Going to the toilet is part of everyday life. It is important for our health and wellbeing.
Toilet Training
Toilet (potty) training is an important milestone in a child's life. Lots of children find learning this skill challenging. For children with additional support needs the journey might look different and may take longer. Many children with physical or learning disabilities can achieve a level of continence with the right support.
For toilet training typically developing children look at:
Toilet Training Children with Additional Support Needs
Many people wait for signs of readiness before starting toilet training. Don't wait for your child to show signs of readiness, as some children never will. Even if they don't show signs they may still be able to achieve a level of continence.
If your child has additional support needs look at:
It is important to be in the right position when we wee or poo. Toilets are designed for adults and children sometimes don't feel secure. Using a toilet step and a toilet insert can be helpful. There are lots available. Some children with physical disabilities might need other equipment to be able to successfully use the toilet. An occupational therapist will be able to provide advice.
Cleaning Ourselves After Using the Toilet
How we clean ourselves after using the toilet varies across cultures. Whatever the method, learning to clean yourself is a complex task that needs an adult to teach the child what to do. They will then need lots of practice before they master this skill. Some children may require additional support to adapt the environment or the activity to help them to be successful.
The following strategies talk about wiping with paper but can be adapted to teach different methods of cleaning ourselves after using the toilet. There are several ways to help your child learn to clean themselves. Choose what works best for you and your child.
Hand over Hand
You place the toilet paper in your child’s hand. Then you guide their hand to their bottom and wipe together. Some children do not like having their hand touched in this way. Only choose this method if it works for you and your child.
Take turns
Some children are reluctant to start trying a new skill. Encouraging them to take turns with you can help them adjust to this new step of being independent.
Backward Chaining
Backward chaining is where you do all the steps of bottom wiping but leave the last one for your child to complete. The steps of bottom wiping could be:
tear off paper
scrunch paper into a ball
reach behind body
wipe bottom 2-3 times
throw paper into toilet
Therefore, the step you want your child to do is to throw the paper into the toilet. Once your child can do step 5 every time, get them to do the last wipe and then throw the paper in the toilet. Keep going like this until they are doing all 5 steps.
Forward Chaining
Forward chaining is where you get your child do the first step and then you complete the rest of the task. You want your child to tear off the paper, then you do the rest of the steps. When they can do the first step every time get them to do step 1 and 2. Therefore, your child would tear off the paper and scrunch it up and you would do the rest. Keep going until they are doing all the steps.
Adapt the steps
Remember that sometimes what works for you might not work for your child. You can adapt the steps of the task if your child is finding one step difficult. For example, scrunching the paper into a ball might not work, so have your child try folding the paper instead or wrapping the paper around their fingers. Some children will need more specific instructions like tear off 2 squares of toilet paper. Some will need you to remind them to repeat the steps until the paper is clean. Some children might find using a cloth to wash easier. Some children might prefer a visual task list easier than verbal instructions.
Hand Washing
Hand washing is a essential skill for children and young people of all ages.
The National Infection Prevention and Control Manual has a number of ideas and materials for you and your child to use to help with hand washing. The Children's Pack is full of materials and ideas to encourage children to make hand washing part of their everyday routines.
This cartoon animation helps to explain why, when and how hands should be washed.
The Health Hub has created an animation with the 'Washy Washy Clean' song to help young children wash their hands.
Bedwetting is common and can have a number of causes. Nocturnal enuresis is a term used for children and young people 5-19 years with bedwetting. Guidance indicates treatment options should be made available for children from 5 years of age. (NICE 2010) If your child is over 5 and you are worried about bedwetting please contact your GP.
Bedwetting under Bladder Information in the Information Library from Bowel and Bladder UK
Children Who Only Poo in a Nappy
Lots of children go through a phase, usually soon after potty training has begun, when they refuse to poo in the potty or toilet and insist on using a nappy. Some children will work it out for themselves, but without intervention some would happily poo in a nappy for years. Look at Children who will only poo in a nappy and other toilet avoiders from ERIC for a ideas about how to help your child to move on.
Constipation
Constipation can affect 1 in 3 children (ERIC). Some children can be constipated even though they regularly poo. Constipation is often the underlying cause of many common toileting challenges, including wetting accidents, soiling, withholding and smearing. If you are worried about constipation speak to your GP.
For information and advice on managing constipation look at:
Daytime wetting under Bladder Information in the Information Library from Bowel and Bladder UK
Poo and Wee Withholding
Poo (stool) withholding is common when children are potty training. It can also affect children who have additional support needs. Poo withholding is when people avoid passing a poo. Look at Stool withholding: why & how to stop a child holding poo from ERIC for advice about how to help. Holding on to wee is something that children can get into the habit of doing. It is not as common as poo withholding. Look at Wee withholding from ERIC for more information to help them stop avoiding the toilet.
Sensory Issues with Toileting
Many children find the sensory experiences of going to the toilet challenging. We can change the environment to make going to the toilet easier. Understanding your child's sensory preferences can help you work out what might be causing problems. You can complete the questionnaires on the I'm Concerned About Sensory Processing page to help you work out your child's preferences. For more information look at Sensory needs and toileting from ERIC.
Smearing
The term smearing is used to describe children spreading poo on walls, furniture, themselves…anywhere apart from the toilet/potty or pants/nappy.
Some children who are learning to clean themselves after using the toilet might get poo on their hands. They might then wipe the poo off on the wall, their clothes or somewhere else. If this is the situation then look at the cleaning ourselves after using the toilet section.
For more advice and support on managing smearing look at:
Understanding why some children smear poo in Other Bowel Issues under Bowel Information in the Information Library from Bowel and Bladder UK
Toilet Anxiety
Many people, of all ages, find toilets unpleasant and sometimes worrying. It is particularly common in children and can impact on their bowel and bladder control and function. Look at Toilet anxiety and toilet phobia in children from ERIC for advice.
Toilet Issues in Schools
Lots of children and young people find going to the toilet in school challenging. For information about how to work with schools to support children and young people using the toilet look at:
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KIDS Content Group, SCS Clinical Governance Executive Group
Reviewer name(s):
KIDS Content Group.
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You place the toilet paper in your child’s hand. Then you guide their hand to their bottom and wipe together. Some children do not like having their hand touched in this way. Only choose this method if it works for you and your child.
If you are out and about 
