Magazine article The Exceptional Parent

INCONTINENCE: Toilet Training a Child with Special Needs

Magazine article The Exceptional Parent

INCONTINENCE: Toilet Training a Child with Special Needs

Article excerpt

Parents often find that toilet training their child can be a frustrating process. Some children may toilet train quickly and easily, but for many children it can take time. If a child has special needs, it can be even more difficult. Parents know that every child is unique and different. Advice from other family members or friends may or may not be helpful.

Typically, children can achieve toilet training by 2 to 3 years of age, regardless of special needs. Toilet training increases a child's self-esteem and independence, especially as he or she enters school or daycare. It can also be a stressful situation. However, only you and your child can determine whether they are ready to learn.

Is your child ready to begin?

The Readiness Checklist, (left) can help you determine if your child is ready to begin the toilet training process.

There are several steps to follow to help clear the way:

* Have your child seen by your pediatrician for a medical check-up to make sure he or she is healthy before you determine readiness to potty train. Continence can depend on whether or not your child has a disease or disorder that affects the bowel or bladder.

* Also, be sure and let your nurse practitioner or doctor know if your child complains of pain when urinating, the urine has blood or pus in it, the urine smells foul or different, your child is always dribbling urine, or has a really hard time starting to urinate. These problems need to be addressed before toilet training begins or at any time in the process.

* Additionally, pain on urination or defecation can hinder the readiness process. The skin covered by a diaper can become red and irritated. This may cause pain when your child urinates, and may cause him or her to withhold urine. It is important to always keep the diaper area clean and dry so your child will not want to hold the urine.

* Often, children feel inhibited about having a bowel movement outside of a diaper. If they are pressured to have bowel movements only in the toilet before they are ready, they may stop having bowel movements altogether. Likewise, if it hurts to have a bowel movement because of hard stools, your child is not going to want to pass it. This can lead to a vicious cycle. Slightly changing your child's diet may help, but check with your child's physician first. Fruits like pears, prunes, and peaches, which are high in fiber, can soften stools. Parents know which foods will work for their child.

Sometimes, medication is necessary for constipation to keep stools soft. Laxatives most commonly used are stool softeners like docusate sodium, osmotic laxatives like lactulose, and stimulants like Senokot[R] syrup. Other children may respond to suppositories or enemas. Again, it is important to always check with your nurse practitioner or pediatrician to see what medicine (if any) is appropriate.

Environmental factors

Begin training when your child is starting to learn cooperation, and when there is not a lot of stress at home. For instance, do not start toilet training around the holidays, when weaning him or her from a bottle, or soon after bringing home a new brother or sister. Also, from a practical point of view, it may be easier to start potty training when it is warm outside because your child will be wearing less clothing.

One of the first steps of toilet training includes keeping a diary for about three to five days. The diary should note when your child goes (either bowel movement or urine), when she or he is soiled, and what and when your child drinks. This will show you your child's toileting pattern and help clue you in as to when to have him or her start sitting on the potty.

Even if your child is fully trained, accidents often happen. Accidents may occur when your child is excited, fearful, absorbed in play, or awakened from a bad dream. They may also occur if there is any change in home routines, like the birth of a sibling, a move, or starting school. …

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