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How to help children with Down Syndrome use the toilet
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.
Resources
Potty time for kids with Down syndrome :
Potty time for kids with Down syndrome :
"The guide discusses physical, medical, and behavioral issues that...
"The guide discusses...
The parent's guide to occupational therapy for autism and other special needs :
The parent's guide to occupational therapy...
"Expanding upon the award winning first edition, this essential...
"Expanding upon the award...
The parent's guide to occupational therapy for autism and other special needs :
The parent's guide to occupational therapy...
"Expanding upon the award winning first edition, this essential...
"Expanding upon the award...
The potty journey :
The potty journey :
"Systematic, comprehensive and proven way to toilet train children...
"Systematic, comprehensive...
Ready, set, potty!
Ready, set, potty!
"Bursting with ideas on how to see past conventional strategies and...
"Bursting with ideas on how...
Ready, set, potty! Toilet training for children with autism and other developmental disorders
Ready, set, potty! Toilet training for...
"Bursting with ideas on how to see past conventional strategies and...
"Bursting with ideas on how...
Toilet training success :
Toilet training success :
"From sitting on a toilet to independent use of a public restroom,...
"From sitting on a toilet...
Steps to independence: teaching everyday skills to children with special needs
Steps to independence: teaching everyday...
Gives proven strategies for teaching the life skills children from...
Gives proven strategies for...
Safety and Consent for Kids and Teens with Autism or Special Needs :
Safety and Consent for Kids and Teens with...
"The developmental challenges of children with special needs means...
"The developmental...
Safety and consent for kids and teens with autism or special needs :
Safety and consent for kids and teens with...
"The developmental challenges of children with special needs means...
"The developmental...
Toilet training for individuals with autism or other developmental issues :
Toilet training for individuals with...
"Toilet training can become a battleground for caregivers and...
"Toilet training can become...
What to do about smearing :
What to do about smearing :
With down to earth advice and tried and tested strategies, this...
With down to earth advice...
What to do about smearing :
What to do about smearing :
With down to earth advice and tried and tested strategies, this...
With down to earth advice...
Are you ready? a toilet training package.
Are you ready? a toilet training package.
Gives a step by step guide through the toilet training programme....
Gives a step by step guide...
Bowel and bladder assessment pack :
Bowel and bladder assessment pack :
"Some children and teenagers with a learning disability, physical...
"Some children and...
Continence New Zealand
Continence New Zealand
Home page of Continence New Zealand. "Continence NZ was established...
Home page of Continence New...
ERIC, the Children's Bowel and Bladder Charity
ERIC, the Children's Bowel and Bladder...
ERIC provides expert support, information, education and...
ERIC provides expert...
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Resources for kids
Bobby can use the toilet /
Bobby can use the toilet /
"This is a social story to help children learn to use the toilet....
"This is a social story to...
Liam goes poo in the toilet :
Liam goes poo in the toilet :
Liam learns to poop in the toilet after a little difficulty.
Liam learns to poop in the...
A wee secret
A wee secret
Jet Johnson has a secret ... find out how he bravely gets the help...
Jet Johnson has a secret...
A wee secret
A wee secret
Uses a story format to address the problem of bedwetting in...
Uses a story format to...
Poo Hoo
Poo Hoo
The story of Tim Thompson who is having problems with sore tummies...
The story of Tim Thompson...
Poo hoo /
Poo hoo /
Uses a story format to address the medical problem of fecal...
Uses a story format to...
How to poop everyday /
How to poop everyday /
A boy is encouraged to develop healthy habits by using the potty...
A boy is encouraged to...
Willie wants to wee-wee!
Willie wants to wee-wee!
When Willie woke up he knew what he wanted to do, and it was...
When Willie woke up he knew...
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Meryl Richards
I’m Meryl Richards. What a pleasure it’s been to join the Awhi team. I get to spend my days researching information that supports me as a parent, and sometimes challenges me to rethink what I thought I knew. My hope is that it will be useful to you too. I live in Kapiti with my partner and two teenage boys, and spend as much time as possible in the surrounding bush and at the beach.
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The Awhi Ngā Mātua team would like to thank Takai, the IHC Foundation and the Dines Family Charitable Trust for their generous contributions to our work. A huge thank you also to the IHC Programmes team, in particular the IHC Library which has worked so hard to make their remarkable collection available to us.