Potty Training Readiness
When should children start?
When they are ready (not an exact answer, generally between 18 & 30
months if typically-developing) Not an
age, but a window of opportunity.
· Readiness Indicators for Potty Training
o Is
the child at least 18 months old?
§ Muscles and bladder capacity develop between 18-24
months
§ To master, child must be able to consciously tighten
sphincter muscles so they can “hold it” until they can get to the potty. Most children gradually master this between
ages 2 & 4 years (but 5-10% don’t for daytime dryness, and 15-20% don’t for
night time)
o Are
the child’s diapers dry for at least two hours at a time?
§ Indicates that bladder is large enough and mature enough
to start
§ Babies urinate as a reflex 15-20 times a day, #
reduces as bladder enlarges
o Does
the child know – and let you know – when he is wet or has a bowel movement?
§ If not, don’t start (or consider a schedule method if
child is at least 4 years old)
o Does
the child tell you or indicate that she is uncomfortable in wet or soiled
diapers?
§ If not, it will be difficult to convince him/her to
use the potty
o Can
the child sit upright for five minutes?
§ If not, it won’t be long enough to void
o Can
the child undress enough to sit on the potty?
§ If not, it will be hard for child to get to the potty
“in time” if she has to wait for an adult to help with clothing
o Is
the child able to get himself to the potty?
§ Get to it and get on/off of it
o Does
the child follow simple directions?
§ Needs to be able and willing to cooperate (at least
most of the time)
o Does
the child answer simple yes-and-no questions?
§ Communicate enough to answer when you ask if wet, if
ready to use potty
o Does
the child imitate others – parents, caregivers, or other children?
§ More likely to imitate others
o Does
the child trust and feel comfortable with the adults who care for her?
§ Make sure child goes with someone they trust or it
will be very hard
o Does
the child show pride, joy, or excitement when he learns new skills?
§ If not, may be more difficult
o Do
the adults – parents and caregivers – know what they will have to do to help
the child learn to use the potty?
§ Be on the same page, consistency is crucial
o Are
parents and caregivers willing and able to devote the time and attention to
helping the child learn to use the potty?
§ Must make some changes to routine, some sacrifices and
some time adjustments, if not, you set up a difficult situation for the child
§
Cannot just
switch back to diapers for convenience for a vacation or a trip to the
store
·
Special Circumstances to Consider:
o Have
there been any recent changes in the household that seem difficult for the
child?
§ Serious illness (child or parent)
§ Separation or divorce
§ Death in the family
§
Move
§
New baby
o Have
there been any changes in the childcare?
§
Just started
§
Change in programs, locations, or rooms
§
Change in providers
o Is
the child in a very negative phase (resisting lots of things)?
Toilet Training
Dry Pants Check:
A Dry Pants Check
consists of having your child touch his pants to see if they are dry. This is done by asking your child to feel the
front on his pants with his hand. You
might have to assist your child to do so hand-over-hand or point to where to
touch in order to see if the pants are dry.
If your child has dry pants, he is given a “dry pants” treat.
Toilet Opportunity:
This is each time your
child sits on the toilet. Any assistance
should be given hand-over-hand or with a pointing prompt accompanied by verbal
directions. This should last
approximately 5 minutes, unless you feel longer is appropriate. In the school setting, we usually only have a
student sit for 5 minutes. If your child
urinates or has a bowel movement while on the toilet, he should immediately
receive the pre-determined treat (“toilet treat”).
Toilet Training
Reinforcers:
The most important detail
is that none of the reinforcers you use for toilet training can be available at
any other time of the day. For example,
if you are giving your child a mini-Twix for urinating in the toilet, he CANNOT
be able to eat any sort of Twix for any other reason throughout the day.
Reinforcers for dry pants
checks should be smaller than those given for going to the bathroom in the
toilet, for example, a single Skittle or an M&M. At the same time, it is important to keep in
mind your child’s preferences. If your
child loves Skittles more than anything, that might make a better toilet treat
than dry pants treat.
Schedule:
Dry Pants Check = approximately every 15 minutes Toilet Opportunity =
approximately every 30 minutes
Approximate Time
|
Procedure
|
What do I do?
|
|
1.
|
8:00am
|
Dry Pants Check
|
*If dry, give dry pants
treat.
*If wet or soiled, have
sit on the toilet for 5 minutes and change clothes.
|
2.
|
8:15am
|
Dry Pants Check
|
*If dry, give dry pants
treat.
*Change if wet/soiled.
|
3.
|
8:15am
|
Toilet Opportunity
(5 min)
|
*If goes in the toilet,
give treat and allow to flush the toilet.
*If not, do NOT flush
toilet and give neutral response.
|
4.
|
8:35am
|
Dry Pants Check
|
See line 1.
|
5.
|
8:50am
|
Dry Pants Check
|
See line 2.
|
6.
|
8:50am
|
Toilet Opportunity
(5 min)
|
See line 3.
|
7.
|
9:10am
|
Dry Pants Check
|
See line 1.
|
8.
|
9:25am
|
Dry Pants Check
|
See line 2.
|
9:25am
|
Toilet Opportunity
(5 min)
|
See line 3.
|
|
9.
|
9:45am
|
Dry Pants Check
|
See line 1.
|
10.
|
10:00am
|
Dry Pants Check
|
See line 2.
|
11.
|
10:00am
|
Toilet Opportunity
(5 min)
|
See line 3.
|
*Continue toilet training
schedule throughout the day. Time
between dry pants checks and toilet opportunities can be extended as
appropriate as your child progresses.
Dry pants checks can also be eliminated as appropriate.
*Always keep track of
when your child has an accident. If
there is a pattern, you can arrange to have your child go to the bathroom at a
certain time.
General Potty Training Tips
Taken from Book “Good Going! Successful Potty Training for Children in
Child Care” By: Gretchen Kinnell
·
Toilet learning
as opposed to toilet training
·
Perspective:
o Potty
training is a process that helps children master toileting as a self-help
skill.
o When
children are in group care, parents and caregivers must work together so the
children can be comfortable, confident, and successful while they learn toileting
skills.
·
Moving toward independence in the following
skills:
o Realize
they need to use the potty without anyone reminding them
o Take
themselves to the potty
o Undress
enough to use the potty
o Urinate
and have bowel movements in the potty
o Wipe
themselves
o Pull
up their pants
o Flush
the toilet
o Wash
their hands
·
Phase 1: Getting Started
o Chart
diapering/toileting of individual children (dry, wet, bowel movement)
o When
there is a pattern of dryness for at least 2 hours at a time, go to phase 2.
o Using
the data, establish a changing schedule.
So, if child is dry from 9-10:30 usually, but wet by 11:00, change child
at 10:30 and as part of changing process, have child sit on potty for a couple
of min. (Take off dry diaper, sit on potty, put on clean diaper).
·
Phase 2: The Child is Ready to Start
o Agree
on a potty training procedure to be carried out at home and in the program.
o Have
child begin to wear training pants (send in lots of extra clothing to center –
training pants, pants, socks, shoes, and shirts)
o Suggest
to child to go potty at regular intervals (announcing “potty time” to the child
rather than asking if he “wants to go”.
Sets up the expectation that the child will go. (This is NOT taking the whole group all at
once, just one or two kids.)
o If
child wets or has a bowel movement in her pants, clean her up immediately while
reassuring her that it is alright.
**It’s important that parents and staff accept that accidents will be
inevitable at first.** Do not punish the
child for them because it will slow the process down.
o At
the same time, send a message that they need to use the potty and you believe
they are capable of doing so.
o Encourage
children to take themselves to the potty whenever they have to go.
o For
boys – if learning standing up, place a square of toilet paper in toilet to aim
at. Many programs start boys sitting
backward on the potty before trying standing up.
o If
child asks you, “Can I watch you go potty?” and you are not comfortable with
it, a good answer is, “No. I like to go
potty by myself. I know how to do
everything in the bathroom, so I just go all by myself.”
·
Equipment:
Toilets, Potty Chairs, and Potty Seats
o Make
sure potty chairs are child-size, have a wide enough base, and are heavy enough
not to tip over or stick to the child when they stand up after using it
(feeling of safety and security is vital).
o Make
sure child’s feet can touch the ground or a stable step when seated on the
toilet. (Helps them feel safe and helps push a BM)
o They
DO NOT recommend the little seat that just affixes to the toilet seat because
it doesn’t feel as safe or stable to the child.
o They
DO NOT recommend potty chairs or seats with deflectors or shields designed to
keep little boys from urinating out of the potty (convenience) because they can
cause injury to children.
o It’s
important that the potty be easy to clean.
o Bathrooms/potty
chairs should be inviting, have enough light, and be easy to supervise.
o They
suggest putting up pictures or designs on walls at children’s eye level.
o Be
aware of and respectful of a child’s need for privacy (need belongs to
individual).
·
Hygiene during Potty Training:
o Children
should wash their hands each time they use the toilet or potty, even if
“nothing came out”.
o Make
sure children can reach and use all of the supplies and equipment to wash their
hands.
o Don’t
demand that children who are afraid of flushing do it. You can do it for them and let them watch
from a distance. You can have them try
flushing bits of toilet paper if they’re scared rather than their bodily secretions.
o Proper
wiping needs to be taught:
§
Take turns, you take first two, then
alternate.
·
Teach child to look at the toilet paper after he
has wiped.
·
As long as there is brown on the toilet paper,
there is still more to wipe.
·
When there is no more brown, wiping is complete.
·
Teach girls to wipe from front to back (to avoid
infection)
o Little
poem/jingle you can repeat frequently to help children remember good hygiene:
§
After I go potty, I wipe myself,
I flush the potty, and I wash my hands.
1-2-3!
Wipe, flush, wash!
Common Toilet Training Problems
Taken from Book “Good Going! Successful Potty Training for Children in
Child Care” By: Gretchen Kinnell
·
When children refuse to go:
o Only
worry if over 3 years old and they clearly have control over the bladder &
bowels
§
Usually child perceives too much pressure and/or
feel controlled (nagging)
§
Back off and let child be responsible, minimize
attention to accidents, don’t nag or belittle.
§
When the pressure is genuinely off, children
usually choose to use the toilet rather than be uncomfortable.
§
Low-key intervention – let child set a timer to
remind self when to go.
·
When children will use the potty in one setting,
but not the other (home vs. school):
o Try
to figure out what the child sees as the difference between the two
§
Privacy
§
Stability/security
§
Time
§
Pressure
o “I
know it’s hard for you to use the toilet here and that you feel okay about
using it at home (or vice versa). I
wonder why. (Note: The “I wonder. . .” approach does not demand an answer from
the child, nor does it call for a yes-or-no answer.”)
o “What
could we do about the potty here?” Then
listen to what child says.
o Do
not punish the child for not using the potty in one setting
o Do
not force the child to use a potty they are resisting (it only reinforces the
child’s feeling that it’s unsafe.)
·
When children will not have bowel movements in
the potty:
o Sometimes
this is the result of child having had painful bowel movements and trying to
keep it from happening again.
o Sometimes
its when a child feels pressured to use the potty (control)
o Sometimes
they will develop rituals around having bowel movements
§
Particular places (often private)
§
Specific gestures (shifting from foot to foot
while shaking hands)
§
Specific sounds
o When
you notice these rituals, treat it as constipation or “holding back”.
o Children
who are constipated should see their health care provider for treatment. Adults should not use laxatives, enemas or
suppositories unless directed by the health care provider.
o There
is a higher incidence of this in boys and in every case the author has been
involved with, the child actually had several bowel movements in the toilet and
then stopped. They would continue to
urinate in the toilet though. They were
also overwhelmingly “good” children who were cautious by nature. They did not seem to be deliberately trying
to do the wrong thing, just avoiding having bowl movements in the potty.
o What
to do – temporarily stop interfering with their bowel movements (ie. Don’t try
to find them and get them to the potty when you see they are having one.)
o When
they are done with the BM, calmly and in a matter-of-fact way say, “You had a
bowel movement in your pants. Soon you
will have your bowel movements in the potty.
Let’s go to the bathroom and finish up,” which sets up the expectation
that they will use the potty in the future.
o Don’t
scold or yell. The child knows they
should have used the potty, but are too worried or scared to do it.
o Put
the feces in the potty, wipe the child (or have him wipe himself). Change clothing as needed. Flush the toilet and wash hands.
o This
takes the pressure off of both the adults and the children and most children
come around pretty quickly once they realize they are safe.
·
When Children Want to Play with Their Feces:
o Many
children are interested in their stool.
Some view it as a “creation” and are surprised that adults don’t see it
that way. They may be angry that you
want to flush it away.
o Not
unusual for children to want to touch or play in stool, usually just curiosity.
o Of
course, we can’t let them touch or play with it due to sanitary reasons.
o Tell
them what TO do rather than what NOT to do.
“When the poop comes out of your body, it goes in the potty. Then, we look at it, and then we flush,”
(combined with careful supervision during and after using the potty).
·
When children regress:
o Different
than accidents from “forgetting” to go or because they can’t manage their
clothes fast enough.
o Regression
is usually due to emotional factors: not quite ready, dealing with a stressful
situation (new baby, divorce, etc.)
o Best
response is to comfort and reassure the child and continue to expect and
encourage child to use the potty.
o Do
not punish or browbeat the child into getting back on track. Be patient, but don’t quit.
·
When children use potty training to control
adults:
o Children
figure out that they get a quick reaction and undivided attention from adults
surrounding potty training.
o Instead
of thinking “How can I get him to stop using potty training as a way to control
me?” or thinking that their child is a manipulator, adults should realize that
the child is bright and figured out that this works! They will continue to do
it as long as it works.
o Adults
need to understand that children will ask to go potty when they really don’t
have to as a way to test the control they have over the process and to see if
adults will take them when they say they have to go. Good reasoning, analysis and prediction
skills.
o Best
practice – Most kids stop this on their own if you take them when they need to
go and don’t react strongly if they don’t go.
Also, you need to wean them off of having you take them every time. It needs to become a self-help skill. Encourage them to do as much as possible for
themselves.
-->
By: Kent Moreno
From: http://www.ds-health.com/train.htm
(Note: Kent Moreno is a Behavior
Analyst and father of a child with Down syndrome. He is employed by the West
Virginia Austism Training Center at Marshall University as an education
specialist. He can be reached at knm@access.mountain.net.
In addition to the protocol listed below, it can be helpful if a child is able to observe others using the toilet. This may be something a family is not comfortable with or is not appropriate in certain settings. That's fine.
A major factor in the success of this program is based on the development of an effective toileting schedule. To determine the right schedule for the child, data needs to be taken for at least 2-3 days on how often the child goes to the bathroom. To do this, dry pants checks should be done every 20 - 30 min (20 minutes is preferable). If you’re lucky, you can find diapers that have a strip which changes color when the child voids. Otherwise, it will be necessary to feel for moisture. Take special care to write down the times of the day that the child defecates as most people defecate at approximately the same time each day. This procedure is called baseline data. Once 2-3 days of data has been gathered, it will be necessary figure out approximately how often the child goes to the bathroom. To do this, divide the number of waking minutes by the number of times the child went to the bathroom.
The toileting schedule can now be set up. As a rule of thumb, the child should be taken to the bathroom twice as often as the child's average for urinating and defecating. So, for example, if the child goes to the bathroom an average of once an hour, the child would be taken to the bathroom every 1/2 hour. When setting up the toileting schedule, keep in mind the times of the day that the child is most likely to defecate and try to have the toileting schedule occur close to these times.
Prior to taking the child to the bathroom, give the child a cue that it is time to go to the bathroom. I recommend helping the child to make the sign for toilet until they can make it independently. Using the sign for toilet will not stop those children who are verbal from saying "toilet" and will give the child a way of communicating when they have to go to the bathroom once they have mastered the toileting procedure thus making a toileting schedule unnecessary.
It is important that the bathroom be a very fun place. Reserve a couple of the child's favorite toys or books, which they can only have access to while they are seated on the toilet. Also, music can be very helpful. Mozart and Rockabilly seem to work well.
When having the child sit on the toilet, don't force it. The experience needs to be a positive one. If the child doesn't want to sit on the toilet, leave the bathroom and try again at the next scheduled time. Also, don't have the child sit on the toilet for more than 5-7 minutes. If the child is going to void in the toilet, they will usually do it within that time frame. If the child voids in the toilet, make a big deal out of it, praise the child verbally and tactilely (hugs, pats on the back...) and give them access to a small very preferred edible reinforcer (not always necessary). While it will be important to reduce the use of the edible reinforcers as quickly as possible but, in the early stages of acquiring toileting skills, it will be more important to make voiding in the toilet an extremely momentous and positive experience for the child.
One modification which can be made to the protocol which many times will increase the child's rate of success at voiding in the toilet is to give them something to drink 15-20 min prior to the scheduled toileting time.
-->
Clothing That Will Help Children Master Potty Training:
·
Elastic-waist,
loose-fitting pants
We recommend these pants over
those with buttons or snaps because they are easy for children to pull up and
down themselves.
·
Waist-length
undershirts
Longer undershirts interfere with
the toileting process.
·
Thickly
padded cotton training pants
Use thickly padded training pants
when potty training starts. They absorb
better when children have accidents, and children can pull them up and down
themselves.
·
Regular
underwear
As children experience success,
allow them to wear underwear. Children
can easily pull the underwear up and down themselves; they also give immediate
feedback when children have accidents.
Underwear must not be a reward for learning to use the potty. It should be considered one of the tools.
·
Lots of
extra clothes including training pants, extra pants, socks, and shoes
We want to be able to clean
children up as quickly as possible and with as little fuss as possible. Children must never be forced to stay in
clothes that are wet or have a bowel movement in them.
Clothing That Makes Potty
Training Difficult for Children:
·
Bib
overalls or pants with belts, buckles, snaps, or buttons
Many young children ay not have
the fine-motor skills or the finger strength to unfasten these on their won.
·
Tight-fitting
pants
Many young children may not have
the strength, patience, or coordination to pull them down. If they get wet, many adults may not have the
strength, patience or coordination to pull them off.
·
One-piece
outfits and jumpsuits
One-piece outfits require a lot of
time to get off. Some of the jump suits
that snap in the crotch, but not all the way down the legs, are especially
difficult to get out of. These outfits
also leave you practically naked just to pee!
·
Onesie-type
undershirts or bodysuits
Many young children cannot unsnap
these shirts. In addition, the long
backs frequently fall in the toilet and get wet. Children may feel that they have failed
because their clothes got wet even though they got all the urine in the potty.
·
Dresses,
skirts, and tights
Toileting can be difficult when
little girls try to use one hand to hold the dress or skirt up and have only
one hand available to pull down panties.
Tights are usually difficult to pull down and seem especially difficult
to pull back up. Elastic-waist skirts
can work if they can be pulled up and down easily like pants.
·
Pull-up
type disposable diapers
Disposable,
pull-up type diapers are marketed as a type of underwear that is especially
good for potty training. They may be
designed to look like underwear but they function like a diaper, making it very
hard for children to feel when they are wet. Young children then have a
difficult time making the connection between the feeling of a full bladder and
the need to use the potty.
Possible Phrases to Announce Potty Time
Taken from: “Good Going: Successful Potty Training for
Children in Child Care” by Gretchen Kinnell, et al (pg. 12)
· It’s potty time.
I’ll sing a song while we get ready to go to the potty.
· It’s almost time for lunch. Let’s go potty and wash our hands before we
eat.
· We had such a good time on our walk. As soon as we get back to our room, we’ll
have potty time.
· It’s potty time.
You can bring your toys over here to the potty room door. We’ll put them on this chair so they can wait
right here while you use the potty.
· Some programs set a timer for a specific interval
(e.g. one hour)
In case of accident:
· Oh, I see your pants are wet. Let’s change you. The next time you have to go pee, you can go
on the potty.
· DO NOT ask “Are you wet?” because they may feel
ashamed and answer no. Guilt and shame
are not effective.
No comments:
Post a Comment