With Amanda Carmody
Amanda Carmody is a registered nurse, child and family health nurse, midwife and paediatric continence nurse. She is based in Queensland, and she uses attachment-based strategies to help families and children with both sleep and continence issues. These strategies put attachment and connection between parents and children as a top priority when making any change.
Amanda states that children will typically toilet train themselves with a little help and encouragement, so if toilet training is delayed, not progressing or the child is struggling; getting professional help sooner rather than 'waiting and seeing' is always better.
Children are never incontinent on purpose; it is not laziness nor bad behaviour. Children want to fit into their community and they want to feel normal, so when things go wrong, they feel different and it can affect their self-esteem.
It can alter parents’ self-esteem as well. Parents will often compare themselves to others. When their child is not achieving toileting skills they may feel ashamed. Amanda’s role is to help parents understand what’s going on in their child's body, normalise the frustration they feel, and explain that there are strategies and support available. “I'm trying to build up both the parents and the child’s self-esteem. There has been no failure, this is a problem that we need to get on top of.”
Attachment refers to the emotional bond between a child and their parent, this is crucial for healthy development. When the attachment is secure, children feel safe and supported, and are likely to cooperate. This is why working with attachment strategies is important in addressing incontinence in children. When families understand any underlying medical reasons and obtain a treatment plan, they can then support their child to take actions that will address the incontinence, with open communication, understanding and empathy.
These new habits are often about helping the child to strengthen their mind-body connection. For some of the children Amanda works with, this can pose extra challenges.
Children with neurodiverse conditions such as Autism Spectrum Disorder (ASD) or Attention Deficit Hyperactivity Disorder (ADHD) will have sensory difficulties along with planning and cognitive issues. To successfully get to the toilet when they need to, a child needs sensory skills (a strong mind-body connection) and planning skills (an ability to think and plan ahead).
Learning how the body works can help. Amanda uses lots of visual aids to help families, including pictures and even playdough, to make models and to demonstrate how our parts move. The more families understand the easier therapy becomes. Parents and children can then problem solve together and the child gains more control over their own body. “Once you explain to parents how systems interact and work they can then understand and follow through with therapy. If they don't understand why they are doing things or where you are going with therapy, they may stop it, just when things are about to improve.”
Amanda explains to parents how the body can miscue the child, and how that can be changed so that the child’s brain, body and nervous system all start to work together. Amanda recommends always seeing a healthcare professional with relevant qualifications and/or experience, that you feel comfortable with and who has a positive approach that nurtures family relationships. “When things go wrong, or toilet training is delayed, my tip is to ask for help sooner than later.”
Incontinence in children is not a failure, it is a common condition that can be treated. Any underlying medical cause should always be identified and treated first. The bonds between family members can be strengthened and the family’s connection can be repaired. In almost all cases, with the right professional help, your child can have a successful toilet training journey.
Pull-out information:
What is attachment theory?
Attachment theory is a body of thought about the relationships and bonds between people, especially those between a parent and child. Caregivers who are responsive and nurturing to a child allow the child to develop a sense of security. This is relevant to toilet training because that trust and security can help a lot when you’re trying to achieve something new.
Getting emotional support
Remember it is completely normal for parents to experience negative feelings, just as it is for children. Children usually express their feelings as behaviours, but as an adult you have a few more options.
Some helpful strategies:
- Talk to someone. Call a friend or call the Foundation’s National Continence Helpline for free and confidential advice on 1800 33 00 66
- If you are very stressed in the moment, put your child in a safe place and leave the room, go outside or to a window and breathe deeply
- Connect with other parents who you can share your tips, concerns and successes with
Learn about child development so you know what to expect. To find reliable resources, look for websites that are published by government health organisations, peak bodies or hospitals. Your local library can be a great place to find books on child development and your maternal and child health service may also offer resources or recommendations.
Neurodiversity and toilet training
All children can experience extra challenges with toilet training, but some of these challenges are more commonly experienced by neurodiverse children (children with ASD and children with ADHD).
Neurodiverse children may attain toilet training independence a bit later than their peers. Even though they may take a little longer, it might be reassuring to know that most children can be toilet trained eventually and that the positive reinforcement and the help with forming habits that are suggested for neurotypical children will also assist children with ASD and/or ADHD.
Two skills a child needs for toileting independence:
1. A reliable mind-body connection. The first skill that’s needed for independent toileting is an awareness of what is happening in your body and the ability to respond to these feelings. Children with ASD often experience nervous system overload, making it harder for them to be aware of feelings in their body.
2. Planning skills. These are the skills to independently plan a trip to the potty or toilet in response to the body feelings. Neurodiverse children might need some extra help to plan ahead to ensure they get to the toilet in time.