Toilet training is a significant developmental milestone for children, yet many, including those with intellectual or developmental disabilities, face challenges when it comes to bowel movements. This reluctance can stem from various factors, including fears, discomfort, and sensory sensitivities. Understanding these elements can help caregivers support children through this process.  

The EarlyBrain’s toolkit “Marta Against the Toilet” will provide theoretical and practical information for children, parents and caregivers.

Understanding the Challenges 

Cognitive Inflexibility 

Children’s cognitive flexibility is still maturing during early childhood. In the in-between years, inflexibility may manifest itself in the form of resistance to change, in particular for children with neurodevelopmental and behavioural conditions. One common example of this resistance occurs during the transition from diapers to the toilet. Children may struggle with the new sensations and routines associated with toileting, leading to anxiety and refusal to use the toilet. 

Tactile Hypersensitivity 

Many children experience tactile hypersensitivity, where certain textures or sensations become overwhelming. It is a common symptom in several neurodevelopmental and sensory processing conditions. The feeling of the toilet seat, the coldness of the porcelain, or the sensation of sitting can be uncomfortable for some. This discomfort can deter them from using the toilet, as they may associate it with negative physical sensations. 

Anxiety and Phobia 

Toilet anxiety, or phobia, is common among children. It can be triggered by various factors, including a traumatic experience with constipation or fear of falling into the toilet. Children may also develop anxiety in unfamiliar environments, such as public restrooms, where sounds and smells can be overwhelming. This anxiety can lead to avoidance behaviours, such as withholding bowel movements, which can exacerbate the problem. 

Intentional Withholding 

Urinary retention often occurs alongside stool withholding, creating a cycle of discomfort. When children withhold stool due to fear or pain from previous experiences, they may also experience urinary retention. This can lead to further complications, including constipation, as the stool hardens the longer it remains in the colon. 

Behavioural Approaches 

Behaviour Modification: Token Economy 

Implementing a token economy can be an effective strategy for encouraging positive toileting behaviour. This approach involves rewarding children with tokens for successful attempts to use the toilet, which can later be exchanged for a larger reward. This method reinforces positive behaviour and helps children feel a sense of accomplishment. 

Optimal Diet 

A well-balanced diet is crucial in preventing constipation, which is often a significant factor in toilet refusal. Ensuring that children consume a diet rich in fibre —fruits, vegetables, and whole grains— can promote regular bowel movements. Adequate hydration is also essential to soften stool and ease the process of using the toilet. 

Developmental Considerations 

Evolution of Toilet Training Skills 

Toilet training is an evolutive process that varies significantly among children. Factors such as developmental readiness, personality, and environmental influences play a crucial role in how and when a child learns to use the toilet. Understanding that each child develops at their own pace can help parents and caregivers approach the situation with patience and empathy. 

Anticipation and Routine 

Establishing a consistent routine can help children anticipate toilet use, reducing anxiety. Regularly scheduled toilet times can create a sense of normalcy and expectation, making the experience less intimidating. Incorporating enjoyable activities during toilet time, such as reading or playing with toys, can also help ease the anxiety associated with using the toilet. 

Conclusion 

Addressing the challenges children with developmental issues may face when transitioning to toilet use requires a multifaceted approach. By understanding the underlying fears, sensory sensitivities, and the importance of routine, caregivers can create a supportive environment that encourages children to overcome their reluctance to use the toilet. Patience, empathy, and appropriate behavioural strategies can significantly ease this transition, fostering a positive experience for both children and their caregivers. 

The EarlyBrain Consortium is developing toolkits, encompassing stories and training materials for parents and caregivers to support children. The first story “Marta Against the Toilet” will be available on the project’s website and will provide theoretical and practical information, as well as a tale for children to enjoy and learn about the challenges and how to overcome them.