Though most children are toilet trained by the age of 4 it is still relatively common for school children to be still experiencing bed wetting at night. A few children will still be experiencing occasional daytime bladder control issues, particularly in the first year or two of school. One or two children may start school requiring daytime nappies (diapers) but it is unusual for this to persist unless there are other factors. These can include specific physical or medical reasons that contribute to bladder or bowel difficulties or it can be a result of other behavioural or psychological needs. For example, some children with Autistic Spectrum Disorder can have extreme anxieties and even phobias about toiletting. Children with Social Anxiety Disorder may also be fearful of using public and school toilets. However, many children, particularly girls, avoid school toilets unless totally desperate.
Strategies:
Encourage your child to sit on the toilet playing with fiddle toys or playing electronic games.
Make the toilet a friendly place by placing happy pictures of your child in there. They could also have a small picture of themselves doing a favourite activity which they can look at.
Keep a diary of when your child passes a motion to see if there is a pattern to this. If there is, predict when your child will next need to defecate and encourage them to be sat on the toilet at the appropriate time.
Establish whether your child has any sensory needs or anxieties about using the toilet. E.g. the noise of the flush; a fear of losing something down the toilet; the smells; the seat feeling cold or hard.
Get your child to draw a picture of their perfect toilet/bathroom. Encourage them to talk about the features they have put in and use questioning to establish the reasons for their choices.
Use a reward chart to encourage use of the toilet.
Give your child more responsibility for cleaning themselves up after using a nappy (diaper). It is important that the child learns to self-manage this unpleasant task. It then in turn makes using the toilet a more desirable option.
Avoid creating anxieties over touching faeces. Encourage hand washing after passing motions but try not to worry about accidental or purposeful contamination during cleaning process. Discuss each poo matter-of-factly.
Use of a portable toilet or potty may be an easier step for the child to accept in their transition from nappy (diaper).
