“The sooner the better,” Debbie Atkins, occupational therapist at Toilet Time, tells Bridge Magazine.
There are so many aspects of going to the toilet that can affect young children's lives, and acknowledging there may be a problem early is important. If you struggle to go from nappies to undies, notice a change in your child’s toilet habits, such as an increase or decrease in going to the toilet, a regression in skill development, or expressed fearfulness or refusal to go to the toilet, it might be time to seek help.
Be mindful of information you read on social media and online, and instead try to get help from reputable sources such as Raising Children Network, Continence Health Australia website, or the Continence Foundation helpline (1800 33 00 66 8am-8pm AEST Mon-Fri).
Myth busting
“What works for one child is different for another,” Debbie tells Bridge, “If you see something on social media saying it will solve your child’s toilet training in two days or two weeks and it doesn’t work, it doesn't mean you've done anything wrong at all. Firstly, you have to be very careful about which information you read. And secondly, remember that we all learn differently. We all experience change differently, and it is more helpful to recognise and adjust to your child's individual learning needs.”
Be aware that accurate and appropriate information can change over time. The toilet teaching methods that may have worked for your neighbour or mother-in-law may not be suitable for your child, or in line with current health advice. So try not to get disheartened by comments from other parents or family members about your child’s individual toileting journey.
One of the biggest myths especially around nighttime toileting is that you should restrict fluids before bedtime. This advice can be problematic for many reasons. Having concentrated urine (that can occur with a lower fluid intake) is a bladder irritant and may actually contribute to more frequent urination. Plus, if your child doesn't remember to drink much at school during the day, they may become dehydrated, and this can contribute to constipation.
What to do if you suspect your child might have a bladder or bowel problem
Observe and monitor your child’s toileting patterns and find out what is normal for them. A bladder and/or bowel record chart/diary can be a helpful starting point.
You can also look at the bathroom/toilet environment, which can especially impact children's ability and willingness to sit on the toilet long enough to do a wee or a poo.
“Along with the capacity to learn a new routine, there are two key components that contribute to successful toileting: Development of sensory awareness and motor control."
Where can I seek help for my child's incontinence?
“Your medical practitioner (GP) is always an important first contact as underlying bladder or bowel dysfunction is one of the primary reasons for toileting difficulties,” Debbie tells Bridge. “Your GP can then refer you to paediatric allied health clinicians with a range of skills to support children and their families, including a continence nurse, physiotherapist, psychologist, dietician, developmental educator and an occupational therapist.”
“After ruling out underlying medical conditions, most toileting issues are greatly influenced by a healthy diet and daily fluid intake."
"There can be a range of additional factors that impact on a child's confidence and capacity with learning toileting skills and an occupational therapist is a great addition to your child’s care team.”
Being referred to an Occupational Therapist
The role of a paediatric occupational therapist is to support development of a child's capacity to participate in a toileting routine independently across home, school, and community settings. An appointment with an occupational therapist can be in a clinic, online via Telehealth, or in your home. The occupational therapist can help to assess your child’s developmental skills alongside consideration of the toilet environment and daily routines (both inside and outside the home). This assessment then contributes to a collaboration to find strategies that support your child’s learning within functional daily routines.
OTs often consider:
- Postural control needed to sustain a sitting position on the toilet
- Difficulties with awareness of the bladder or bowel sensations (this is often called interoception)
- Coordinated motor control of pelvic floor muscles
- Sensory issues/ regulation (emotional comfort within the bathroom environment, including sounds, smells, or textures that may cause distress)
- Attention span/distractibility
- Skill building
- The child's understanding of the behavioural expectations as they change from nappies to a toilet routine
- Collaboration with families and other education and care providers to ensure a consistent approach to developing a routine
So, when should I ask for help with my child’s toileting?
“Always seek early advice. Any issues with incontinence in childhood should be dealt with straight away. Difficulties with toileting can commonly become a long-term problem for the child with associated long-term health, emotional and social impacts.
However, early advice with medical, allied health and developmental strategies can often result in quick improvements and better long-term outcomes."
If your child experiences regular wetting, soiling and/ or chronic nighttime wetting then please get in touch with the free National Continence Helpline 1800 33 00 66 8am-8pm AEST Mon-Fri or contact your GP for guidance and referral to a specialist.
Read more from Bridge: https://issuu.com/continence.org.au