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Toileting is a complex task for many children. It involves many smaller steps before a child can become independent.

These steps include:

  • Recognising the feeling that they need to use the toilet

  • Getting to the toilet and sitting on it

  • Undressing

  • Passing urine or a bowel motion

  • Using core strength to maintain a sitting position on the toilet

  • Wiping

  • Getting dressed again

  • Flushing the toilet

  • Washing hands

For many children, toileting can also involve sensory challenges. These may include the smell, lighting, splash back from the toilet, or being hypersensitive to wipes or toilet paper.

There may also be medical factors that create barriers for children using the toilet. These can include constipation, undiagnosed allergies, or medication.

So – where to start?

It is important that children have the physiological skills to stay dry for at least two hours before starting toilet training. This is a sign they are developing the control skills needed for independent toileting.

Starting toilet training before a child is ready can make the process more difficult and take longer.

It is also important to consider whether parents are ready to begin toilet training. Choosing when to start is important, so think about what works best for both the child and your family.

Daytime continence is typically developed between 2–5 years of age, while nighttime continence usually develops later, between 5–7 years. However, every child is different, and these ages should be considered in relation to each individual child.

Before you start

There are a few things to rule out first.

Any constipation needs medical input. Having soft stools helps reduce pressure on the bladder and supports progress with toileting, with less pain associated with bowel motions.

It is also important to consider whether the toilet environment is suitable for your child. For example:

  • Is the toilet in a dark hallway?

  • Can the child get onto the toilet without adult assistance?

  • Is the child scared of falling into the toilet?

  • Do they avoid the toilet?

Some strategies that may help include:

  • Decorating the toilet space with your child’s interests, such as stickers

  • Having “toilet only” books or fidgets available

  • Using steps

  • Using smaller toilet seats

  • Using air freshener

Strategies

Use consistent language at home

Depending on your child’s communication skills, decide as a family what language will be used for the toilet. For example: toilet, bathroom, pee/wee, poo, wet/dry, or full/empty.

Try to keep this language consistent between all caregivers.

It is also important to keep language around the toilet positive. Toilet training can sometimes be frustrating, so try to make a conscious effort to remain calm and positive.

Toilet timing

Toilet timing can be a helpful first step. Take your child to the toilet every two hours, based around their general pattern. For example:

  • About 20 minutes after food

  • Around the time they usually have a bowel motion

Other things to try

  • Social stories – to encourage understanding of all the steps involved in going to the toilet

  • Reward charts – depending on your child, these can help build motivation. Start with achievable and immediate rewards (such as a sticker). Over time, increase the time needed to earn a reward, such as one day using the toilet before a preferred activity

  • Involve your child in the clean-up process – independence doesn’t always mean continence

  • Be prepared – have spare clothes and cleaning wipes ready

Toileting is a huge step in your child’s independence, health, and quality of life, but it is also a very complex skill.

If your child is having difficulty gaining this skill, or you would like support with this process, please contact one of our occupational therapists to support you and your family.