Tips for toilet training a child with additional needs

If your child finds it hard to understand what happens next, use simple language. For example, say “time for potty” instead of “do you need to use the potty now?”

Use a visual schedule that explains what’s coming next. This might also help them remember the toileting steps.

Visual aids for learning toilet training for boys (PDF, 501 KB, 4 pages)

Visual aids for learning toilet training for girls (PDF, 676 KB, 6 pages)

Pay attention to your child’s gestures or body language. For example, they may rub their tummy, become upset, lead you to the toilet or rub their bum.

Respond to their gestures. For example, if they pull at their underwear, say “time for potty”.

It may help if they use the long mirror in the bathroom to check themselves.​

You could try a technique that is called backward chaining. This means you start the task and your child completes the final step.

In this case, you do all of the wiping. Then your child has a turn to do the final wipe to make sure they are clean.

Over the next weeks or months, you reduce the amount of wiping you do. They do more and more of the steps, until they are doing the wiping from start to wipe to finish.

Bottom wiping activity sheet (PDF, 157 KB, 1 page)

Many young children's hand strength and motor skills are still developing. Sometimes this means they have difficulty flushing the toilet or holding on to the edge of their pants while pulling them up.

You can guide your child's hand with yours. Place your hand over your child's to show them how to flush the toilet. This is called hand-over-hand assistance.

Not all children find this comfortable, so be gentle and observe how they react.

When you provide physical guidance, your child is still dependent on your help. Phase out physical guidance over time as they get better.

This means that you begin to guide in other ways. You could use words, gestures or a visual sequence that you could have on the bathroom wall.

You can try hand-over-hand assistance. This means you place your hand on your child’s hands to guide them with their pants or hand washing. Slowly move to verbal prompting over time.

You can help your child to develop their motor skills and coordination with many games and fun activities outside toileting time.

This may help their overall ability to use their hands and fingers for some tasks.

But the best way to teach them the motor skills needed for toileting is by practising the specific steps together during toileting.

Children learn best by doing the real task, over time, with support and encouragement.

Some children get upset or frightened by the noise of the toilet flushing.

To help your child manage this, you could:

• let them leave the bathroom when you are flushing​
• shut the lid to reduce the sound
• let them stand outside the door while you flush and gradually come closer, until they can flush ​
• show the workings of the toilet so they can understand what is making the noise​
• use ear plugs or ear defenders to block the noise of the flushing, especially if you are in a public toilet

• physically cover the toilet handle to remove it from sight
• give them something else to hold and manipulate ​
• use a visual sequence to show them when to flush - for example, after pulling up their pants
• use visual prompts - for example, give your child a sticker that matches to a sticker on the toilet handle​ when it’s time to flush

Most toilets have an easy-to-turn valve under the toilet tank. In an extreme situation, use this to turn off the water supply.

If your child does not like the sensation of the toilet paper, try using something else. For example, a wet sponge or wet wipes and then toilet paper to dry.​

Use labelling language when you do this, such as “the wet wipe is wet”, “the toilet paper is dry”.

Let your child choose a smell for the bathroom that you both like.​

Try lavender or chamomile​, or citrus smells to increase arousal​. Be aware of allergies.

Sense of smell issues with toileting information sheet (PDF, 177 KB, 1 page)

Some children are reluctant to put their hands anywhere near poo. Sensory or 'messy play' can help introduce your child to different textures. You could do this by playing with sand, playdough, water or finger paints.

Use social stories or videos that explain how poo is made and what to do if they have to poo​​.

This helps them understand the body and plan for how the poo leaves the body and where it goes to.

Labelling or modelling interoceptive awareness can help. Interoceptive awareness is the sense we have of the physical signals we get from our body. For example, feelings of hunger, thirst, body temperature and digestion.

If a child is pulling at their underwear, you could say "does ​poo need to go into the toilet?”

You could tell them: "When I need to use the toilet, my tummy feels tight and I need to push."

You could use external strategies​ to help your child understand that the feeling of poo has an end point.

For example, you could say: "We sit on toilet first, then we go to football."

This can help reassure them that there will be an end to the toilet time.

Interoception is one of our 8 senses.

Interoceptive awareness is our understanding of the internal workings within our own bodies.

You could use a social story to explain where to go to the toilet​.

Use the bathroom for all toilet-related activities. For example, changing their nappy or cleaning up after an accident.

When it's time to go, it's time to go booklet (PDF, 8.59 MB, 22 pages)

Some children have toileting anxiety when they need to use the toilet.

You can help by:

• using a visual schedule - routine and predictability can help reduce anxiety​
• assessing the sensory environment and removing items your child finds unpleasant
• using rewards
• using a social story to explain what happens in the toilet - for example, doing a pee and poo

Establish habits or routines. For example, look at their toilet chart and check when they usually poo. Use that as a guide for a routine.

It is important your child is relaxed when they empty their bowels. Make sure they feel safe and sits comfortably on the toilet or potty.

Check that your child is not constipated.

How to identify and treat childhood constipation (video)

Poo checker chart (PDF, 76.3, 1 page)

Some children like the feel of pee or poo in their nappy. Others like the firm containment they feel from the nappy itself.

Try to provide containment in other ways. For example, allow your child to wear tight-fitting pants, leggings or shorts.

Gradually reduce the tightness of the nappy as your child gets more confident.

A social story might be helpful to explain why you are taking their nappy off.