Toileting Readiness

We all develop at different rates. Unique Biology and lived experiences impact development. While there is a general progression of developmental skills (you crawl before you walk… ) the specific age you should reach a developmental milestone is defined by age ranges with outer limits of these ranges signaling a possible delay or developmental issues.

Independent toileting is one of the most fundamental developmental milestones and holds much weight in the journey to independence. Toileting independence is influenced by culture and societal norms. Preschool/daycare requirements of toileting independence are an example of cultural and societal norms that weigh heavily on the caregiver's decision to begin toilet learning. While toileting is a fundamental milestone, it can also be a cause of great stress for both child and caregiver. Many caregivers report anxiety, stress, confusion, and feelings of failure if their child doesn’t learn to toilet independently and within a certain time frame. Children can also experience stress, anxiety, and confusion during the toilet learning process, however, a child’s expression of these emotions may vary greatly and may be expressed by withholding, fear, distraction, and tantrums.

Acquiring toileting independence typically takes longer than most caregivers expect and may include more involvement and support for a longer period than anticipated. With the rise in preschool demands, and in toilet training guides for parents indicating that a child will reach independence with toileting in 3 days, or a weekend, it’s no wonder that caregiver expectations are quite different from reality. The lack of quality guidance and support for caregivers who are helping their child toilet coupled with the current climate of social media parenting “examples” overwhelming inboxes, ads, and other media is a recipe for confusion - if not disaster!

So… if three days isn’t realistic then what to expect? A child may very well learn to use the toilet quickly if they are “ready” and motivated to do so. Children need to be both psychologically and physiologically mature enough to begin the process of learning to toilet independently. While the idea of accomplishing a major developmental milestone in “10 easy steps” or “3 days” is VERY appealing it is also not very achievable for most children. While some children/families can achieve independence in these advertised timelines, the majority of children will require 3-6 months to achieve independence. This does not include the time spent modeling, discussing, and gaining buy-in from a child. This timeline can also be impacted by developmental delays, sensory processing differences, family dynamics, and biological issues.

While timelines may vary, there are a few concepts and progressions that are important to understand to support your child, catch issues early, and make progression toward toilet learning a positive experience.

Perhaps the most important foundation needed before toileting (or any life skills learning) begins is that the caregiver-child relationship should be supportive, trusting, and responsive to needs. A child’s brain and body both need to be mature enough to begin toileting independently.

From a motor perspective, a child should be able to: get to the toilet and get on and off the toilet (or potty, or adapted toilet) with little assistance; manage their clothing to pull off and on their bottoms to toilet; maintain postural stability when seated in a supportive chair and be able to translate that skill to a supportive toilet seat; manage some of the fine motor tasks (gather toilet paper, flush).

From a sensory perspective a child should be able to: regulate while in the bathroom environment; demonstrate interoceptive skills by indicating the need to go pee/poo; able to hold their pee/poo until a specific moment; remain dry for several hours. Remaining dry is an indicator of neurological maturation that a child’s bladder can hold urine.

Cognitively, a child should demonstrate some kind of understanding of toileting, communicate the need to go, and have some motivation to be independent with toileting. This may look like physically indicating they need to relieve themselves (holding their body, dancing, squeezing their legs together), or communicating “I need to pee” “I pooped!” verbally. A signal of cognitive readiness may also look like telling you the steps of toileting, or showing excitement towards using the toilet.

Sensory wellness, development, home environment, time spent preparing and fear/motivation are key factors impacting readiness. Caregivers must ask themselves, “am I ready to physically and emotionally handle this situation? Do I currently have the patience and the time to dedicate towards this process?” If the answer is no, a caregiver may want to plan accordingly by finding a chunk of time in their schedule they can dedicate to this task, or ask for additional help from family or other caregivers (baby sitters). If sensory or developmental concerns arise during this process it may be helpful to request an occupational therapy evaluation to better understand your child’s motor and sensory processing.

If you or your child are not quite ready there are many anticipatory ways to prepare. Modeling is very motivating for children. If the caregiver is comfortable, they can model toileting

themselves. There are also many videos of toileting and books that model toileting. Play is the way towards many life skills and toileting is no exception. Using toys that interest your child, have the toys model using the bathroom to go pee and poo. During play, you can emphasize the routine of toileting, that it’s natural and everyone does it, how it’s OK to stop playing to go to the bathroom, and then come back to what you were playing. Make sure to positively praise the toys as you would your child - it’s all part of the process! Another way to prepare for toileting is to talk about it more often. Weave potty talk into general family conversations…. “My tummy feels full. I need to go pee” or “I had a feeling of pressure on my bottom and that meant I had to poo! I feel much better now”. While these conversations may feel forced at first, they will become more natural with time and will give your child excellent modeling and vocabulary to describe their own toileting experiences.

Whether you are ready to take the plunge into toileting or you are planning how to start planting the seed keep in mind the fundamentals of toileting readiness:

• Motor maturity: Able to get on and remain stable on the potty

• Sensory regulation: able to regulate while in the toileting environment

• Cognitive readiness: Understanding directions and routines

• Ability to signal or communicate needs to go: communicating the need for the potty

• Motivation: a good relationship with the caregiver and the desire to be more independent.

References:

Ann C. Stadtler, Peter A. Gorski, T. Berry Brazelton; Toilet Training Methods, Clinical Interventions, and Recommendations. Pediatrics June 1999; 103 (Supplement_3): 1359–1361. 10.1542/peds.103

.S3.1359

David R. Fleisher; Understanding Toilet Training Difficulties. Pediatrics June 2004; 113 (6): 1809–1810. 10.1542/peds.113.6.1809

T Clifford, FP Gorodzinsky, Canadian Paediatric Society, Community Paediatrics Committee, Toilet learning: Anticipatory guidance with a child-oriented approach, Paediatrics & Child Health, Volume 5, Issue 6, September 2000, Pages 333–335,