toileting Archives

Tips For Potty Training -Occupational Therapy & Physical Therapy

September 21, 2023June 8, 2022 by Colleen Beck OTR/L

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?

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.

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

Looking for more functional ideas for kids?

Potty Training Seats for Special Needs

October 17, 2023June 7, 2022 by Colleen Beck OTR/L

Potty training seats for potty training special needs kids

Occupational therapy professionals work with clients of all ages and abilities on toileting and hygiene. That’s why this resource on special needs toilet training seats is so important. In therapy sessions, a skilled assessment of the whole individual can indicate a need for postural modifications to support motor skill needs. When it comes to potty training and toileting in general, there is a LOT of information out there. And, if you ask around for suggestions for the best potty training seats, you will probably get a variety of answers.

Some of these seats will help with independent perineal care, too because of the positioning and stability added for balance. Potty training supports like handrails, grab bars, and guards can help with the hygiene aspect of toileting.

Special Needs Toilet Training Seats

It can be overwhelming to weed through all of the potty seats out there on the market and in the local box store toddler aisle. The difficulty compounds when you consider potty training with special needs children.

Today, I wanted to pull together a list of kids toilet seats out there on the market that are perfect for special needs kids, as well as typically developing kids. Why? Because so often, a few simple changes with positioning, balance, and stability can be the tool to help kids feel more comfortable, confident during the toileting process.

Adding a stable support at the feet, back, or bottom can help a child to relax so they can toilet.

These potty training chairs help address the underlying needs that kids might struggle with when it comes to potty training. These potty training seats and supports can be the tools needed to address a variety of underlying needs when it comes to getting started with potty training.

Here’s the thing: it can be difficult to make suggestions or come up with a comprehensive list that covers ALL of the special needs out there. (That’s where your occupational therapy evaluation or equipment analysis will come into play!)

BUT, I can definitely address some of the more common potty training seats out on the market and address the underlying areas that they can address and hopefully target a best fit.

These recommendations for potty training seats are guided by development and great for kids of all needs. Use these potty training seats as suggestions when starting potty training for toddlers or preschoolers.

Potty Training Seats are Not One-Size Fits All!

Let’s face it. There is no one-size-fits-all approach when it comes to potty training. Because of the vast differences in in kids development, interests, motivation, physical or special needs, potty training can be a challenge to know where to start.

This list is hopefully a start for addressing some of the areas kids need for successful potty training.

Amazon affiliate links are included below.

Portable Seat– (affiliate link) This type of seat is great for kids who need a smaller opening on the toilet. Kids of all needs benefit from a larger seat area when first potty training. This one is nice because it can be carried from place to place when on the go outside of the home. Just fold it up and place in it’s carrying bag. Using a portable seat can make it easy to add interests when beginning potty training. Add interests such as special toys and items to make sitting motivating.

Squatty Potty– (affiliate link) The squatty potty is a helpful way to provide a more stable base of support while sitting on the toilet seat. Kids can place their feet on the support that curves around the toilet base and improve balance while sitting. This base of support can help kids who need extra support or have balance needs.

The Step and Go stool (affiliate link) is another, more inexpensive option. Adding a supportive base can help calm nerves of unsupported sitting. Children can use a wider base of support with this type of stool.

Potty Training Chart– (affiliate link) While this isn’t a potty training seat, a training chart can be used to promote extended sitting on a potty chair, and to allow kids the ability to build up patience to sit and wait on a potty chair.

Starting out by using a potty training chart to encourage kids just to go to and sit on the potty seat is a great start for younger kids or those who need to accommodate for sensory needs.

A visual tool such as a potty training chart can be a practical way to reinforce individual skills that make up the process of toilet training. The nice thing about toilet training charts is that they can be individualized, based on the child’s needs.

Some kids with special needs or sensory needs may be afraid of walking into the bathroom. A sticker chart can be one strategy to address that aspect given various modifications or activities that can help address needs.

Step Stool with Handles– (affiliate link) Having a handle can help little ones who struggle with balance or feeling unstable when sitting on a regular sized toilet seat. This one has a step stool that provides a base of support through the feet.

Toilet Seat with Pee Guard– (affiliate link) This seat insert has handles and slight curvature to the sides of the toilet seat ring, providing support and a sense of stability when seated on a regular size toilet. The urine guard is helpful for both boys and girls.

Three-in-one Potty Training Seat– (affiliate link) As a mom of four, this 3-in-one potty training seat is a favorite. It goes with kids from the toddler stage when a smaller, floor potty chair is helpful in training. The ring insert can then be used when transitioning to a regular sized toilet. Finally, the seat forms a step stool for using either on the toilet or when washing hands. This is a convenient toilet training seat for families!

A lower toilet position is closer to the ground and fits a smaller bottom. This helps with transition to a regular size toilet and allows for comfort and confidence in young children. This potty training system is great for the child who appreciates consistency.

Ring Reducer– (affiliate link) There are many styles of toilet seat ring reducers out there and they serve a great purpose; to reduce the size of the opening on the toilet seat, allowing for small kids to feel more safe and secure when sitting on the toilet. This is a good transition seat to a regular sized toilet. For kids who struggle with coordination and balance, this ring reducer can be just the ticket to potty training success.

Disposable Seat Covers– (affiliate link) These seat covers are convenient for kids who tend to grab the toilet seat when sitting on a regular-sized toilet. When out and about in the community, it can be helpful for some kids to use a seat cover that is more effective than just using toilet paper. Some of our kiddos can’t tolerate sitting without holding onto the seat or just can’t follow the directions to “not hold onto the seat”.

These special needs potty training seats can be a guide to getting started with potty training for special needs kids.

Physical Limitations and Special Needs Toilet Training

While these potty training seat options just cover the surface of potty training, it’s important to remember to consider the underlying and developmental aspects of potty training.

The therapist’s perspective can play an important part in identifying any developmental or transitioning needs when it comes to potty training. While there are many more specific tools that can be used with special needs toilet training as well as typically developing kids, these are just some of the basics.

Remember that there truly is not a one-size-fits-all aspect for toileting. Some of our kids with more physical special needs or developmental considerations may benefit from a more extensive and supportive seating system.

That’s where the occupational therapist comes into play with identifying needs and tools that will promote independence and function.

There are many considerations that should be addressed when it comes to seating and toilet seats. First and foremost is the safe positioning of the individual on the toilet. Other considerations, depending on the special diagnosis may include:

reflex development and maturation
muscle tone
range of motion
balance
motor skills
attention span
motor planning
visual perceptual skills
postural reactions
joint tightness
eye mobility
cognitive considerations
weakness
sensory processing challenges
self-concept
body awareness

In the book, The Toilet Training Book: A Developmental Take on Potty Training for Kids of all Abilities, we cover more on special diagnoses and potty training, including strategies and tips for individuals with cerebral palsy, Spina Bifida, trauma, Traumatic Brain Injury, ADHD, Autism, and other general considerations.

Use these potty training seats for special needs kids when beginning the potty training process with kids of all needs.

Potty Training Seats for Physical Needs

Toileting Seat System- There are many toileting systems on the market that address physical needs. Seating systems are intended to promote positioning, safety, mobility, transfers, function, and quality of life of the individual. Look for a system that meets the budget and can efficiently accommodate various needs such as toileting, showering/bathing, hygiene, etc.

Systems can come with a variety of adjustments and supports. Consider the need or use of the following supports:

Headrest
Backrest
Armrests
Lateral back supports
Harness
Seat belt
Tray
Anterior support
Hip guides
Abductor
Urine deflector or guard
Calf supports
Lower extremity lateral supports
Ankle straps
Footrest
Tilt in space (backward/forward)
Recline
Height adjustments
Push handles (for caregiver support)
Wheeled base
Molded and Foam cushions
Pan/adaptability for use over a toilet or as a stand-alone toilet chair

Support Station for Toileting- A standing support station can be used in assisted hygiene or assisted toileting. The standing station can be a support to transfers and can be beneficial to clothing management, self-care, skin care, and undergarment changing.

The support station is a helpful tool for improving function and dignity of clients as can perform aspects of toileting, as well as participate in self-care. This is a means for reducing diaper use as well, further improving dignity.

Additionally, support stations are a tool for improved safety of caregivers. When clients stand at a standing support frame, they are truly building strength, endurance and self-care skills in a natural manner within the occupation of toileting.

Wiping after toileting and special Potty seating

When it comes to pericare, there are things to consider with the various special needs toileting systems.

Can the child maintain their balance while reaching for toilet paper?
Can the child weight bear or shift their weight from side to side or forward in order to wipe?
Can the child reach around their body to wipe?

For More information on Potty Training

Watch for information coming soon to this space on the new Toilet Training Book! It’s about to be released and is your go-to resource on potty training based on development and individualized needs.

This book was created by occupational therapists and physical therapists who are experts in the field of child development, sensory processing, motor skills, and function. Need more information and real strategies to improve potty training success? Want insider tips and tools from the occupational therapist’s and physical therapist’s perspectives? The Toilet Training Book is here!

Potty Training Help

Tackling 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.

This digital e-book is a deal of a resource at $19.99

The Toileting Book is a comprehensive resource covering every aspect of toilet training.

Details about The Toileting Book:

Written by a team of experienced pediatric occupational therapists and physical therapists with decades of experience
Packed with information on toilet training readiness and achievement of toileting success
Includes Toilet Training Guides for special populations (children with fine or gross motor needs, behavioral or cognitive challenges, physical disabilities, etc.) including Sensory Processing Disorder, Trauma-Informed Needs, Autism Spectrum Disorder, Cerebral Palsy, Spina Bifida, Spinal Cord Injuries
Provides information on interoception and the role this sensory system plays in potty training
Discusses common toileting equipment and special needs toileting tools
Includes tips and suggestions for individualized toilet training

This book is available in digital, e-book format AND in a physical, soft-cover book format.

The Toilet Training Book- the potty training resource you need!

Perineal Hygiene

September 21, 2023June 7, 2022 by Colleen Beck OTR/L

Here, we are covering an aspect of potty training that comes up for every parent: pericare, or perineal hygiene, and teaching kids how to wipe when toilet training. So often, a young child learns to use the toilet and other aspects of potty training, but then struggle for a long period of time with the wiping aspect. Teaching children to wipe thoroughly is a hygiene task that can be limited by many underlying areas. Here, you’ll find strategies to help wiping bottoms and interventions for perineal hygiene. Also check out ADLs for more information on daily tasks.

How to teach pericare, or perineal hygiene needed to wipe completely during toileting.

What is pericare?

For the uninitiated, pericare (or peri-care) is short for perineal care. Perineal care refers to the hygiene and self-care of the perineal area following toileting, cleaning, and wiping of the perineal area of the body is the “private parts” area. Pericare is a term for the hygienic tasks involved in this part of the body, such as wiping one’s bottom.

Anyone of any age may need help wiping their bottom with their perineal care, but it is especially important to teach our little ones the proper way to manage their bottoms as they become more independent.

This component of toileting is one that impacts overall independence and self-care with the toileting process. So often, we cheer and celebrate making it to the toilet on time, but the perineal hygiene aspect is equally as important.

You may be thinking, “Why do I need to teach my child how to wipe!?!”. For something that is such a natural task for many, it can feel odd to teach somehow how to do it.

However, learning how to maintain a clean bottom is important for one’s health and confidence. Wiping properly, washing gently, and wearing appropriate clothing decreases the risk of yeast infections, urinary tract infections, and odors. Plus, discussing peri-care can open the door to many other conversations about the body, health, and safety – if that’s something you are interested in exploring with your child.

A great time to educate your child about peri-cares is while potty training. It is easier to teach the correct way first than to re-learn how to do it later. If you are stuck on potty training, we feel you there! Check out this Toliet Training Book that can help you help your children of varying needs.

Don’t be discouraged if your child is already potty trained and they have yet to learn how to take care of their bottoms independently – it can take time and practice!

Development of Pericare

An important area to cover first is the development of pericare skills. It is so important to remember that we are talking about young children who are learning a whole new skill with toileting. There are many considerations: autonomy, body awareness, interoception, self-awareness, the sensory processing and interoception aspect, family perspectives…potty training can be very overwhelming for kids.

Then, to break it down even further, the hygiene aspect of toileting is another ball game!

In our book, The Toilet Training Book, we cover the development of potty training and really cover what underlying skills play into potty training and independence with toileting.

But, one important thing to remember is that a three year old child may be able to make it to the toilet in time to go, flush, and wash their hands, but the wiping aspect can developmentally, come with time.

Developmentally, perineal hygiene, or wiping completely after toileting, may be a skill achieved during a range of 4-6 years. This range is so wide due to the underlying skills, sensory considerations, motor skills, and cognitive growth needed for perineal hygiene including knowing when and where to wipe after a bowel movement or urination, using enough pressure on the toilet paper to clean completely, wiping enough times to clean completely, and maturity to complete the task.

The emergence of these skills takes time, but there are ways to support development of perineal hygiene.

GET COMFORTABLE with perineal hygiene

Everyone wants a clean bottom, let’s start there. It can be smelly and embarrassing to talk about, but it is an important step to understanding personal healthcare.

We want to give you the confidence to discuss this in any way that you and your family feel comfortable with because it is a “touchy” subject for some. The more comfortable you are with peri cares, the more comfortable the child will be.

Let’s start off the potty training wiping techniques by talking about good hygiene.

Here are some ideas to talk about perineal hygiene with kids:

Make it silly: Some people respond best to humor but watch out for demeaning jokes.
Make the conversation about pericare hygiene scientifically accurate: It becomes less embarrassing when you hardly know what is being said!
Make pericare sound similar to washing hands: We have to clean away the germs; they can make us sick!
Make discussions about perineal hygiene your own: You know your family best. Think about terminology that works for the individual. In what ways can you increase trust and comfort for all?

GENERAL GUIDELINES for teaching perineal hygiene

Here are some general tips for a healthy bottom that should be shared for children and adults alike. Please speak to your family physician if you have any questions or concerns related to your child’s unique needs.

Wear breathable (preferably cotton) underwear that is not too tight. Change daily or when soiled.
Don’t hold it in. While it is good to wait to “go” until you reach the toilet, holding in pee or poop for too long can result in a variety of issues.
If it is comfortable, sit on the toilet with elevated feet. You may have heard of the (Amazon affiliate link) Squatty Potty – placing the legs in more of a squatting position helps bowel movements pass. More importantly, children should have access to a either a smaller potty or a footstool (or a box,etc.) near the toilet so that their feet do not dangle.
Wipe from front to back to reduce bacteria entering the urethra. Talk about anatomy and why wiping front to back is effective and safe.
Wipe gently with 3-4 squares of folded toilet paper (each household can determine the amount – some kiddos use way too much!) until clean. I always recommend to look at what you are wiping away so that you learn about how much you need to wipe.
Consider use of warm or cool wipes over toilet paper.
When bathing, wash the genital area gently with mild soap and rinse with clean water. No soap should be entering the body through the anus or the vagina.
For bathing a uncircumsized child, refer to this article for great information and consult your family doctor for personalized advice.

Pericare INTERVENTION IDEAS

Children will not know unless we lead them, so here are some fun ways to teach pericare!

Areas that can be broken down to increase overall self-care include:

Address balance
Pulling up and down undergarments
Wiping front to back
Wiping thoroughly
Wiping with enough pressure
Gripping the toilet paper
Washing hands after wiping
Reaching around to the back

Each of these areas can include aspects of balance, gross motor skills, fine motor skills, strength, coordination, sensory processing, executive functioning skills, and visual motor skills. It’s important to look at each individual’s area of difficulty and then break it down into the underlying areas that are impacting success with pericare.

First look at the area of difficulty. Then, consider how underlying areas are impacting that particular area. Come up with intervention strategies that support that need and create a “just right” challenge to build independence and pericare functioning.

Let’s look at each of these areas of perineal hygiene…

Pulling up and down undergarments:

Fine motor strength and coordination fine motor activities to the rescue! There are so many fantastically fun ways to increase this skill, but here are some that are more directly associated with potty training.
- Lei Obstacle Course: Grab some Hawaiian-inspired leis, hula skirts, or long necklaces and create a long pathway. As a child walks through the pathway (hopefully to another fun activity in the course), they must step inside the lei and pull it up as high as it will go. If it fits over their arms/head, they can wear it as a necklace. Pulling up the lei and wiggling their body through will strengthen the same skill as in pulling up pants. Reverse the challenge to mimic pulling pants down.
- Silly Socks: Grab a variety of socks in fun colors and different sizes and see how many you can put on in one minute! Layering socks up the arms and legs (and removing them, too!) mimics the skill of pulling up and down undergarments.
- Stickers: Challenge them to peel off stickers all along the waistband of their pants. Don’t forget the backside!

Pericare: Wiping Activities

Balance and reach are huge parts of perineal hygiene. Staying balanced on the potty while wiping is a big challenge for our core strength, flexibility, and range of motion. To practice this skill through play-based activities, see the ideas below!

Play-pretend: Place peanut butter on the back of a disposable or washable diaper and have your child wipe it off. Any familiar paste will do – sun butter, nutella, cookie butter…anything to wipe! When they think they are done wiping, show them the diaper to see if they actually cleaned it.

Art-based: Wipe a plastic plate with toilet paper to create an art project – the toilet paper acts as the paintbrush. They must wipe clean the whole plate! For an extra challenge, place the plate behind their backs, and the work of art in front of them.

Play activity: Using static electricity, tape, or velcro, have your child squat to “pick up” pom-poms or other sticky and lightweight items on their bottoms (think: window stickers, damp tissues, etc.). They carry them carefully to a container and remove them one by one. You can really make this game your own!

Wiping Front to Back

There are so many ways to work on perineal hygiene to cover other aspects besides the balance consideration. Consider these strategies to teach kids to wipe front to back:

Use toys, books, clothing, and other items to work on teaching front and back directional concepts.
Teach children to count to help with wiping a certain number of times.

Reaching Back to Wipe During Perineal Hygiene

Clip and unclip clothes pins on the back of clothing to work on reaching back and around..
Use a pool noodle to reach around and through the legs to work on reach, visual attention, scanning, and eye-hand coordination. You can tap the pool noodle on a target and create a game.
Practice wiping the backside in the bathtub.
Put a handkerchief or scarf in their back pocket for the child to reach for and pull out.
Put stickers on the child’s back or pants for them to reach for and grab.

Wiping with enough pressure

Work on tearing paper for hand strength and eye-hand coordination to pull off appropriate sizes of toilet paper.
Use play dough, LEGO, tong activities to develop hand strength.
Wipe dry erase marker off a dry erase board. Then, position the dry erase board on the ground between the feet to bend and wipe. Then, position it behind the back to reach and wipe.
Wipe peanut butter or washable paint from a plastic baby doll.
Help kids to wipe thoroughly by painting with toilet paper with having them try to wipe a blob of paint off a plastic plate and remind them to keep going until the plate was empty.

More perineal care and potty training tips

Looking for more information on underlying considerations that impact toileting? Need strategies, supports, and tools to facilitate independence with toileting skills? Need support strategies for potty training an older child, but not know where to begin?

Looking for ways to help individuals with toileting skills when cognitive, behavioral, motor skills impact participation in independent toileting? Trying to initiate or progress with potty training when a diagnosis of Down Syndrome, Autism, or a motor skills challenge is at hand? Check out the Toilet Training Book: A Developmental Take on Potty Training for Kids of All Abilities.

Resources for toilet training kids of all abilities — The Toilet Training Book: A Developmental Look at Potty Training for Kids of all Abilities

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.

Behavoral Issues with Potty Training

June 7, 2022March 23, 2022 by Colleen Beck OTR/L

Here we are covering behavioral issues with potty training and potty training problems that impact toilet training in kids. Teaching a child to potty train is a complex task. You’ve probably tried some of the common tips for potty training. But what happens when there are real problems? There are many components that can affect a child’s progression and retention of toileting independence. Let’s go deeper.

Behavioral issues with potty training

Parents often times seek out potty training help when they are working on building independence in this functional skill of childhood.

While there are many considerations that go into the developmental progression of independence, attention and behavior are key skills in function.

Behavioral issues with potty training can look like many different things:

Intentionally urinating on the floor
Impulsive actions in the bathroom
Hyperactivity during toilet training
Playing in the toilet
Using too much toilet paper in anger or frustration
Hitting
Aggression during toileting

Full disclosure: This post contains affiliate links.

Potty Training Tips and Help for kids with attention or behavior problems

Behavior and Potty Training

It is important to note that many times, behaviors that are seen with potty training are a result of potty training starting too soon.

When a child demonstrates behaviors, there is often times, a communication point that the child is trying to get across: Behaviors are many times just information.

Other times, behaviors are normal development of a child’s cognitive and imagination. Children who are potty training might refuse to take time to toilet, make urine or fecal messes on the floor intentionally, throw objects into the toilet, or refuse to use certain bathrooms, among many other behaviors.

It is important to take the behavior objectively and think about the behaviors as information. Information should be viewed objectively and without bias.

A behavior can be viewed as good or bad but in order to address the behavior, it is necessary to figure out the reason behind the behavior.

A child who has tantrums and hits an adult is considered to have bad behavior while a child who attends to a task is considered to have good behavior. This bias is a perception of behavior.

There are many reasons behind behaviors related to potty training and the act of toileting.

Problems with potty training and behaviors during toileting may be a result of:

Sensory concerns with steps of toileting
Fear of going into the bathroom
Anxiety as a result loud hand dryers or other sources of over-stimulation
Fear of self-flushing toilets
Consider a need for a special toilet training seat, especially for kids with special needs.
Uncertainty of the steps of toileting
Difficulty with fine motor or gross motor/positioning needs related to toileting
Constipation due to holding output or other physical discomfort
Cognitive delays limiting understanding of portions of the toileting process
Unfamiliarity with surroundings when using different bathrooms
Difficulty with the breakdown of a multiple step task such as clothing management, toileting, and hygiene
Inability to communicate effectively
Typical development of boundary pushing and expression of language and cognition

For a more comprehensive look at all areas that can impact successful toilet training, be sure to dive into The Toilet Training Book: A Comprehensive Take on Potty Training for Kids of all Needs and abilities.

These types of difficulties can result in reactions that lead to frustration and tension between the child and adult.

It is important to remember the causes of behaviors throughout the potty training process.

Once there is a potential reason identified for the cause of behaviors related to toileting, examine the behaviors and consider the following questions:

What is the child getting or not getting from the behavior?
What makes the behavior stop?
What makes the behavior continue?
What are precursors to changes in the behavior?
Does the child withhold toileting breaks to avoid going into the bathroom?
Does the child demonstrate cognitive, communication, sensory, fine motor, or gross motor difficulties that might interfere with steps of the potty training process?

How to support Children with potty training problems

Let’s talk tips to help with behaviors related to potty training.

Aggressive behaviors might include shouting or physically hitting and might occur suddenly as a result of frustrations perceived by the child. Other children might become upset in certain bathroom environments like public restrooms. Still others might overly focus on certain details. It is important to try and understand what is causing the child to become angry, upset, anxious, or agitated.

Some of these strategies can work to support children that struggle with potty training problems.

Modify the Task– One tip to adjust the precursors to behaviors in toileting is to modify the task or simplify the steps that you are asking the child to complete.

Begin where the child is consistently successful. A child who’s anxiety of entering a bathroom prevents further progression of independence may begin with the child walking into the bathroom, and staying in the bathroom for a count of five.

Continue practicing this portion of potty training until there is success. Then the child will be capable of moving on to other steps of toileting.

Gradual progression of potty training coincides with waiting to begin potty training until the child has shown readiness cues.

Take time to respond– Before responding or reacting, take a moment before you respond as the parent. Before reacting to potty training behaviors, consider:

Think about the cause of the aggression or anxiety.
Focus on the child’s emotions.
Be positive and reassuring.
Provide reassurance through calm a voice and phrases.
Reduce noise and distractions to help the child relax.
Follow the child’s lead.
Realize that some behaviors can indicate that the child isn’t ready and they are communicating a lack of readiness through their behaviors.
Keep it simple: reduce verbal cues.
Boys can sit to pee at first until they get the hang of the physical act of awareness of the urge to urinate and clothing management.
Use the same gender roles to make learning easier.
Begin potty training when it works for your family time-wise: don’t start potty training during a vacation or when other changes are happening in the household.
Also accept that there will never be perfect timing to start potty training.

Support perineal hygiene with specific strategies.

Attention Considerations in Potty Training

Like the reasonings behind behaviors seen in potty training, children often times have a reason for inattention leading to poor carryover of skills or steps of toileting.

There are certain attention areas that should be achieved by children before attempting to begin potty training.

A child should have an attention span that allows them to respond appropriately to verbal instructions when they are given one step verbal cues:

Sit down in a chair.
Stand up.
Walk to another room.
Imitate a parent in a simple motor task.
Point to body parts when asked.

If a child is not able to attend to these tasks, they may not be ready to begin attention.

Strategies for Helping with Challenging Behaviors and Attention Difficulties during Potty Training

Tips and help for potty training with behaviors and attention problems like this key chain schedule.

Potty Training Schedule

Visual Supports– These might include visual schedules, or visual supports are schedules, dry erase boards, and timers.

Start with this information on how to use visual reward charts for the most success.

A schedule can be as basic as a “first-then” cue or complex and including each step of the potty training process. I have created a customized schedule card that can be attached to a key chain and taken to various bathrooms during outings as well as used in the home.

Use the steps printable to customize the schedule card to meet the needs of your child.

Another quick tip can include using an Alexa skill to create a timer or schedule for time to try the bathroom routine.

How to make a customized potty training schedule for kids:

Print the schedule images. Cut out the pictures that work best for your child’s needs. You can adjust the length or steps of the schedule based on your child. Changes to potty training schedules should be practiced for at least two weeks before giving up on a specific technique or schedule.
Using card stock, cut a 2 1/2″ by 9″ length.
Create 2 1/4″ x 2″ card stock squares for covers.
Fold and tape the covers to the back of a 2″ square card stock. This will hold the different steps of potty training.
Create a small slit and attach a badge clip. Use this clip-on schedule by attaching to clothing or hang it in a bathroom.

Choices– Incorporate choices into the potty training process. Choices might include:

Do you want to use this restroom or that one?
Do you want to use the paper towel or the hand drier?
Do you want to walk or hop into the bathroom?

Choices like these allow the child to feel in control of a situation that has to happen. Toileting is a task that must occur and the choice that a child makes can sometimes be withholding toileting or purposefully urinating on the floor instead of in the toilet.

Positive Reinforcement– Positive behaviors can be rewarded to provide feedback to the child with behaviors. Feedback is the information about the outcome of a response.

Internal feedback is the response of the sensory systems in respond to a task. A child feels better after toileting.

2. External feedback comes from a source. In potty training, external feedback might be visual cues or praise from a parent in response to completed tasks. A reward system is another type of external feedback.

Feedback can be provided after every completed step of potty training, or it can be varied to transition to the end of tasks. Feedback (like a small food reward) that is given after every step of potty training becomes a crutch.

Positive reinforcement should be transitioned to the end result of toileting, including hygiene, washing hands, and leaving the bathroom in order to help with skill retention.

Initially, a positive reinforcement such as a food or sticker reward should be given immediately after the child does the expected behavior. They can be given the reward every time they complete that part of potty training. Gradually you will increase the steps the child needs to accomplish before earning a reward. Parents should be specific with the behavior that is being reinforced. Say,“I like the way you are sitting on the toilet,” as they are given a tangible reinforcement.

This potty training incentive resource covers more on positive reinforcements for toileting.

Reinforcer Chart– A child who is working on multiple steps of potty training or who has moved on from single step positive reinforcement can use a reinforcer chart to earn a small prize after multiple successful attempts at toileting.

The child might earn a toy from a prize bin or a small treat at a store. Even a picking a sticker out of a basket and allowing the child to place the sticker onto a potty training chart is a great tool that offers positive reinforcement.

This type of reinforcement builds delayed gratification.

Positive Communication– When behaviors arise during potty training, it is important to use effective communication and not respond with criticism to behaviors or inattention.

Also important is avoiding the term “good job” as a reward to accomplishing desired behaviors. A child might not be successful but tried hard. Other more appropriate terms include words or gestures for encouragement or suggestions for “next time”.

Potty Training Tips to Help with Behavior and Attention Concerns:

Simplify when teaching new skills. Break down tasks into smaller, obtainable steps to allow success. Provide positive reinforcement to each step.
Use stronger reinforcers for more difficult tasks. This might include holding urine overnight for several nights or continuing potty training skills at different settings outside the home.
Verbal cues are more difficult to fade than physical cues. Limit the amount of verbal cues once a child has shown success with steps of potty training.

Potty Training Resources:
Warwick, T. (2013, February). Effective Strategies for Decreasing Challenging Behavior in Individuals with Autism Spectrum Disorders. OccupationalTherapy.com, Article 2174.

Potty Training Book

The Toilet Training Book is a comprehensive resource for all aspects of toilet training.

The Toilet Training Book is a developmental resource on potty training children of all abilities and skills. Created by occupational therapists and physical therapists, and guided by child development, this toilet training resource is like no other.

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

In the book, you’ll find guidance, tips, and actionable strategies to support all aspects of toilet training, including tools and supports for kids with physicals needs, neurotypical individuals, and children of all needs and levels.

Written by a team of experienced pediatric occupational therapists and physical therapists with decades of experience
Packed with information on toilet training readiness and achievement of toileting success
Includes Toilet Training Guides for special populations (children with fine or gross motor needs, behavioral or cognitive challenges, physical disabilities, etc.) including Sensory Processing Disorder, Trauma-Informed Needs, Autism Spectrum Disorder, Cerebral Palsy, Spina Bifida, Spinal Cord Injuries
Provides information on interoception and the role this sensory system plays in potty training
Discusses common toileting equipment and special needs toileting tools
Includes tips and suggestions for individualized toilet training

Click here to read more about The Toilet Training Book: A Developmental Take at Potty Training for Kids of all Needs.

Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.

What you Need to Know about Interoception

February 5, 2024March 14, 2022 by Victoria Wood OTR/L

Interoception is a sensory term you may not have heard of before…but you have certainly felt or been impacted by the processing of our interoceptive sense! Internal feelings of hunger, fatigue, thirst, body temperature, digestion, and other internal systems offer a certain “feeling”, right? This is your interoception sensory system at work! Here, we’re covering everything you need to know about this complex sense, and taking a detailed look at how interoception impacts function.

Interoception sensory input impact regulation, modulation, and function.

Interoception The 8th sense

Did you know that the five senses we were taught in school is not actually a complete list of a human’s senses? In fact, there are 7 or 8 senses that humans experience, depending on who you ask.

Understanding our many senses helps us comprehend how we and others experience the world around us. For the sense we are highlighting today, it is how we understand what is going on inside of us. Check out this post on the OT Toolbox regarding Multisensory Learning: Emotion Activities.

Definition of the interoception sense

Interoception is the sense of oneself; it is the ability to understand the body’s physical signals that tell you when you are hungry or full, thirsty or quenched, hot or cold, scared or calm, etc.

Interoception refers to the body’s ability to identify and process internal actions of the organs and systems inside the body. This lesser-known sensory system helps you understand and feel what’s going on inside your body. You can then make essential decisions about eating when you are hungry, drinking when you are thirsty, going into the restroom when you need to toilet, and other physical actions.

There are nerves throughout the body that send these signals to the brain to help regulate the body, and promote homeostasis.

Some of these signals require a conscious act, like drinking water when we are thirsty, while others are non-conscious, like sweating when we are hot.

Interoception comes into play when we consciously realize, “Oh, I am sweating because I feel hot, I should take off my jacket to cool down.”

Information on interoception, this blog post covers the definition of interoception, and interoception sensory strategies.

How Does Interoception Impact Function?

Interoception can be thought of as a mind-body connection. Having a strong interoceptive sense would mean that you have a strong sense of the physical self, and what you need to promote comfort at any given time.

Being able to confidently act on your body’s needs, makes everything a bit easier. You are likely able to make it to the bathroom before an accident, eat food before you feel light-headed, and stop eating before you feel sick.

But what about individuals who are not able to accurately process the bodies internal signals? They may find it more challenging to be potty trained, have a healthy diet, or emotionally regulate.

The ability to understand and respond to our body’s needs is a huge factor in our independence. If we don’t quite know what our bodies need, it makes everyday activities much more challenging, and focus on school or work tasks may dwindle.

Interoception even has to do with how our body moves, the action of bones in the skeleton, bone growth (growing pains have a lot of “pain” that is felt internally for kiddos who are rapidly growing! Be sure to check out this related blog on bone names to help tach kids about this concept.

Functionally, interoception impacts so many areas of everyday tasks:

Eating
Drinking
Sleep
Toileting
Getting dressed (putting on temperature-appropriate clothing, or taking off clothing before becoming overheated)
So many more considerations!

Interoception and Emotion

Interoception has a strong connection to emotional processing because of the physical way that we experience emotions. Our muscles clench when we are angry, quiver when we are scared, and relax when we are calm.

Likewise, the stomach may feel upset when we are nervous, and one might get a headache from frustration. People with good interoception can relate these physical feelings to emotions.

If a person sensory processing differences, the signals from the body may not be accurately represented or relayed to the brain. They may be muddied or confusing, leading to a misunderstanding of what the body is trying to tell the brain. Because of this, a tickle may feel like pain, or a person may not know why they are experiencing discomfort.

Without interoception, labelling emotions is then a bit more challenging, as well as understanding how to remedy undesired feelings.

Children may act out in aggression, cry or scream uncontrollably, or show other signs of sensory dysregulation, potentially due to a lack of interoception.

If you know a child who has multiple characteristics of reduced interoception, like potty accidents, over/under eating, and emotional dysregulation, they may benefit from therapeutic intervention to improve their body awareness.

The interoception system plays a part in feelings and emotions, too.

When we feel anxious or worried, we might feel a tenseness about us. Our heart rate might speed up, and we feel that anxiety coursing through our systems.

But for the child with difficulty expressing these feelings, they can’t tell us what they are feeling on the inside. They don’t have the words to identify specific interoceptive feelings they are having.

Others might not recognize a racing heart. They might not realize that physical implication of anxiety or worry because they can’t actually feel their racing heart (when it is very much racing).

When one feels anxious about a situation or an idea, we can help them to focus on their heart beat. We can help them take deep breaths to calm down. This focus on how their body is responding can help their internal state match the environment.

Other ways to help with interoceptive identification include habit and routines to help us feel organized. When we know what to expect, we feel a lot more organized. The body is able to modulate better.

As we increase the challenge, we have to also increase our supports. We can use some external organizational strategies (deep breaths, awareness, mindfulness, heavy work, routines) to help compensate for the lack of internal ability to organize ourselves.

When we are disorganized, this is where we can fall apart. We have to be mindful ahead of time, and be accommodating and accepting of immature nervous systems, whether this is with our children, our spouse, or ourselves.

Tips for Improving Interoception

There are all sorts of activities you can do with children to help increase their interoception skills. Below you will find tips for improving interoception, including mindfulness, and children’s books on topics like emotions, potty training, and problem solving.

Modelling how you understand your bodies signals may also help – be sure to emphasize how you are feeling, and what you will do about it!

Mindfulness – the act of intentionally connecting to oneself and/or the world around them. This can help an individual get “out of their head” and feel more grounded in the present moment. By doing so, it may improve self-awareness and a positive mood. Mindfulness is not just great for improving interoception – see this article for more information
- This video guides a progressive muscle relaxation. Intentionally contracting and releasing muscles brings more awareness to the physical body, and deepens the connection that we feel to it.
- Here we have another video that guides mindfulness, in the form of a “body scan”. It also adds a great piece of education for children on what it means to understand their bodies signals, and why it is important.
- The OT Toolbox has this great list of more active ways to explore mindfulness through gross motor play.
Focus on awareness- So often, parents, children, clients, educators, and even professionals are not aware of ALL of the ways that the interoceptive sense impacts everyday functioning, learning, and daily participation in everything one does throughout the day. Educate, educate, educate! Then, bring that awareness to a full circle with activities that take the concept of interoception in daily tasks home. For example, you can cover how sleep is impacted by interoception and incorporate a few of our hibernation activities. Without interoception, animals that hibernate would not instinctively know to fill up on foods before winter and to keep eating even when they may feel full. Then that sleep that allows them to slumber through the winter is in effect. It’s all related!
Try calm down toys– Use a variety of supports in the form of play to support regulation needs. This can offer heavy work, regulating movement, or calming input.

Books to Improve Interoception

Below are Amazon affiliate links to resources and books on interoception and internal states.

We Listen to Our Bodies is a book that follows a young girl as she feels emotions through her day. The physical representations of emotions are highlighted in ways that are familiar to young children.
For a similar read pick up this book, that follows a boy and his day full of feelings at the zoo!
Time to Pee by Mo Williams is a great book that helps kids understand how to respond when they have that ‘funny feeling’ in their tummies.
I Feel… activity books have been praised by therapists for their ability to make learning mindfulness fun! The activity book linked here focuses on sickness in the body and what it feels like to be sick in different ways.
The OT Toolbox has a great resource called the Sensory Lifestyle Handbook to tie sensory processing together
For more children’s books on mindfulness to elicit peace and calm, check out this resource:

Sensory lifestyle handbook- How to create a sensory diet

While interoception is new and lesser known, it is an important sense to have.

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