Clinical update

Toilet training

Charity Education and Resources for Improving Childhood Continence has published new information for families and healthcare staff.

Essential facts

Most children with additional needs can be successfully toilet trained with the right support, according to charity Education and Resources for Improving Childhood Continence (ERIC). The impact of continence problems can be profound on any child or young person’s life and can continue to affect them as adults.

Picture: Alamy

What’s new?

The organisation has just published new information for families and healthcare staff on when and how to start toilet training for children with additional needs.

It is aimed at any child with delayed toileting, including those with learning and physical disabilities, and those with autism. One in ten callers to ERIC’s support line are by parents of children with additional needs.


Develop a toilet training plan, starting with using forms to assess if the child is ready, to help find out if there is a pattern to toileting habits and using these timings as a starting point. If not, sit the children on a potty or suitably adapted toilet 20 to 30 minutes after a meal or feed and before bed.

Create a timetable so that everyone who cares for the child is informed. If toilet training is not successful the first time, parents are recommended to wait for three months, and then try the assessments again. There is also practical advice given to help parents including advice about choosing easy to access clothes, communication tips, rewards and handwashing.

How you can help your patient

Encourage parents to ensure their child is drinking plenty of liquid, between six and eight cups a day, to avoid constipation, and keep bladder and bowels healthy. This should be the aim whether children are being toilet trained or not. Do not wait for a child to give a sign of readiness, some never will, but that does not mean that they cannot. Complete a bladder/bowel assessment chart available from ERIC to see if a child is ready.

Constipation in children with additional needs is often poorly recognised and under treated. Manage bowels proactively to avoid this.

Expert comment

 Brenda Cheer is children’s specialist continence nurse and an ERIC nurse

‘There can sometimes be an assumption that a child with additional needs cannot be toilet trained, or that it is not a priority and it is left until the child is quite a bit older. The main message is that the majority of children with additional needs can be toilet trained, and it should be started at a similar time as for other children.

'Parents shouldn’t necessarily wait for signs that a child is ready, as they may not happen. Instead toilet training should be a systematic approach to assess if they are ready and when they are, the leaflet provides a step by step method.

'Waiting too long, such as when a child is eight or nine, can make it much harder as they have become so accustomed to using a nappy as a portable toilet, so changing habits can be more challenging. For families who don’t try toilet training, getting out can become much harder as they child gets older, as there are few facilities for changing adults.’


Further information

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