Ideas to Help Reduce Your Child’s Fear and Anxiety

About Using the Toilet

Judy Benz Duncan, Occupational Therapist

Toilet training can be difficult enough, but when your child is also afraid or becomes anxious when going into the bathroom and using the toilet, it makes the whole process even harder. Many people are happy to share their toilet training ideas and experience, however all children are different and sometimes it helps to have a list of different ideas and suggestions to try out.

The toilet can be a scary experience for any child, and for those children with sensory processing disorders the whole toilet training process can be overwhelming, and even painful. Being able to use the bathroom and toilet at home is one thing, but then moving toileting into the outside world of new, and often noisy, bathrooms in a store, restaurant, school, movie theatre, or friends home, typically turns a normal bodily function into a new nightmare.

A wide variety of ideas to try follow. Hopefully you will find several of the suggestions work for your child and help to ease the transition from diaper/ pull-up to using a toilet on a consistent basis.

Ideas for Reducing Toilet Anxiety and Fear

☐ Make your toilet kid-friendly by using toilet seat inserts, foot supports, lighting that is less glaring and bright

☐ To associate the toilet with the need to change and/or sensation of having to go to the bathroom, keep all items (pull-ups, wipes, powder, etc) in the bathroom so they get used to going in there.

☐ For any pull-up, clothing changes related to “accidents” complete in the bathroom – room may be tight, but the idea is to get your child used to going into the bathroom for any toileting related activities and clean-ups

☐ Move needed items down to your child’s level (soap, towels, wipes, toilet paper), using a step stool if needed

☐ Depending on your child’s sensory needs, use unscented soaps, soft towels, check temperature of water, dim the lighting, muffle toilet sounds with towels or padding, keep the ceiling fan off if it bothers them

☐ Make a visual card or booklet to show the bathroom, toilet, toilet paper, sink for washing hands, towels, and talk about the sequence of what will happen in the bathroom

☐ Having a more complex visual card of photo’s or drawings showing pants down, sitting on toilet, wiping, flushing, washing hands may help with understanding the bathroom process as a whole

☐ If the “flush” is a big sensory trigger for your child, leave that picture off of the visual cards so they will not be worrying about that before they even begin the process of sitting on the toilet

☐ If they cannot handle the sound of the “flush” don’t force it – praise their efforts at sitting on and going in the toilet

☐ Check out some Free to Print Toileting Picture Cards (this takes you off this site to another 3rd party website)

☐ Work on developing a toileting tracking chart to determine typical times that your child wets / has accidents throughout the week in order to determine their own toileting pattern

☐ Provide a toy to play with, sing a song with them, blow bubbles, and so on while they are sitting on the toilet to help distract and keep any anxiety levels down

☐ Build confidence and reduce anxiety about using the toilet by following a sequence:

o   Have your child start by sitting on the toilet with the lid closed with their clothes on – let them play with a favorite toy or hold items for you while you are “doing your thing” at the sink

o   Have them sit on the toilet sit (with the lid up) with their clothes on

o   Move on when they are ready to sit on the toilet without their clothes on, possibly after wash-up, or while changing their clothes

o   While they are sitting on the toilet ask them to go “pee” (or use the word you usually do) while they are sitting there. If they can sit for 3-5 minutes it may help relax them enough to allow even a small tinkle – praise any effort and success

o   Work toward developing a toileting schedule – before meals, after meals, before bedtime, on awakening – have them sit on the toilet during those times for no more than 5 minutes at a time

☐ If your child seems to only have a BM while wearing a diaper or pull-up you can try to determine what times they usually go, have them sit on the toilet with their pull-up on during those times

o   Before having them sit on the toilet with their pull-up on, tear out the back of the pull-up so that when they go (if they are fairly regular to following a certain time they go) they will “poop” into the toilet

o   Slowly increase the hole in the back of the pull-up so that finally they are just sitting holding a clean pull-up – this “backward chaining” idea can help with the transition to only using the pull-up for BM’s to using the toilet

☐ Encourage your child to jiggle the handle of the toilet and talk about that’s how you get the toilet to work

☐ Take off the tank lid to show them what’s inside the toilet tank and tell them that when you jiggle and push the handle down the water runs from the tank into the toilet and out of the house – if they can tolerate it, let them push the handle enough to feel the pressure and to see the reaction inside the tank – if they will, let them push enough to activate a full flush

☐ Put some food coloring (blue or green) into the tank with your child watching and let them, or have them help you flush the toilet to watch how the colored water comes out of the tank, into the toilet, and then down the drain

☐ Encourage your child to flush after using the toilet

☐ To reduce flush noise, you can close the lid, add some towels on top of closed lid, or you can sit on the closed toilet while your child flushes

☐ If they are not able to stay in the bathroom to flush, let them stand in the doorway and wait until the flush is done – give warning that you are going to flush in the event they are not able to tolerate the noise from flushing

☐ If you are able, let them see you sit on the toilet, flush, and wash hands – make it all a normal routine to see and understand

☐ Let your child help choose a themed toilet seat cover that they like and let them help you put the lid and/or tank cover on

☐ Hang a vinyl coated toilet “go” chart in the bathroom and let your child add their special sticker or star to the chart when they use the toilet

☐ Let everyone know what your routine is so that they all help to follow what you are working on, and how you are presenting everything to your child

☐ Try to take to the toilet at regular set times – whether they actually go or not – keep at it!

☐ Let and encourage your child to help pull down and pull up their pants or pull-ups – make them part of the whole process

☐ With dirty pull-ups, have your child help in the disposal – you can wrap up so they will not have to “get their hands dirty,” but let them toss the wrapped up pull-up in the garbage pail (or wherever you are putting them)

☐ Let your child help decorate the toilet and/or wall next to the toilet with vinyl easily removable stickers

☐ Help your child to put a new roll of toilet paper on the holder, hang new clean hand towels, check the soap level, wipe off the vanity after use, bring in a supply of pull-ups, etc.  – get them involved in the process even if they are not up to sitting on the toilet yet – you are getting them used to the bathroom, the materials they will be using and helping them participate in routine chores

☐ Keep certain toys and/or books to use and keep in the bathroom – associate their use with sitting on the toilet and using the bathroom; it takes some trial and error to find the toy or book that works the best for reducing anxiety and encouraging sitting time

☐ Try to keep the sequence, timing, directions, words used, the same each time to avoid confusion, misunderstanding, or sparking a reaction to the situation

☐ Discover if your child responds to praise for efforts and success, or if keeping the whole process structured and routine without any change in expected reaction works best for you and your child

☐ Moving from using the toilet at home to using a toilet somewhere else is a big step – go slowly, use the same or similar methods you have been using at home, try to start with less crowded and less noisy bathrooms, and carry a change of clothing and extra pull-ups for when “accidents” happen.

☐ Take a similar or the same toilet insert seat with you when you are out and about (maybe use a large bag to carry in – you already have a bunch of stuff to take, but having a seat they are used to will help tremendously when they are out in new and unfamiliar bathrooms)

☐ “Holding” their poop, or acting like they are in pain when going may be constipation or another situation – consult with your pediatrician for any issues that need to be addressed; pain and/or difficulty with the act of having a BM will make wanting to try going in the toilet even more difficult

☐ Toileting takes a long time to accomplish. Stick with it. Breathe! Praise efforts and treat accidents very matter-of-factly. If may be frustrating for you, however anger and punishments for accidents or disruptive toileting related behaviors will not make the situation any easier and can actually cause your child to regress or demonstrate even more behavioral issues.

☐ Good luck! You are not alone! All of us had to go through toilet training long long ago.

☐ Toilet training takes a long time – look for special moments you will remember and jokingly share with your child when they are all grown up!

This blog focused on reducing fear and anxiety about using the toilet.

There are many more areas to cover!

The series on Toilet Training 101 continues!

Stay tuned for more!

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