Accessories to support toilet training

DAVINA RICHARDSON, CHILDREN’S SPECIALIST NURSE FROM CHARITABLE SERVICE BLADDER & BOWEL UK OFFERS A LIFELINE TO PARENTS WHO ARE FINDING TOILET TRAINING CHALLENGING. SHE DISCUSSES WHICH EQUIPMENT MIGHT BE MOST APPROPRIATE FOR A CHILD OR YOUNG PERSON ON THEIR TOILET TRAINING JOURNEY.

So much about childcare has changed in a relatively short space of time, including how families are advised to approach toilet training. Toilet training is a key developmental skill addressing how and when children learn to pass urine and open their bowels in an appropriate place. Within a couple of generations, the age at which training begins has increased. In the 1960s most children were toilet trained between the ages of 18 – 24 months. Now it is not unusual for children with typical development to still be in nappies at three or four years old. It is often assumed that children with additional needs will not be able to learn the necessary skills until they are much older than this. Therefore, their families are often advised to wait to start the process until their child is much older, in the mistaken belief it will get easier if delayed.

There is evidence that having a child who has not attained continence is stressful for families and can have negative impacts for the child. It can result in difficulties finding suitable changing facilities when out and about, in social isolation and for some children will

impact on self-esteem. However, although support for delay in other developmental skills is offered promptly, when it comes to toileting too many families are still advised to wait until other issues have been addressed, or until the child appears ready to use the potty or toilet. Postponing working on the skills needed for toilet training may have a significant impact on how long it takes be successful. This is because the child is being taught to use a nappy for much longer and many struggle to change an established routine, particularly if they have difficulties in this area or sensory processing issues or learning disabilities. Furthermore, bladder problems or issues such as constipation can be missed.

The current advice is to start working on the skills for toilet training as soon as the family are able – the earlier the better, although it is never too late to start. Experience with children with Down syndrome has shown that with the right approach most are able to learn to wait to be put on the potty to open their bowels by the time they are 1214 months old and can be clean and dry to start school. One of the key skills for toilet training is learning to sit in the right place. The child or young person needs to be relaxed and to sit for long enough to complete a bladder or bowel emptying. Therefore, one of the earliest considerations in a family’s toilet training journey is deciding what equipment will be most appropriate for their child or young person.

Sitting on the potty results in the child being in the best position for bladder and bowel emptying having a well-supported bottom, feet flat on a firm surface and knees higher than the hips. This position helps to relax the pelvic floor, but also straightens out the bends at the end of the bowel, which helps with complete emptying of the rectum (the rectum is the portion of the bowel nearest the bottom). Correct positioning is therefore useful in prevention of constipation, as well as being part of its treatment.

While a potty may be most appropriate for smaller children, if there is poor sitting balance, a potty with a raised back or a potty chair designed with additional support may be required. For children who want to imitate other family members a potty that looks like a miniature toilet is an option. For trips away from home a travel potty may be the simplest solution, with many available to purchase online.

Older children and those with processing differences may be better going straight to a toilet. The size of the toilet may be more appropriate for the older child and there will be no need for them to learn a new routine around where to toilet when they grow, or for other venues such as school, on holidays or staying with family or respite carers. However, the toilet can cause anxiety for many children. They are not used to sitting on a seat with a hole under their bottom and may feel worried about falling in. The family toilet may feel very high and insecure, and it is difficult to fully relax and empty the bladder and/or bowel if the individual is tense.

Most children and young people will need an insert seat and appropriate height of step to ensure that their bottom is well supported, and feet are flat on a surface high enough to allow their knees to be above their hips. Some reducer seats have integral steps with height adjustments. Folding seat reducers with a separate step may provide a simple solution when out and about.

are working on the skills for toilet training, but have balance or sensory issues, will also benefit from having something to hold onto or to support them. Some insert seats have handles, or handles can be fixed to a wall, if there is one adjacent to the toilet. Toilet frames and moulded toilet seats, which fit around or over the existing toilet are also available to meet a variety of seating needs. Different mobility needs should not, of themselves, restrict a child’s ability to toilet train. There are several products available to assist where access to the toilet or potty is difficult. These include urinals, with a wide variety available for both boys and for girls. Specialist granules can be used to convert the urine into a gel that can be flushed down the toilet if spills or splashes are a concern. ‘Accidents’ are part of learning a new skill and it can be helpful to think about how to manage these at early on. Using nappies, pull ups or other continence pads help to keep the individual feeling dry and warm. Therefore, they can be unhelpful if they cause confusion for the child or young person about what is expected. They may use these rather than trying to get to the toilet or potty, or they may not notice when they do not make it to the correct place.

Washable pants, with extra absorbency, allow the child to feel wet, which is an important part of the training process, but they will hold most of the leakage, so protecting outer clothes, furniture, and carpets. Other options include washable or disposable continence mats, which will protect car seats, chairs, and mattresses. All of these are widely available. For more information about how to approach toilet training visit the Bladder & Bowel UK website here. Support should also be available from your child’s healthcare professional (health visitor, school nurse or specialist nurse). If your child has physical disabilities or sensory issues then ask if their occupational therapist can do an assessment of their toileting needs. The occupational therapist should be able to suggest suitable equipment to meet your child’s needs.