Toilet training and the skills needed for a successful experience
If you’re starting to think about toilet training with your child, then you’ve undoubtedly spent a bit of time thinking about how to approach “toileting”. First and foremost, success with toilet training requires that the child is physically and emotionally ready, not a specific age. We have assembled some helpful occupational therapy based tips to help get you started and take out some of the confusion around toilet training.
Before even attempting to start toilet training there are some basic functional skills and physical attributes in which your child is recommended to be meeting. The ability to complete the task of toilet training requires awareness of ones body in addition to strong muscles, good coordination and balance skills. A child needs to be able to complete the following skills to effectively use the toilet: control their body to sit upright, have sufficient balance to sit, strength to control their body movements, ability to reach for toilet paper and coordinate wiping movements.
The steps of toileting can be broken down into smaller steps to achieve using the bathroom independently, without adult assistance.
Step 1: Entering the bathroom: Can the child get the door open? Can the child get into the bathroom independently?
Step 2: Removing clothing: Can the child remove the proper clothing? Can the child undo clothing?
Step 3: Getting on the toilet seat: Can the child transfer onto the toilet without assistance?
Step 4: Sitting on the toilet seat: Can the child maintain independent sitting on the toilet?
Step 5: Wiping clean: Can the child maintain his/her balance while reaching for toilet paper? Can the child weight shift side to side or forwards to reach and wipe the area clean?
Step 6: Getting off the toilet or potty: Can the child transfer from sitting to standing without assistance? Can the child step down from a step stool if present?
Step 7: Getting dressed: Can the child pull up his/her pants?
Step 8: Exiting the bathroom: Can the child open the door to exit the bathroom?
The previous steps include the gross motor skills necessary, but children also need a significant amount of motor planning and body awareness to carry out the entire routine. Toileting is a multiple step activity that poses motor planning challenges. A child may need to react and move to avoid obstacles in the bathroom. A new motor plan is necessary every time a child uses a different potty, toilet or bathroom.
Gross motor activity suggestions to help building skills for toileting:
Postural control, muscle strength and coordination are beneficial when it comes to developing independence with toileting. Here are 5 suggested activities, which involve these areas:
- Motor planning activities – Practice following multiple-step motor commands in different environments. Obstacles courses are great fun. Try setting up an obstacle course that includes stepping up and down, kicking a ball and bouncing on a small ball.
- Balancing while sitting on a bench or seat – This activity will allow children practice time without the stressors of being in the bathroom. Children can reach for toys outside their base of support and weight shift to the right or left. Practice reaching forward for toys to encourage maintaining balance while leaning over in order to wipe.
- Squatting activities – Position toys so the child has to squat down to retrieve objects.
- Balance activities in standing – Practice maintaining balance while on one foot which is required to step up/down on a small step stool. This can be very simple activities such as stepping on and off a step outdoors, playing games in standing with one foot elevated on a small block or walking along a balance beam.
- Turning body activities – Any crossing midline (reaching across ones body e.g. crossing left hand to right side of body) activities encourage rotation of the body, which build strength. For example, try digging in the dirt or sand. The child can sit down, kneel or squat. Place a bucket on one side of the child and the shovel on the other side. Have the child dig and then rotate to place the dirt in the bucket. Do not let the child switch hands with the shovel when going to put the dirt in the bucket.All of these activities work on skills involved in toilet training! Good luck on the “toileting” journey with your child.
- Furano et al and Parks, S (2014). HELP® Checklist 0-3 Birth to Three Years. VORT Corporation.
- Lee, D. F., Ryan, S., Polgar, J. M., & Leibel, G. (2002). Consumer-based approaches used in the development of an adaptive toileting system for children with positioning problems. Physical & occupational therapy in pediatrics, 22(1), 5-24.
- Queck, L. (2018). Toilet Training a Child Diagnosed with Autism.