Children with Down Syndrome face particular challenges when it comes to toileting. These can be physical, behavioural, and cognitive. But with a gradual, consistent approach, backed up by positive, creative encouragement, your child will get there.

Devising a toilet plan for your child requires parents to consider their particular strengths and challenges. Some of the more common challenges and strategies to overcome are listed below. For detailed advice on how to gather the data, create the plan and implement it, check out our other posts about toileting.

Common Physical challenges:

• Delays in motor control and gross motor skill development.
• Low muscle tone.
• Constipation due to medical conditions.
• Constipation due to physical inactivity or dietary issues.
• Celiac disease.
• Difficulties with sitting on the toilet seat and wiping, due to shorter stature and shorter arms.
• Delays in fine motor skills – e.g., ability to undo buttons and zips.

These tips might help...

• Be patient and allow for your child to take longer to reach physical milestones.
• Short stature and limbs can be accommodated by adjusting the toileting environment based on an occupational therapist’s recommendations – for example, installing a bar that helps your child with stability and balance. A foot stool will also help.
• To allow for difficulties with fine motor skills put your child in looser clothing and use pants with elastic bands. Wet wipes may be easier to use than toilet paper.
• For constipation caused by medical conditions consult your doctor.
• For constipation caused by dietary issues, consult a dietician, but also make sure your child is well-hydrated and encourage a varied diet.
• Encourage your child to be physically active – make sure they have physical activity breaks throughout the day and incorporate physical tasks into ordinary activities – such as pushing the shopping cart. Being physically active is important for building muscle tone as well as preventing constipation.
• Celiac disease – act on the advice of medical experts.

Common Behavioural challenges can include: 

• Attention span and impulse control difficulties
• Anxiety over mastering the different steps required for toilet training.
• Sensory issues
• Reluctance to change routines.
• Compliance issues

Some tips that might help... 

• If your child’s low attention span makes toileting difficult, make it an activity they enjoy, such as looking at a book, or playing with a designated ‘toilet toy’. And remember to lavish them with praise for every achievement!
• If your child seems anxious about toilet training, break it down into smaller steps, and explain what you’re doing and why. Again, praise and reassure them as much as possible.
• Some children with Down Syndrome have sensory difficulties. If your child does not realise when they are wet or dry, help them to notice the difference. Some children are overly sensitive to certain sounds, smells and sensations. Notice if anything is bothering your child in the toilet, then do what you can to eliminate it, or decrease its effect.
• If your child is reluctant to change routines, introduce the new routine very slowly. It can be motivating to give them more control with the new routine. Make sure your new routine is more fun than the old one, so if you’re fading out ‘nappy-changing’ make sure it’s as boring and unstimulating as possible!
• If your child is being particularly non-compliant about toileting, find out what’s behind the behaviour. It may be due to some of the reasons above, they have sensory issues or are constipated which makes it painful to poo. Once you know the reason you can figure out how to solve it. 

Common Cognitive challenges:

• Communication difficulties
• Difficulties with transferring skills from one context to another
• Difficulties understanding why and when the toilet should be used.

These tips might help...

• Remember behaviour is communication. If your child is non-verbal, become attuned to their facial expressions, gestures and whether they show distress or pleasure when on the toilet, use picture cards or sign language, if they are appropriate.
• Creating a visual schedule, which shows what activities can be done where, will help your child understand how to transfer a skill from one context to the next.
• Talk your child through what is happening to their body and why, when they’re in the toilet. Engage their curiosity and show them how impressed you are with their achievements. 

It can be a good idea to start toilet training around the same time as typically developing children age – that is, between eighteen months and three years of age. But you’re the parent - you know best. In order to start toilet training, a child needs to be able to sit safely and independently on a toilet. Don’t worry if they don’t haven’t passed all the ‘readiness milestones’ too much.

Remember, your child is an individual, so you will know best what motivates them and how to overcome their specific challenges.

Toileting is a complex issue and IHC Library and Awhi Nga Matua have produced a series on toileting issues.

For more information give the library a call on 0800 442 442, or email: librarian@ihc.org.nz.