Toilet Training for CYSHCN
Determining Readiness
- Diapers are typically dry for at least 2 hours.
- The child can feel the difference between being dry or wet/soiled. Sometimes the child has to be changed into regular underwear instead of absorbent diapers or pull-ups for a few days to assess this.
- The child is capable of delaying urination or stooling until reaching the potty, with help if needed.
- The child is motivated to use the potty and to help remove clothing when possible.
- The child is commonly >4 1/2 years.
- The child displays no fears of being in, on, or around the bathroom. If fears exist, a behavioral desensitization program needs to be done first.
- All medical or physical barriers (e.g., constipation) have been addressed.
Natural Schedule
Toilet Training as a School Goal
Toilet Training in the Home
Subspecialists Collaborations
Refer for assistive equipment and communication programming needed to accompany the toilet training program. These consultations can be obtained through the school services but, on occasion, private consultation may have to be arranged if the school lacks adequate resources. Once continence is achieved, consultations for additional or updated equipment, training to enhance independence as the child matures, or teaching of optimal transfer techniques for parents may be helpful.
Refer for behavioral desensitization if child displays fear of being in, on, or around the bathroom.
Refer for concerns about unaddressed medical or urological issues that may impede toilet training when a child is otherwise ready for this process.
Refer if a child needs additional specialized evaluation or support in managing effective stooling.
Resources
Information & Support
Incontinence Issues among Students with Disabilities (Council for Exceptional Children)
A practical guide for teachers of children with special health care needs that includes terminology, schedules, and areas that need to be addressed need in toilet training; by Clarke LS, Embury DC, and Bauer A (2014).
For Professionals
Toilet Training: A Practice Guide (AAP) ( 153 KB)
Education for clinicians about providing guidance for toilet training and recognizing parental frustration with toilet training,
which increases the risk of child abuse (not focused on children with special health care needs); American Academy of Pediatrics
- downloaded May 2018 from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/practicing-safety/Pages/Toilet-Training.aspx.
For Parents and Patients
Toilet Training Children with Special Needs (AAP)
An excellent resource for toilet training children with sensory disorders, behavioral disorders, autism, spina bifida, cerebral
palsy, intellectual disability, and developmental disorders; American Academy of Pediatrics.
Complete Guide to Special Needs Toilet Training (One Place for Special Needs)
Extensive toilet training strategies for children with a wide variety of special health care needs including developmental
and behavioral, cognitive, sensory, physical limitations, and more.
Toilet Training (healthychildren.org)
Extensive information about potty training that addresses problematic behaviors, readiness, choosing a potty, cognitive and
emotional issues; from the American Academy of Pediatrics.
Bedwetting (healthychildren.org)
How to manage bedwetting and recognize signs of a medical problem; from the American Academy of Pediatrics.
Toilet Training for Children with a Disability (Continence Foundation of Australia)
How-to video for toilet training children with disabilities at home featuring an Australian occupational therapist and toilet
training consultant (8½ minutes).
Patient Education
Bedwetting Brochure (AAP)
Explains the causes of nighttime bedwetting and provides techniques to help parents manage the condition until it is outgrown.
Also provides signs of a possible medical problem; available for a fee from the American Academy of Pediatrics.
Toilet Training Brochure (AAP)
Details a step-by-step training program for potty training (not focused on children with special health care needs); available
for a fee from the American Academy of Pediatrics.
Toilet Training Resistance: Daytime Wetting & Soiling (Contemporary Pediatrics) ( 248 KB)
A printable handout for families with tips for helping the child to overcome hurdles in potty training.
Toilet Training your Child: The Basics (Contemporary Pediatrics) ( 375 KB)
A printable handout about potty training using the Barton Schmitt developmental approach; includes “the bare-bottom weekend”
and other helpful information (not focused on children with special health care needs).
Tools
Potty Tracking Chart (AAP) ( 96 KB)
A simple, printable chart to count potty times each day for a week; from the American Academy of Pediatrics.
Potty Tracking Chart in Spanish (AAP) ( 86 KB)
A simple, printable chart to count potty times each day for a week; from the American Academy of Pediatrics.
Services for Patients & Families in Rhode Island (RI)
Service Categories | # of providers* in: | RI | NW | Other states (5) (show) | | ID | MT | NM | NV | UT |
---|---|---|---|---|---|---|---|---|---|---|
Behavioral Therapies | 25 | 30 | 12 | 142 | 34 | 28 | ||||
Occupational Therapy | 11 | 27 | 39 | 298 | 21 | 41 | ||||
Pediatric Gastroenterology | 19 | 1 | 3 | 16 | 8 | 6 | 4 | |||
Pediatric Urology | 1 | 1 | 5 | 4 | 13 | 3 | ||||
Physical Therapy | 3 | 34 | 44 | 321 | 22 | 49 |
For services not listed above, browse our Services categories or search our database.
* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.
Helpful Articles
Foxx RM, Azrin NH.
Dry pants: a rapid method of toilet training children.
Behav Res Ther.
1973;11(4):435-42.
PubMed abstract
The original and most replicated rapid toilet training program (not specific to CYSHCN). More modern practice often removes
the negative reinforcement from this program.
Warzak WJ, Forcino SS, Sanberg SA, Gross AC.
Advancing Continence in Typically Developing Children: Adapting the Procedures of Foxx and Azrin for Primary Care.
J Dev Behav Pediatr.
2016;37(1):83-7.
PubMed abstract
A review of adapted rapid toilet training approaches based on the original Foxx and Azrin procedure in typically developing
children.
Klassen TP, Kiddoo D, Lang ME, Friesen C, Russell K, Spooner C, Vandermeer B.
The effectiveness of different methods of toilet training for bowel and bladder control.
Evid Rep Technol Assess (Full Rep).
2006(147):1-57.
PubMed abstract
A review of studies examining effectiveness of primarily 2 different methods of toilet training for children with diverse
health care needs. Demonstrates the effectiveness of both the Azrin and Fox model and other approaches that differ from toilet
training of typically developing children.
Levato LE, Aponte CA, Wilkins J, Travis R, Aiello R, Zanibbi K, Loring WA, Butter E, Smith T, Mruzek DW.
Use of urine alarms in toilet training children with intellectual and developmental disabilities: A review.
Res Dev Disabil.
2016;53-54:232-41.
PubMed abstract
A review of studies investigating the use of daytime wetting alarms to help children with intellectual and developmental disabilities.
Macias MM, Roberts KM, Saylor CF, Fussell JJ.
Toileting concerns, parenting stress, and behavior problems in children with special health care needs.
Clin Pediatr (Phila).
2006;45(5):415-22.
PubMed abstract
Emphasizes the importance of medical home providers in assessing and intervening to help families with toilet training their
child with special health care needs.
Kroeger K, Sorensen R.
A parent training model for toilet training children with autism.
J Intellect Disabil Res.
2010;54(6):556-67.
PubMed abstract
Discusses a rapid training method for parents to use to toilet train children with autism within a few days. Articles discusses
a case study of two children with autism, based on the Azrin & Foxx intensive protocol.
Wright AJ, Fletcher O, Scrutton D, Baird G.
Bladder and bowel continence in bilateral cerebral palsy: A population study.
J Pediatr Urol.
2016;12(6):383.e1-383.e8.
PubMed abstract
This study describes the age of achieving day and night continence relative to the degree of motor and intellectual impairment
in children with bilateral CP.
Zickler CF, Richardson V.
Achieving continence in children with neurogenic bowel and bladder.
J Pediatr Health Care.
2004;18(6):276-83.
PubMed abstract
Detailed material on caring for and achieving continence for children with neurogenic bowel and bladder in a variety of settings.
Written from a nursing perspective.