Personal Care for Young Children with Disabilities:
I. Toilet training
This is one of the big steps in personal care and the first most people want to attempt. No one enjoys changing diapers and it is even less fun when the child is five and the mess is bigger. Children with disabilities may become toilet trained later due to mental or physical disability. If the child is in an early childhood program, the the family will expect staff assistance in toilet training.
The very first step is to decide if the child is ready to be toilet trained. Obviously, the baby on the rug is not. You know that already, but how did you know?
If you're like most people, you thought about the fact that he obviously doesn't have the physical ability yet to walk to the bathroom. He doesn't have the mental ability yet to understand the idea of dressing and undressing himself. Trying to toilet train a child this young is just cruel. It will frustrate both you and the child.
What about a four-year-old with a disability? Is he ready to be toilet-trained? Here are some questions to ask yourself:
- Does the child have any interest in becoming toilet-trained? Often, children begin toilet-training around age two or three years. They want to be a 'big girl' and use the bathroom and wear 'big girl' pants. This does not describe most children with autism, who do not have much interest in social interaction and how others see them. It does not describe many children with mental retardation who may not understand these concepts.
- Does the child have a way to communicate with you that he or she needs to go to the bathroom? This doesn't have to be speech. It can be sign language, pointing toward the bathroom - anything that makes the child's needs clear.
Here are some tips on how to decide if a child with a disability is ready for toilet training. Four we'd like to emphasize are:
- Positive reinforcement - particularly with children with mental retardation, we have found the positive reinforcement method to work well. What is a reward is different for every child. We have used everything from stickers on a calendar to checking a child every twenty minutes and praising what a 'big, good girl' she was for not having wet her pants.
- Patience - if you are changing a smelly bowel movement in the pants of a child you asked two minutes ago if he needed to use the bathroom and he said, "No", it is easy to get angry and lose your temper. Just keep reminding yourself the child did not do it on purpose and take several deep breaths.
- Patience again - sometimes accidents happen and it is your fault. Unless you are perfect, there have probably been times when you are in a rush, you think, "I just got everyone in their snowsuits, he can wait two minutes," or "I just have three more napkins to put down for snack time and then I will take her to the bathroom." When a child says she has to go, take her now. This is even more important than usual when the child is learning to be toilet trained.
- Toilet training in less than a day - this is the name of a book by Azrin and Foxx, written over thirty years ago. Many people we know who work with both children with mental retardation and children without disabilities have used it. We have found that it works to toilet train children, but, regardless of disability, never, ever managed to do it in less than a day, despiet the name of the book. It usually took two to three weeks for children without disabilities and sometimes up to a few months for children with disabilities.
The site we used to recommend on toilet training is no longer available, however, we found a new site on toilet training children with special needs, by Claire Keeler, that is just as good.
