Transcript Potty Training for Children with Challenges

Potty Training for Children
with Challenges
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•
•
•
Christy Moran, OTR
Tasha Heinze, SI
Rachel Harvey, MOM
Chris Asbeck, MOM
OBJECTIVES
• Participants will understand general potty
training
• Participants will understand and be able to
adapt potty training techniques to meet
individual situations and challenges
What’s the Big Deal?
1. Recognize the need to go
2. Wait to eliminate
3. Enter the bathroom
4. Pull down clothing
5. Sit on the toilet
6. Eliminate in the toilet
7. Use the toilet paper correctly
8. Pull clothing back up
9. Flush the toilet
10. Wash hands with soap
11. Dry hands
Where to Start
• Start teaching steps 5 and 6
– Sit on the toilet and eliminate in the toilet
• You will do steps 1-4 for your child
– Recognize the need, wait, enter the bathroom and
pull down the clothing
• Help your child do steps 7-11
– Toilet paper, flush, pull clothes up, wash and dry
hands
Is Your Child Ready?
Follow simple directions?
Sit in a chair for 5 minutes?
Dry for 1 ½ hours?
Are You Ready?
Time
Patience
Consistency
Why Start with BMs?
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BM’s are consistent
BM’s are infrequent (once or twice a day)
Diapers are continued during BM training
Less time during the day is needed for BM
training for child and parent
Let’s GO!
• Determine your child’s pattern
– Keep a record for 2 weeks
– Do not change your routine during this time
– Record from the time your child wakes up, every
hour if the diaper is wet, soiled, or dry
– Use a chart that you only have to check wherever
you normally change diapers
– This is to establish your child’s pattern of
elimination and make your job easier
Day 1
7:00
8:00
9:00
10:00
11:00
12:00
1:00
2:00
3:00
4:00
5:00
6:00
7:00
8:00
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
7:00
U
U
D
U
D
U
U
8:00
D
D
UBM
D
D
D
D
9:00
BM
BM
D
BM
UBM
D
BM
10:00
D
D
U
D
D
UBM
D
11:00
U
U
D
U
D
D
U
12:00
D
D
D
D
D
D
D
1:00
D
D
D
D
D
D
D
2:00
U
D
U
D
U
U
U
3:00
D
U
D
UBM
D
D
D
4:00
D
D
D
D
D
D
D
5:00
BM
BM
BM
D
U
BM
BM
6:00
D
D
D
U
BM
D
D
7:00
U
U
U
D
D
D
U
8:00
D
D
D
D
U
U
D
Determine the Schedule
• Look at the 2 weeks data
• Circle the BM’s on the sheet
• Is there a pattern?
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
7:00
U
U
D
U
D
U
U
8:00
D
D
UBM
D
D
D
D
9:00
BM
BM
D
BM
UBM
D
BM
10:00
D
D
U
D
D
UBM
D
11:00
U
U
D
U
D
D
U
12:00
D
D
D
D
D
D
D
1:00
D
D
D
D
D
D
D
2:00
U
D
U
D
U
U
U
3:00
D
U
D
UBM
D
D
D
4:00
D
D
D
D
D
D
D
5:00
BM
BM
BM
D
U
BM
BM
6:00
D
D
D
U
BM
D
D
7:00
U
U
U
D
D
D
U
8:00
D
D
D
D
U
U
D
What Do You See?
• This child’s pattern is twice a day – around
9am and 5pm
• The focus time would be approximately
– 8:45 to 9:05 and 4:45 to 5:05
Focus Time
(20 minutes)
• Put your child on the potty 15min before
anticipated BM. (Approx. 8:45am/4:45pm)
• Sit for 5min. Praise for sitting
• Wait 10min, if not had BM, put your child
back on the potty for 5min
• Again - Praise for sitting
Day 1
8:45
9:00
4:45
5:00
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Keeping Records
• During the first week do not alter the plan
• Record when your child sits on the potty (we
use x for sitting only)
• Record when your child has a BM in the potty
(P – BM in the potty!!!!!!)
• Record when your child has a BM in the
diaper (D – BM in the diaper and what time
the BM occured)
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
8:45
X
X
X
D8:40
X
X
X
9:00
X
D 8:55
P
X
P
D8:55
X
X
P
X
D 9:10
D 9:10
4:45
X
X
X
X
5:00
D 4:55
X
D 4:55
P
D5:10
D 4:45
D5:10
Checking Progress
Do We Need to Change?
• Are the BM’s still around the anticipated
time?
– If yes – keep the same plan
• Is your child consistently earlier or later than
the focus time?
– If yes – consider altering the time to better match
your child’s body schedule
Consistency
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Follow the plan every day
Praise for sitting on the potty
Bigger praise for BM in the potty
During this time do not try to urine train
IF your child asks to go to the potty during
other times of the day it is OK
TIME FOR A CHANGE?
Is Your Child Ready to
Urine Train?
• Begin Urine Training when your child
consistently has a BM in the first sitting of
toileting times
• And they have no more than one BM in the
diaper during a typical week
Are You Ready To Urine Train?
• Change your child from diapers to training
pants during the day
• You may want to “double up” on the undies
since this may be messy
• Children are comfortable wetting in diapers.
We need to remove this comfort to be
successful. Now comfort comes from staying
dry by way of wetting in the potty
Urine Training
• Determine a schedule of when your child is
most likely to urinate
– Look at two weeks data of when they have wet
diapers
– Circle the U’s on your chart
– Find 4 to 6 times a day when they are likely to
urinate
– Add those times to the schedule you already have
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
7:00
U
U
D
U
D
U
U
8:00
D
D
UBM
D
D
D
D
9:00
BM
BM
D
BM
UBM
D
BM
10:00
D
D
U
D
D
UBM
D
11:00
U
U
D
U
D
D
U
12:00
D
D
D
D
D
D
D
1:00
D
D
D
D
D
D
D
2:00
U
D
U
D
U
U
U
3:00
D
U
D
UBM
D
D
D
4:00
D
D
D
D
D
D
D
5:00
BM
BM
BM
D
U
BM
BM
6:00
D
D
D
U
BM
D
D
7:00
U
U
U
D
D
D
U
8:00
D
D
D
D
U
U
D
New Schedule
• This child has 4 times they are likely to urinate
– 7am, 11am, 2pm, and 7pm
• Add those times to your new schedule
• Use the same focus times as before – start 15
minutes before anticipated urination, sit for 5
min, praise for sitting, 10 min later if still dry,
sit for 5 min, praise for sitting
Day 1
6:45
7:00
8:45
9:00
10:45
11:00
1:45
2:00
4:45
5:00
6:45
7:00
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Record Keeping Again
• During the first week do not alter the plan
• Record when your child sits on the potty
(we use x for sitting only)
• Record when your child urinates (U)
or has a BM
• Record if it is in the potty (P)
or in the training pants/diaper (D)
DAY 1
DAY 2
DAY 3
DAY 4
DAY 5
DAY 6
DAY 7
6:45
X
X
X
X
UP
X
UP
7:00
UD
UD
UD
UD
8:45
BM P
BM P
X
BM P
9:00
BM P
BM P
BM D
10:45
X
X
X
X
X
11:00
UD
UD
UD
UP
UD
1:45
X
X
X
UD
UP
2:00
UD
UD
UP
4:45
BM P
BM P
BM P
5:00
BM P
UP
UP
X
X
X
7:00
UD
UD
UD
UD
UD
X
BM P
BM P
X
6:45
X
U BM P
X
X
X
UD
UD
UD
Do We Need to Change?
• Are the U’s still around the anticipated times?
– If yes – keep the same plan
• Is your child consistently earlier or later than
the focus time?
– If yes – consider altering the time to better match
your child’s body schedule
Consistency
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Follow the plan every day
Do not change the plan the first week
Use the same words/signs/pictures
Use the same toilet if you can.
If your child shows signs of a BM (squatting,
straining, going behind the sofa) or needing to
urinate (holding themselves, crossing legs) at
other times, go ahead and let him potty
Rewards
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Use rewards to increase desired behavior
Start small – for just sitting on the potty
Work up to sitting for 5 minutes
Then give for eliminating in the potty
Use immediate rewards – praise, high fives,
hugs, stickers, goldfish crackers, teddy
grahams
• Have them close by (immediate)
Reward or Not?
• Decide ahead of time what gets reward
• Make it easy to achieve
• IF they do not do the behavior – do not give a
reward
• Quietly lead your child out of the bathroom
• Do not talk about the missed reward
No Attention (?)
• When they soil or wet their diaper/pants quietly change them in the bathroom
• Try to focus on changing without making eye
contact or talking to your child
• Then quietly lead them out of the bathroom
• If your child is given attention for accidents
they are likely to continue
More Keys to Success
• Use the regular toilet from the start
• If your child is too small, use a smaller seat
that sits over the regular one
• Have a stool/bench to help your child get onto
the toilet and to place their feet on while on
the toilet. This will help them feel more
secure, and relax better.
• If you use a potty chair, keep it in the
bathroom
Even More Keys to Success
• Limit distractions in the bathroom
• Talk about the toilet and what you want your
child to do in a concise, non-demanding way
• Sing a potty song
• Wait patiently
• Give reinforcements
• Do not turn it into “playtime with mommy”
Phasing Yourself Out
• When your child is consistent with sitting on
the potty, begin to phase yourself out
• Start by attending to other things in the
bathroom
• Then wait at the door
• Then leave the bathroom, start brief then
gradually go for longer periods of time
Phasing Out Rewards
• As your child is beginning to use the potty
with consistency begin phasing out the
rewards
• IF you have done stickers or food, begin to
give them less often or move to High Fives
• Continue to tell your child that you are proud
of him for going to the potty
ADAPTATIONS
Positioning
• IF your child has high or low muscle tone, or if
they seem to be “wobbly” and lean often
when sitting make sure their feet are on a firm
surface, like a wooden stool
• They may need arm rests, or to hold onto the
counter/wall
• They may need to sit facing the back,
straddling the toilet, with arms on tank
– This is also good for boys to learn aiming
Picture Schedules
• If your child learns better from pictures than
from words you may want to have a picture
schedule for toilet training
• It should be brief but contain the information
your child needs
• It could be in a book format for reading OR in
line format that you have on the bathroom
wall easily visible from the toilet
Vision Impairment
• The same readiness signs apply
– Follow simple directions
– Sit in a chair for 5 minutes
– Stays dry for 1 ½ hours
• The same positioning tips apply
– Have a firm surface for their feet – wood bench
Looking With Your Hands
• The child with severe vision impairment will
need to touch and feel the toilet and toilet
paper with your hands guiding them
• They may need to touch the bowel movement
or urine to understand
• This is ok at the beginning but should not
become a part of the regular routine
Constipation
• Liquid Intake
– Most children need 1 ½ ounces of fluid per pound
of body weight
– Hot weather, fever, and excessive drooling can
cause that to go to 2-3 ounces per pound
• Fiber Intake
– Add fiber to your child’s diet through fresh fruits,
vegetables, whole grains, and cooked beans
DAYCARE / PRESCHOOL
What Do They Do?
Habit Training
Token System
Potty Day
Habit-Training Program
• Once a day (usually in the morning) the child
drinks liquid (2-4oz) prior to toileting
• The child sits on the toilet until they urinate in
the toilet. (Up to 30 minutes) They may need
to stand up or walk in the bathroom a minute
• If they have not urinated within 5-10 minutes
more liquid is given (8-10oz) while on the
toilet
What Else?
• Wait until the child urinates.
• When the child starts to urinate stay quiet,
then praise them for urinating in the toilet.
• IF they have an accident while they are
standing, try to catch it in a cup and put it in
the toilet. Do Not scold.
• Do this once a day until they are urinating
within 2-3 minutes of getting on the potty
Continuing
• Add toilet times during the day
• Start with one additional, then when they are
urinating within 2-3 minutes each time add
another
• Eventually your child should urinate whenever
you put them on the potty. This means that
they are “Habit Trained”
Moving to Independent
• Once your child is habit trained, teach words,
signs, or use of pictures so they can let you
know when they need to potty
• Give them reminders or suggestions but do
not take them until they ask. When they have
accidents change them in the bathroom as
quietly as you can without giving attention
Completing the Process
• Start rewarding them for being dry during the
day.
• Check them throughout the day when you
know they will be dry and give them a small
reward for being dry
• As your child gets more independent, space
out your rewards
Token System
• The Token system rewards the child with tokens
each time they successfully “go potty”
• They are usually star charts or sticker charts
• Each time the child goes to the potty they get a
star or sticker added to his chart
• When they achieve a set number of stars they get
a reward – treat, outside play, special toy, special
video
• As the child becomes more successful, more
tokens are required to achieve the reward
Potty Day
• Similar to the system we discussed to start
• The child is taken to the potty at times during
the day when they are most likely to go
– First at school
– After lunch
– After nap
• The child is given a reward for going potty
Night Time
• When your child is successful during the day,
you may start night time training
• Take your child to the potty before going to
bed, then wake them once during the night
• Sit with them until they urinate (10 min only)
• If they wet just before waking, begin waking
them 30 minutes early and take them directly
to the potty
Last Minute Notes
• Potty training usually begins sometime after
18 months of age (when the child is ready)
• Potty training should begin by age 5
• When training, make sure all caregivers,
including school caregivers, are expecting the
same things from the child
• Do not flush while the child is sitting on the
toilet.
Reward Yourself
for Sticking to the Plan
(This is a difficult time for the trainer as well as
the trainee, so do not forget to give yourself
rewards at whatever interval you need)
References - Books
• Baker, Bruce and Alan Brightman. Steps to
Independence: Teaching Everyday Skills to
Children with Special Needs. 4th Ed.
Baltimore: Brookes Publishing, 2009. Print.
References - WEB
• Wilson, Mike. “Generic Habit-Training
Program.” BBB Autusm Support Network. Web.
www.bbbautism.com/pdf/article_9_generic_habit_training.pdf
• “Potty Training Your Child with Autism: Ready,
Set, Go!”. Autism Asperger’s Digest Magazine
2010. Web.
http://www.autismdigest.com/Portals/0/docs/ArticleToilet%20Training%20Ready%20Set%20Go.pdf
Joshua as a little guy
Joshua in his crib
Roar!
Joshua with his backpack
Joshua - Happy
Joshua Contemplating
Joshua’s Family
Joshua and his brother
Potty Training Chesca
Why we started
Someone told us we couldn't
Caught in the act.
When we started
Two years old
Sitting up
Starting to walk
Still non-verbal
How we started
Internet
Tools
Schedule
What we could have
done better
Consistency
Consistency
Consistency
Training pants
Tools
Potties
Videos
Charts
Potty Watch
Problems
Health problems
Working with school
Regression