Tips For Potty Training -Occupational Therapy & Physical Therapy

occupational therapy potty training tips

There are many tips on potty training out there, including many toileting methods, training strategies, and potty training charts. But, what if you could have the occupational therapy potty training strategy? Toileting is an ADL and potty training is part of that. What if you could get the low down on potty training from an occupational therapy or physical therapy professional, that is guided by development, focuses on underlying skills needed to use the bathroom, and addresses the whole child perspective? What if you could ask every developmental question under the sun and get tips for toileting straight from the pediatric OT and PT?

occupational therapy potty training tips

This blog post covers just that! I’ve joined forces with some of the best occupational therapy and physical therapy bloggers to to bring you the best potty training tips.

Occupational therapy Potty Training

When occupational therapists work with children, they focus on the whole perspective. We look at development, environment, and every aspect that contributes to the entire process of toileting:

  • Awareness (sensory, cognition) to know when to go to the bathroom
  • Clothing management (fine motor skills, gross motor skills, visual motor skills, bilateral coordination, crossing midline, coordination skills, executive functioning skills, cognition, sequencing)
  • Motor skills to sit, balance, stand, grasp, wipe, clean
  • Bowel movements and urination (sensory processing including interoception aspect, contributing factors such as sleep, nutrition, sensory integration) Related, read our resource on not sleeping through the night.
  • Pericare
  • Hygiene– washing and drying hands (fine motor skills, gross motor skills, visual motor skills, sensory processing, executive functioning skills, attention and behavior)
  • Parent education
  • Physical adaptations and modifications– adaptive equipment, specialty toilet seats, environmental changes, visual schedule use, etc.
  • Play-based activities to support development of underlying areas that impact each of the above areas

As you can see, occupational therapy professionals focus on the overall development and whole view of the child, the environment, and many other perspectives. This is a wider focus than your typical 3 day potty training method, or a sticker chart!

Potty Training Tips

Toilet training tips can look like a checklist of tasks to complete. But, when you consider all of the aspects of development that play into the process of toileting, there is much more than just a list of potty training tips to accomplish.

Potty training is an important rite of passage for children. For most individuals, they use the toilet each day without a single thought. And it is possible for the toddler or preschooler to get to that stage. Children of all ages, including older kids can struggle with the process, which is all very typical.

1) ROUTINES- The most valuable potty training tip for parents, no matter the age of the child and the physical or cognitive ability is consistent routine.

Routine, whether it is practiced with a visual schedule, a potty training sticker chart, toileting adaptations, special nutrition, timers, physical exercises like yoga…all should be consistent and replicated on an ongoing basis.

There are so many aspects of development that contribute to underlying skills and the process of toileting. Whether these factors are addressed in occupational therapy sessions or in a home program, that consistent practice and routine trial is needed to support development.

2) PATIENCE- A second and worthy toileting tip is to focus on the patience.

Toileting is a complex process. Add in environmental considerations such as public toilets, loud hand dryers, noisy flushing toilets, and other sensory-based distractions.

  • Consider rushed schedules to get out the door in the morning.
  • Consider typical behaviors and attention spans of toddlers and preschoolers.
  • Consider day to day stressors.
  • Consider the distraction of screens and social media (“My infant is using the toilet all by themselves!”…yeah right!)

This is just the tip of the iceberg when it comes to all the factors that play into potty training. The fact is that kids are kids! They are just learning this complex skill, and toileting is a huge developmental process! The key to this whole process is patience and persistence.

3. BIGGER PICTURE- A third potty training tip occupational therapy professionals focus on is looking at the whole child.

This is more on what we covered above. When you take a step back and think about ALL of the developmental areas that play into toileting, self-care, hygiene, there are SO MANY areas at play here!

Let’s look at all of the areas that have a factor in the toileting process:

  • Balance
  • Coordination
  • Dexterity
  • Motor planning
  • Sequencing
  • Impulse control
  • Attention/focus
  • Safety awareness
  • Body awareness
  • Grasping strength and mobility
  • Postural control
  • Fine motor coordination
  • Gross motor coordination
  • Visual perceptual skills
  • Sensory processing- tactile sensitivities, proprioception, vestibular, interoception, auditory, olfactory (smell)
  • Interoception- This is worthy of a second mention- The ability to know when to go, to feel the pressure in the belly area, the sensation of having to pee or poop, the feel of pushing a bowel movement, the sensation of knowing when the process is complete, feeling hunger or thirst, sensing an upset stomach
  • Cognition
  • Communication and language
  • Social and emotional skills
  • Family perspective

This list essentially covers all areas of development! You can see that simply potty training can take longer for some individuals, and that is completely ok!

Occupational Therapy Toileting Strategies

The occupational therapy professional working with families on the functional task of toileting considers all of the areas listed above. They break down the process and use skilled assessment to analyze areas contributing to challenges with toileting.

OT professionals offer strategies and supports to develop contributing areas that impact the challenges that come up with toilet training. They offer suggestions, motivators, fun play activities, schedules, and consultancy that promotes development in the areas that will lead to success.

Occupational therapy practitioners can support families with potty training troubles in so many ways:

  • Development of underlying areas through play
  • Adaptations and modifications to the environment
  • Establishing a routine
  • Creating a sensory diet
  • Writing appropriate toileting social stories
  • Educating parents and guardians on readiness factors
  • Supporting carryover of skills across environments
  • Medical review and ruling out considerations that should be addressed with a physician
  • Focusing on reducing anxiety
  • Supporting with schedules, motivators, and play-based games and activities
  • Creating visual cue cards or tools to support communication skills
  • Address mobility and motor skill issues
  • Supports to address dressing skills
  • Backward chaining or forward chaining methods for potty training process
  • Education on various potty training methods that work best for the individual
  • Data methods
  • Functional skill assessment
  • Address sensory sensitivities
  • Address clothing considerations
  • Educate on sensory and perceptual concepts such as wet/dry, clean/dirty, front/back
  • Body awareness considerations
  • Address physical considerations
  • Address concurrent considerations such as diagnoses and their impact on toileting: physical or cognitive considerations, sensory processing differences, mobility, balance, muscle tone, etc.

The whole process of potty training is complex and aspects can be a challenging and difficult time for parents.  There can even be frustration at times.

All children need to learn and finding out the best potty training tips and ways to help with teaching kids to potty train that works for their individual needs.

To support kids in these areas, I’ve joined a team of pediatric occupational therapy professionals and physical therapists in creating the ultimate resource based on development and the whole child.

The Toilet Training Book: A Developmental Look at Potty Training for Kids of all Abilities was created as a comprehensive resource covering every aspect of toilet training including:

  • Potty training readiness (based on development)
  • The developmental progression of toileting, perineal hygiene, self-care, and handwashing
  • Toileting for special populations including Autistic individuals, those with diagnoses such as Down Syndrome, Cerebral Palsy, Traumatic Brain Injuries, Spina Bifida, Spinal Cord Injuries, and other physical disabilities, etc.
  • Strategies and supports for those with fine motor, gross motor, visual motor, behavioral, trauma, sensory, or cognitive considerations
  • Tips and suggestions when there is trouble with toilet training
  • Equipment suggestions for toileting

The book also includes toilet training matrix for readiness and functioning, readiness skill activities, interoception information, social stories, visual schedules, sticker charts, and other tools.

ackling potty training is a challenge for all kids! What if you had the inside scoop on development in your back pocket? 

What if you had the know-how of occupational therapists and physical therapists with DECADES of experience to guide you?  

The Toilet Training Book offers a developmental look at potty training for kids of ALL needs.

toilet training book

More Potty Training Tips from OT and PT

The authors of the Toilet Training Book have decades of experience working with individuals of all skills and abilities. Check out some of the potty training tips they have, coming from the OT/PT perspective:  

Fine Motor and Toileting- Looking for fine motor considerations when it comes to toileting and potty training? There are many fine motor skill areas that impact potty training:

  • tearing toilet paper
  • wiping with enough grip and strength
  • managing clothing fasteners such as buttons, zippers, snaps, etc.
  • managing the faucet and soap
  • Motor skills to grasp and use towels
  • and even using the sticker chart!
  • Opening locks on public restroom doors
  • Flushing the toilet

We as occupational therapists might focus on the fine motor aspect all of these areas that impact toileting. Still other contributions grasp, coordination, pinch strength, crossing midline, bilateral coordination, eye-hand coordination.

For tips and suggestions to support development of all of theses areas, check out Potty Training, Toileting and Fine Motor Considerations by The Inspired Treehouse.

Gross Motor and Toileting- Toileting has a considerable gross motor skill component. Consider that areas that impact potty training skills:

  • Mobility to the bathroom
  • Managing a small space
  • Getting on and off the toilet
  • For boys, standing and maintaining balance at the urinal or toilet
  • Managing clothing while sitting, standing, squatting
  • Balance
  • Coordination
  • Postural control
  • Weight shift
  • Trunk control

Pediatric OTs and PTs can use task analysis to break down these areas into smaller steps that can be addressed through play, modifications, and activities. Check out Gross Motor Skills and Toilet Training by Your Therapy Source for more information.

Potty Training and Sensory Processing- The potty training process has a huge sensory component. Think about these areas:

  • Tactile components to manage toilet paper, water, soap, etc.
  • Auditory consideration- sound of flushing, echo in the bathroom, sounds of others in a public restroom, hand dryers
  • Olfactory consideration- The smell of bowel movements and urination can be an issue for some, the scent of soap
  • Proprioception- understanding where the body is in space in order to squat, stand, and move with enough force
  • Vestibular- movement into different planes including an inverted head (kids will do this), standing, sitting
  • Interoception- knowing when to go, when bowel movements are completed, the feeling of a full bladder and empty bladder, huger, thirst, and even sweat
  • Sensory defensiveness, sensory seeking, sensory hypersensitivities, poor registration of sensory input all contribute to toileting
  • Body awareness
  • Fecal smearing

For more information on the sensory aspect of potty training, check out Toileting and Sensory Processing by Miss Jaime OT.

Adaptations and Modifications for Potty Training- Modifications to potty training can include many things:

  • adaptive equipment
  • adjustments for fine motor or gross motor
  • seating modifications
  • adaptations for fear
  • social stories
  • visual schedules
  • wiping modifications
  • sensory modifications
  • behavior modifications

For more information on the modifications, check out Modifications For Potty Training from Therapy Fun Zone

Developmental and Environmental Readiness for Potty Training- Readiness is more than development in some cases. Therapy can address these areas that impact successful toileting:

  • Readiness activities such as books, stories, and social stories
  • Following the lead of the child
  • Practicing hand washing
  • Practicing clothing management- removing clothing, dressing skills, buttons, zippers, snaps, buckles, etc.
  • Visual cue cards

For more information on readiness, check out Preparing Your Child & Environment for Potty Training from Growing Hands-On Kids.

Play-based potty training- Occupational therapy professionals use play as a tool to support development, because play is the primary occupation of children. Through play we can develop many skills. Play can be used to address activities in toileting such as:

  • Teaching wet and dry through sensory play
  • Teaching dirty and clean through sensory play
  • Teaching front/back and directional concepts through obstacle courses and doll play or other toys
  • Addressing body awareness through sensory play, obstacle courses, and toys
  • Addressing interoception, proprioception, body awareness, and sensory integration through yoga and heavy work activities
  • Addressing hand strength, gross motor skills, crossing midline, and physical considerations through pretend play, gross motor games, etc.

For more information on using play to support potty training, check out Teaching Concepts for Potty Training Through Play from Your Kids OT.

All of these areas are covered in detail, along with much, much more information in The Toilet Training Book, a Developmental Look at Potty Training for Kids of All Abilities.  

Potty Training tips and ideas to help kids learn to potty train from Occupational Therapists and Physical Therapists
Potty Training tips and ideas to help kids learn to potty train from Occupational Therapists and Physical Therapists

  Looking for more functional ideas for kids?  

Hand Clapping Games

hand clapping games

Do you remember hand clapping games and activities as a kid? I do! We didn’t have the time occupiers of video games and an abundance of technology, so it was bike riding, roller skating, basketball, board games, and well, hand clapping. Finger games and hand clapping games go “hand-in-hand”! This was done with a sibling or a friend, and definitely a go-to when there were sleepovers and visits to the neighbor’s house.  But, did you ever think about the eye-hand coordination benefits, or bilateral coordination, and even crossing midline benefits?

Hand clapping games and activities using clapping rhymes

Clapping Therapy?

Hand clapping games are a fun and engaging way to interact with kids during therapy. Have you tried it? It’s a fun activity, whether it be to a classic game, a made-up song, or just as a quick transition between activities.

There are so many benefits to hand clapping games, from motor skills, sensory motor, visual motor, and even executive functioning skill development. We cover how each of these areas (and the sub-skills) are developed through the simple clapping activity in therapy.

But did you know there is a thing called “clapping therapy”? This was a new concept to me but one that piqued my interest. Essentially, the use of clapping therapy is the act of clapping hands to heal. This is considered a viable therapy because clapping the hands together activates skin and joint receptors in the hands (and upper extremities) to activate various systems within the body and brain.

Some of this idea is linked to reflexology but other considerations can be connected to the proprioception. We know that heavy work or deep pressure through the joints brings awareness and “wakes up” the muscles and joints. So clapping hands is a great way to activate the sensory systems.

Another consideration with clapping therapy is the fact that clapping stimulates blood circulation. This can be a potential way to promote healing.

I wasn’t able to find research on clapping therapy, but these are some things to think about when using hand clapping games to build on therapy goals.

hand clapping therapy games and clapping rhymes

Build Skills with hand clapping Games

Hand clapping actually does have many benefits to skill development, and can be a great way to work on specific skills with children. Why? Hand clapping activities are the ‘no-tools needed’ approach to building so many skills!

In fact, research shows that hand clapping rhymes and games make an improvement in motor and cognitive skills. The study found that kids that participate in hand clapping games have neater handwriting, write better and make fewer spelling errors.

Read on to see what skill areas the simple use of hand clapping can help develop:

  • Executive function skills– To complete a hand clapping activity, a child develops cognitive skills, but some of the softer skills might be overlooked. When playing a cooperative game like clapping together, there is a component of impulse control, task completion, working memory, attention, sequencing, self-reflection, emotional control, and self-monitoring. These skills can be carried over because of the confidence built up while playing with a friend in a low-stress situation.
  • Eye hand coordination skills– clapping hands together with a friend requires motor coordination to move and place hands together at the same time and positioning. Too far and you over-shoot the target. This is a great way to work with a friend on hitting targets and visual motor integration.
  • Bilateral coordination – hand clapping activities work on the use of both hands and arms to coordinate and reach with good timing either to a song, rhyme, a game with a partner, and even when hand clapping alone.
  • Motor planning – Most any clapping game involves a lot of motor planning to practice the movements needed repetitively. Once the movements are learned, they become more automatic.
  • Crossing midline – Let’s consider crossing midline for a moment: left to right, right to left, reaching diagonally across going up or down. Adding verbalizing the correct hand when in use, will help them to build left and right side recognition, and improve body awareness. 
  • Visual tracking – During hand clapping games with a partner, children must move their eyes continually from left to right, up and down. With a song or rhyme, children also learn to visually track with fluidity and rhythm. They need to watch and track their hands and their partner’s too.  
  • Sequencing – Many hand clapping games involve some sort of story telling in the sequence. This helps some children recall the lyrics more easily. When using hand clapping games and songs that tell a story, children develop important sequencing skills. They may also make a mental picture of that story in their minds as they play. Clapping along to a metronome app is excellent for building sequencing and rhythm.
  • Cognitive skills – The brain gets quite a workout when learning and doing hand clapping songs and games. You can use hand clapping to help children learn to spell a problematic word, or even learn the alphabet! Children can use a problematic word, or the alphabet as part of the song which can help them to recall the letters in sequence. They can also learn to sequence a storyline, making it easier to learn how to include a sequence when writing in the classroom. 
  • Social skills – Have a group in therapy? Hand clapping is ideal to help develop teamwork, collaboration, tolerance, and patience, which are all essential to successful socializing within a peer group. Switch it up and have kids work with varied partners, or work together as a larger group. These varied interactions can help build self-confidence, and proper interaction during play.
  • Memory – Let’s consider memory for a moment. Significant memory skills are needed when recalling simple to moderately complex hand clapping songs, these can require various levels of memory. Think about the lyrics and movements needed for: Patty Cake, A Sailor Went to Sea, Down, Miss Mary Mack, See See My Playmate, Miss Susie, etc.
  • Rhythm – Hand clapping is a great tool for rhythm and beat development, as the hands must develop a rhythm to match the lyrics and time with a partner.  Interactive Metronome is a popular program involving rhythm and timing.
  • Listening – It is a given that hand clapping games help work on listening skills, in order to learn the movements that match the lyrics. During this process, children are also developing the skills needed to combine memory, rhythm, and sequencing, as they listen attentively to follow the directions that are given within a song or rhyme.
  • Vocabulary skills – Many hand clapping rhymes or songs include singing the lyrics while clapping which can help build new vocabulary as the songs are learned. When working with a partner, communication skills can be addressed too. 
  • Proprioception– Hitting the palm of the hand against another hand offers feedback through the fingers, wrists, and whole upper extremity with heavy work input. This quick jolt of force through the upper body is a way to add proprioceptive input through play. The benefit for learning the clapping rhyme hand movements and positioning is through practice and that physical touch feedback is a loop that builds on itself.
Miss Mary Mack hand game

Hand Clapping Rhymes

Below is a round-up list of hand clapping rhymes and/or games that you will probably recall from your childhood, but if not, there are links below to YouTube videos that will demonstrate them for you. It is a great idea to practice these before performing with your students.

Patty Cake Patty Cake Baker’s Man

Pat-a-Cake – Actually titled Pat-a-Cake, many children call this rhyme Patty Cake Patty Cake Baker’s Man. This one is instructed by a physical therapist and I love it because she adds great motor planning movements and does it with her 3-year-old co-instructor. 

Here are the lyrics: 

Pat-a-cake, pat-a-cake, baker’s man.
Bake me a cake as fast as you can;
Roll it, pat it, and mark it with B, (or any letter of your first name)
Put it in the oven for baby and me.

miss mary mack Hand Game

Miss Mary Mack – This one is instructed by a K-5 music teacher. She makes the video using a complete tutorial to teach the lyrics and the movements slowly, and then in rhythm to the song by herself, and then with a partner. The Miss Mary Mack clapping game is a fan favorite among children.

Here are the Miss Mary Mack lyrics: 

Miss Mary Mack, Mack, Mack
All dressed in black, black, black
With silver buttons, buttons, buttons
All down her back, back, back.

She asked her mother, mother, mother
for fifty cents, cents, cents
To see the elephants, elephants, elephants
Jump over the fence, fence, fence.
They jumped so high, high, high
they reached the sky, sky, sky
And didn’t come back, back, back
Till the 4th of July, -ly, -ly.

rockin’ robin clapping game

Rockin’ Robin – The Rockin’ Robin clapping game is demonstrated and instructed by a homeschool mom who gives a short demonstration of the hand movements needed to complete the hand clap patterns to the lyrics, in slow motion. It’s only four hand movements that stay repetitive to the lyrics of the song, so it’s an easier one to teach and to do.

Here are the Rockin Robin lyrics:

He rocks in the treetops all day long, hoppin’ and a-boppin’ and singing his song 

All the little birds on Jaybird Street love to hear the robin go tweet-tweet-tweet 

Chorus: Rockin’ robin, Rock-rock-rockin’ robin’ Go rockin’ robin ’cause we’re really gonna rock tonight 

Every little swallow, every chick-a-dee, every little bird in the tall oak tree 

The wise old owl, the big black crow flappin’ their wings singin’ “go bird, go” 

Chorus: Rockin’ robin, Rock-rock-rockin’ robin’ Go rockin’ robin ’cause we’re really gonna rock tonight

The size awareness concept of the tall oak tree and the little swallow can be carried over to work on tall, tail, and short letters, as well as body awareness considerations. Take the activity a step further with our tall and short worksheet which has a fine motor and visual motor component that can be incorporated into whole-body movement activities to teach these concepts that carryover into functional tasks.

double this double that

Double This Double That – This clapping hands rhyme is also demonstrated and instructed by the same homeschool mom who will show the simple hand movements needed, and discusses briefly how it can be used as a fun elimination game. You can do this one at various speeds, making it a super coordination activity in therapy. Use it with a partner, or part of a group activity. 

Double This Double That Lyrics:

Double, double this this,

Double, double that that,

Double this, double that,

Double, double this that.

twinkle twinkle little star

Twinkle, Twinkle, Little Star – This one has a unique teaching approach performed by an occupational therapist using this familiar song to work on hand movements in three different patterns. Go OT! I like this one as it can be done on the table top, but you could easily do the same movements with a partner too. There are no actual lyrics with this version of the activity, but they can easily be added during game play. 

Twinkle Twinkle Little Star lyrics:

Twinkle, twinkle, little star
How I wonder what you are
Up above the world so high
Like a diamond in the sky
Twinkle, twinkle, little star
How I wonder what you are

clap RHyme

Clap – This Clap rhyme activity uses hand clapping as an exercise that is great for a whole-body warm-up, or as a sensory break. It uses upbeat music that the instructor claps along with, showing other body movements that are used in coordination with the clapping to improve body awareness, motor coordination, and endurance too!

There are few lyrics with the Clap rhyme activity, but there is a tune or beat that is played in the background as the video plays. 

avocado Hand Game

Avocado – This hand clap video is demonstrated by Miss Mortimer who is a K-5 Music Teacher. The video is funny because the dog feels left out, and wants to participate too!  She does a great job doing the demonstration of the Avocado hand game slowly, then along with the lyrics. Later Miss Mortimer shows an additional hand movement to make this clapping game more challenging. She also shows how you can speed it up, and then how you change the song when you lose the game. 

Here are the lyrics to the Avocado hand game:

Avocado, avocado, avocado, is the name of the game

If you mess up you have to change the name

a, b, c, d, e, f, g, h, i, j, k, l, m, n, o, p, q, r, s, t, u, v, w, x, y, z.

Hot cross buns Rhyme

Hot Cross Buns – This hand clapping demonstration is done by a homeschool mom with her child. They demonstrate how to do this hand clapping to the Hot Cross Buns rhyme in a variety of ways. I like the hand movements she uses as they incorporate a variety of motor planning skills. 

Here are the lyrics to the Hot Cross Buns rhyme:

Hot cross buns!
Hot cross buns!
One ha’ penny, two ha’ penny,
Hot cross buns!
If you have no daughters,
Give them to your sons
One ha’ penny,
Two ha’ penny,
Hot Cross Buns!

Concentration Clapping Game

In the concentration clapping game, you sit or stand across from a friend. Clap hands together after saying each line from the rhyme. This game supports development of attention, working memory, focus, and impulse control, as well as emotional control when the inevitable mistake happens. Players can list out numbers or they can substitute the numbers for different categories such as fruits, animals, sports, foods, etc. The slaps and claps can be hitting hands face to face followed by crossing the arms to clap. Then player one, continuing the rhythm, says a number or other word (colors, sports, foods, etc.) twice. Then the other player repeats those words and adds their own words in the same category. This goes back and forth as the players keep adding more words to the list.

Here are the lyrics to the Concentration Clapping Game:

Concentration (slap slap clap clap)

Are you ready? (slap slap clap clap)

If – so – (slap slap clap clap)

Let’s – go! (slap slap clap clap)

For example: cat, cat (slap slap)

The other player then does the same, starting with their own number and following with someone else’s:

cat, cat, dog, dog (slap slap clap clap)

Use these clap games in therapy or at home

So, do you feel inspired to get your hands clapping yet? Does this bring back memories of the playground songs, “Say Say my Playmate, Down Down Baby, or Miss Suzie? Once you view these fun videos, you’ll want to start using hand clapping as an intervention tool in your therapy sessions where you’ll start seeing children build important developmental skills while having some fun and getting a few laughs in too!

Pair these concentration clapping games with hula hoop activities and backyard tag games for old school fun!

Regina Allen

Regina Parsons-Allen is a school-based certified occupational therapy assistant. She has a pediatrics practice area of emphasis from the NBCOT. She graduated from the OTA program at Caldwell Community College and Technical Institute in Hudson, North Carolina with an A.A.S degree in occupational therapy assistant. She has been practicing occupational therapy in the same school district for 20 years. She loves her children, husband, OT, working with children and teaching Sunday school. She is passionate about engaging, empowering, and enabling children to reach their maximum potential in ALL of their occupations as well assuring them that God loves them!