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Toilet Training in Down Syndrome - November, 2009

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Toilet Training in Down Syndrome

All material Copyright © 2009 National Down Syndrome Society
Reprinted with the express permission of the National Down Syndrome Society as originally published on their Website.

By: Karen Summar, MD

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NB: This article was originally written for parents but contains excellent information for therapists and so we reprint it here.


Step 1: Determining Your Child’s Readiness

Many parents are eager to start a toilet training program for their children. However, for some children their parents may be ready to start before their children are ready. Starting before your child displays the necessary readiness signs will most likely increase the amount of time it takes for your child to learn this skill as well as decrease the amount of success your child experiences. Starting too early can also lead to other problems, such as an increase in undesirable behaviors related to toilet and high frustration levels in the parent. To ease the toilet training process and ensure that toilet training is a positive experience for everyone involved, it is recommended that parent’s assess their child’s toilet readiness skills. This is described below:
  1. Age: This factor should not be the only one considered when deciding to start a toilet training program. However, it is recommended to wait until after the second birthday to begin considering toilet training. For children with Down syndrome, it has been found beneficial to wait until after the third birthday to begin the process.
  2. Bladder control: Your child completely empties her bladder when voiding and remains dry for at least one and one half hours during the day.
  3. Predictable stooling patterns: Your child’s bowel movements follow a regular and predictable pattern.
  4. Motor skills: Your child demonstrates the abilities to walk to and from the bathroom independently and to pick up objects,
  5. Behavior: Your child can sit on the toilet (or potty chair) comfortably for two to five minutes. You may allow your child to look at preferred books or play with preferred toys while sitting on the toilet.
  6. Instructional readiness: Your child can follow a few simple directions (i.e. sit down).
  7. Indicates needs: Through facial expressions, posturing, gestures, pictures, or words your child indicates the need to go to the bathroom.


Step 2: Determining Your Readiness

Before starting a toilet training program, parents also need to be ready to dedicate time and effort so as to implement an effective program. If your child displays the necessary readiness signs, but your schedule does not allow you the amount of time needed to take your child to the bathroom on a consistent schedule every day, you may want to consider waiting to start until your schedule allows time.

Attached is a form to help you assess your child’s bladder control, ability to demonstrate a need to go, and voiding pattern. Every thirty to sixty minutes, check your child’s diaper. Place a checkmark in each corresponding time slot that your child indicated a need to go. Keep the data for two weeks. If, at the completion of two weeks, the chart shows that your child consistently remained dry for at least one and one half hours, consistently indicated a need to go, and displays a voiding pattern, then your child may be ready for toilet training. If after 2 weeks, the data show that your child does not display the necessary skills, you can decide to continue taking data or to stop and restart at a later date.

[Image: table.jpg]

Step 3: Get set, go!
  1. Your days should look like this: Wake up, take off wet diaper, go to the bathroom. Put on big boy underwear or big girl panties.
  2. Go to the bathroom when you anticipate need to urinate or to stool. (Refer to your Toilet Training Readiness Data Sheet).
  3. Make it fun! Allow your child to read a favorite book or play with a favorite toy
    while sitting on the toilet.
  4. Use a visual schedule to reinforce verbal directions to child.
  5. Use a reinforcer.
  6. Change your reinforcer’s from time to time.

[Image: potty1.jpg]
[Image: potty1.jpg]


Featured Organization: National Down Syndrome Society

We thank the National Down Syndrome Society for allowing us to reprint their copyrighted article. The mission of the National Down Syndrome Society is to be the national advocate for the value, acceptance and inclusion of people with Down syndrome.

The National Down Syndrome Society envisions a world in which all people with Down syndrome have the opportunity to enhance their quality of life, realize their life aspirations, and become valued members of welcoming communities. For more information about this organization please visit National Down Syndrome Society

Tags: November 2009 Newsletter OT School Based Psychology Down Syndrome Article