube, glitter tube, etc.)

• Use a padded lap desk while seated

• Cover the seat until ready to use

• Put a visual cue of where to stand

5. PLAYING WITH THE TOILET PAPER

• Remove the toilet paper if it is a big problem and use Kleenex instead

• Roll out amount ahead of time

• Give a visual cue for how much to use (i.e. put a clothespin on where to tear or making a tape line on the wall for where to stop)

6. RESISTS BEING CLEANED

• Try different materials (i.e. wet wipes, cloth, sponge, etc.)

• Consider the temperature of the material being used to clean

• Take turns with a doll

7. BAD AIM

• Supply a “target” in the water (i.e. A Cheerio)

• Use a larger target as toilet insert and gradually move it down (i.e. contact papered or laminated cardboard with target drawn on it)

• Add food coloring in the water to draw attention

8. RETAINING WHEN DIAPER IS REMOVED

• Cut out bottom of diapers gradually, while allowing child to wear altered diaper to sit on the toilet

• Use doll to provide a visual model

• Increase fluids and fiber in diet

• May need to enlist doctor if serious bowel withholding (may give stool softener if recommended by the doctor)

• At the beginning of toileting, using the bathroom can be initiated by an adult directing the child to a transition object or schedule.

• Eventually your child will need a way to independently communicate the need to go to the bathroom.

• Your child may begin spontaneously going to a familiar and available bathroom.

• Spontaneously using the bathroom is great, but they still need to learn a concrete way to communicate the need so they will be able to request when a toilet is not immediate available.

TOILET TRAINED AND

HAPPY

The 7 Step Eating PlanThe 7 Step Eating Plan1. Touch food to mouth.

Try having the child put the new food to their lips. If the child refuses, you then take the food and touch it to the child’s mouth. Reinforce the child when they do this by giving them a food they like. Do this until your child is doing it by themselves and feels comfortable with it.

2. Licking the food.After the child can touch the food to their mouth then encourage them to lick it. This will allow them to be able to get at least a taste of the food. When they lick the food reinforce it with a food they like. Do this until they feel comfortable and are doing it themselves.

3. Food in mouth and out.In this step the child will need to place the unwanted food in their. When your child can do this by themselves, move on.

4. Food in mouth and count.Once the child can put the food in their mouth encourage the child to keep it in their mouth while you count to 10 and then they can spit it out.

Eating Plan ContinuedEating Plan Continued5. Chewing the food.

This is when the child needs to start chewing the food. Encourage them to bite down on the food before they can spit it out. They do not need to swallow it. Remember to give them a wanted food when they chew the food.

6. Swallowing the food.Your child should now be comfortable with the food. If the child’s wanted food is reinforcing enough, they will swallow the unwanted food so they can have it. If they don’t swallow they won’t get their wanted food. There is no way to make someone swallow. Just keep encouraging them to swallow. Good Luck!

7. Eating more food.When your child is doing well at swallowing food and you want them to start eating more move up how many bites they must take before they can have their wanted food. For example, move to 3 bites then to 5 bites.