Toilet Training Blues
Not to suggest that any of the sensory challenges your child presents to you are necessarily pleasant...but potty training and bathroom challenges are particularly difficult, since there is no way around it. And there are a variety of sensory triggers, sensory explanations, developmental and psychological aspects, all which can play a part in success with potty training. I will break it down into the most common areas with a possible sensory explanation as well as some ideas to help. This is also how my book Understanding Your Child's Sensory Signals is formatted and set up with 210 sensory signals and sensory challenges! So if you find this page helpful, you will likely find my handbook to be very parent/teacher/therapist friendly and useful!
Possible Challenge #1 - No signs of being ready to potty train nor aware of when they need to go or have gone.
Sensory Explanation: The ability for the body to make the connection with the brain that it is time to go to the bathroom, requires a properly working connection between the interoceptors in the bladder and bowels and the brain. Interoceptors are similar to proprioceptors and children who under-register proprioception and sensory input overall, tend to have difficulty with interoception as well.
Ideas to Help!
• The most important step is being aware of this, very likely sensory component, and do not force or put pressure on the child with potty training, as it is very possible that the child is truly not able to recognize and identify when then need to go to the bathroom.
• Please do not scold the child as if they have done something wrong when they have an accident or are unsuccessful with potty training.
• Please refrain from "good girl or boy" when they do go to the bathroom, this implies that they are"bad" when they have an accident.
• Working on interoception is really not possible since these are the sensory receptors within the gut and organs...but what you can do is work on the sensory foundation and power sensations! This will help the sensory systems overall and helping the body and brain make the connection.
• Give the child time. Be patient and understanding.
Possible Challenge #2 - Likes to wear a diaper.
Sensory Explanation: There can be a few possible sensory explanations...One being that the child does not like change. Sensory kids like sameness and predictability, and they have worn a diaper since day one, so simply the act of change and something new can be a big factor. Secondly, some children feel like they are "losing a body part" when they have a Bowl Movement on the toilet, and when they go in a diaper instead, it does not have this same sensation. Third, if there has been pressure placed on the child to be successful and not have accidents, at least in a diaper they will not be scolded for an accident on the couch or in their clothing. And fourth, the child may not like the feeling of the underwear from a tactile standpoint.
Ideas to Help!
• Try not to place pressure on the situation, make it fun and stress free as possible.
• Introduce the idea and concept slowly, having the child wear the underwear very briefly at first.
• Make sure the child is involved in choosing underwear that feels right on their body. There are many sensory friendly options out there!
• Use a "potty chair" first, this is often less scary for the child.
• Have the child squat over the potty chair instead.
Possible Challenge #3 - Holds bowl movement as long as possible.
Sensory Explanation: This can be a challenge for children still in diapers or in underwear. Sometimes children feel like they are "losing a body part" when they have a bowl movement on the toilet, as could be the reason for holding it as long as possible. Another reason could be that the child does not register the sensation and feeling of needing to go until the sensation is so strong and urgent that they must go. This is common for sensory kids who under-register sensory input...as interoception is how the gut and internal organs relay a message to the brain. A third possible reason could be fear of the bathroom environment and all of the sensory components, including the sensation of being wiped.
Ideas to Help!
• Assess the bathroom environment and watch closely for your child's sensory signals. Is it too loud? Too much echo? Does the child not like the feeling of the hard toilet seat? These are just some examples...change the seat to a soft cushion, add a large throw rug to decrease the echo, wait to flush the toilet after the child has left the bathroom, etc
• Try having the child use a low to the ground potty chair.
• Try having the child squat over the low potty chair.
• Encourage regular and ongoing sensory activities involving the power sensations to help the brain improve overall sensory registration.
• Try soft, moist wipes vs. regular toilet tissue.
Possible Challenge #4 - Has difficulty in passing a Bowl Movement.
Sensory Explanation: Passing a BM is more complicated than one might think. It requires peristalsis, which is a contraction and relaxation of smooth muscles. This is involuntary and one can not control this. Sometimes the body has a difficult time with this. Another component is interoception...where the brain gets the message that it is time to "go". If the brain does not get this message, the child simply is unaware of the sensation and need to pass the BM. You then have the component of constipation...are the dietary needs being met for a normal bowel movement.
Ideas to Help!
• A vibrating pillow can help trigger and facilitate peristalsis.
• Be sure the child is well hydrated with pure, filtered water every day.
• Encourage a fiber rich diet.
• Food allergies and intolerance can cause constipation, so be sure to rule this out.
• Try a warm bath.
• Focus on the power sensations every day to help the brain process overall sensory registration.
Possible Challenge #5 - Is anxious being in the bathroom at home.
Sensory Explanation: As you can see by the challenges listed on this page, there are MANY possible sensory factors involved with going to the bathroom and being able to go. Anxiety may set in the minute the child is required and/or requested to "try to go". This can be triggered by the pressure placed on the child to succeed or other sensory components of using the bathroom. Maybe the child does not like the mirror...maybe it is the sound of the toilet...maybe the smell of the soap in the bathroom or the smells involved with going to the bathroom.... Do your best to assess and analyze the various sensory components and adjust and adapt as able. The bathroom itself may be a scary and unpredictable place, and then you add in the expectations and factors of actual toileting.
Ideas to Help!
• Encourage deep breathing while in the bathroom, this can help calm the nervous system.
• Assess the bathroom environment and watch closely for your child's sensory signals. Is it too loud? Too much echo? Too bright? Funny smells? Does the child not like the feeling of the hard toilet seat? These are just some examples...change the seat to a soft cushion, add a large throw rug to decrease the echo, wait to flush the toilet after the child has left the bathroom, etc.
• Sing songs or play clapping and rhythm games as a distraction and as a tool to help self-regulate.
• Use the bathroom sink and tub as a place for messy play and bubble mountain so it becomes a place of pleasant memories, not only stressful memories.
Possible Challenge #6 - Refuses to go in to public restrooms.
Sensory Explanation: Public restroom are one of the most over-stimulating and sensory unfriendly places, and they just keep getting worse. From the extremely loud and unpredictable flushing automatic toilets and hand dryers, to the very strong air freshener smells. Then throw in the baby and child crying and screaming (from the sensory overload). There really is no other way to put it, public restrooms may indeed be the most unfriendly sensory place in the world.
Ideas to Help!
Of course, avoid them if at all possible. Plan accordingly before leaving the house.
• Avoid the big public restrooms at all cost, make an extra trip or stop at a nice gas station that has a single toilet restroom.
• The places that have the "family friendly" extra bathroom are truly a life saver. Watch for those, and try to shop at places that have them.
• If you must use the big public restrooms, bring along sticky notes to place over the automatic sensors in the stall and also at the hand dryer if possible.
• ALWAYS bring along earplugs or noise cancelling headphones, even for children who are not necessarily sound sensitive all of the time.
• Be patient and understanding, as the experience in a public bathroom can truly be painful for the child's nervous system.
Possible Challenge #7 - Bedwetting at night and during naps.
Sensory Explanation: Sleep challenges and difficulties go hand in hand with sensory kids, and this includes the very heavy sleepers. The heavy sleepers tend to be more of the bedwetters, at night and nap time. Also, if a child has difficulty with sensory registration and lacks interoception (the brain getting the message from the bladder that it needs to empty), this will pose to be a real challenge when the child is asleep. So accidents at night or nap time are likely when you have a child who sleeps very sound and/or has poor interoception from the bladder to the brain.
Ideas to Help!
• Please respect this as a true sensory challenge, do not get upset or angry with the child. Instead, be prepared with a non-absorbent bed cover and use Pull Ups.
• It is common for sensory kids, boys more than girls, to wet the bed until 6 years old or older, letting go of the expectations can really help the child.
• Avoid liquids at least 2 hours before bedtime and before naps when possible.
• Focus on the power sensations each and every day to help the brain process and register sensory information.
Possible Challenge #8 - Fecal Smearing
Sensory Explanation: I know, this is NOT a pleasant topic to read about...but it is very common with sensory kids. Fecal smearing is the technical term for one who "plays with their poo". Believe it or not, this is often done to soothe, calm, and self-regulate. It can serve as a sensory anchor for a child. It is sometimes simply for tactile stimulation and messy play.
Ideas to Help!
• Try to not get angry with the child, instead use it as a sensory signal that the child is trying to self-regulate or is tactile seeking, and replace it with appropriate tactile based activities.
• Full body messy play on a daily basis with OTHER tactile mediums.
• Tactile experiences with various textures and mediums.
• Encourage regular and daily doses of activities from the power sensations, this will help self-regulation overall.