Po#yTime:AJourneytoSuccessfulToiletTraining

LinaPatel,Psy.D.SieCenterforDownSyndromeChildren’sHospitalColoradoUniversityofColoradoSchoolofMedicine

FinancialDisclosure

Objec=ves

v ReadinessandChallengestoReadinessforChildrenwithDownsyndrome

v StepstoGetStartedwithToiletTraining

v Troubleshoo=ngAreasofChallengeforChildrenwithDownsyndrome

Necessi=esofToiletTraining(BabyCenter)

Medical/Physical

•  Iscoordinatedenoughtowalk,andevenrun,steadily.

• Urinatesafairamountatone=me.

• Hasregular,well-formedbowelmovementsatrela=velypredictable=mes.

• Has"dry"periodsofatleasttwohoursorduringnaps,whichshowsthathisbladdermusclesaredevelopedenoughtoholdurine

Behavioral

• Cansitdownquietlyinoneposi=onfortwotofiveminutes.

• Canpullhispantsupanddown.

• Dislikesthefeelingofwearingawetordirtydiaper.

• Showsinterestinothers'bathroomhabits(wantstowatchyougotothebathroomorwearunderwear).

• Givesaphysicalorverbalsignwhenhe'shavingabowelmovementsuchasgrun=ng,squaXng,ortellingyou.

• Demonstratesadesireforindependence.

• Takesprideinhisaccomplishments.

•  Isn'tresistanttolearningtousethetoilet.

•  Isinagenerallycoopera=vestage,notanega=veorcontraryone.

Cogni=ve

• Understandsthephysicalsignalsthatmeanhehastogoandcantellyoubeforeithappensorevenholditun=lhehas=metogettothepo#y.

• Canfollowsimpleinstruc=ons,suchas"gogetthetoy."

• UnderstandsthevalueofpuXngthingswheretheybelong.

• Haswordsforurineandstool.

ChallengesinDownSyndromeMedical/Physical

• Delaysinmotorcontrol.

• Lowtone.

• Cons=pa=on(Ano-Rectalmalforma=ons,includingHirschsprung’sDisease).

• ChronicGIissues(Celiac,dietrelateddifferences).

• Differencesinstaturemaycausechallengeswithreachingtoiletseatandcleaningup.

• Finemotorchallenges.

Behavioral

• Delaysinimpulsecontrolanda#en=onspan.

• Mo=va=onandlackofconcernwithsoiledorwetdiaper.

• Demonstratesadesireforindependencebutrelatedtoowninterests.

• Willfulness.

• Breakinganoldrou=ne.

• Familyreadinessrelatedtopriori=za=on.

• Anxiety.

• Sensoryissues.

Cogni=ve

• Communica=onchallengeswithleXngsomeoneknowthattheyneedtogo.

• Lackofunderstandingaboutwhytoile=nginthepo#yisimportant.

• Generaliza=onofskills.

ToiletTraining

Communica=on

Mo=va=on

Cons=pa=on

Step1:

Trackwhenpantsarewet,dry,orsoiledat15minuteintervalsforthreeconsecu=vedays.

DAY1 DAY2 DAY35:00am 5:15am 5:30am 5:45am 6:00am 6:15am 6:30am 6:45am 7:00am 7:15am 7:30am 7:45am 8:00am 8:15am 8:30am 8:45am 9:00am 9:15am 9:30am 9:45am 10:00am 10:15am 10:30am 10:45am 11:00am 11:15am 11:30am 11:45am 12:00pm 12:15pm 12:30pm 12:45pm 1:00pm 1:15pm 1:30pm 1:45pm 2:00pm 2:15pm 2:30pm 2:45pm 3:00pm 3:15pm 3:30pm 3:45pm 4:00pm 4:15pm 4:30pm 4:45pm

KEY W=Wet P=Poop D=Dry

Step2:Createascheduleforwhentotakeyourchildtothebathroombasedondatacollected.Timeintervalsshouldbejustshortof=meintervalsdeterminedonthetrackingsheetforwhenyourchildiswetorsoiled.Naturaltransi=onsworkbest!

Step3:Pickathreetofourweek=mespanwhenyoudon’thavemajoreventsorvaca=onsplanned.Thatwayyoucancommittotheintensityoftheprogram.Rememberthatthis=meframemayvarydependingonyourchild’sownpersonalitystyle.

Step4:Iden=fychild,family,andsystemstrengths

Step5:

An=cipatechallengesandsetupforsuccess!!!!

Troubleshoo=ngMedical/Physical

•  Addresscons=pa=on•  TalktoyourPCP.•  Cleanoutifnecessary.•  Proac=vestrategiesforremainingcons=pa=onfree.

Troubleshoo=ngMedical/Physical

•  Addressphysicalchallenges•  Legsshouldcomfortablyrestonastoolwithknees

abovehips.•  Clothingshouldbeeasytopulloffandon.•  Whichevertypeofseatyouuseshouldprovide

confidenceinstability.•  Flushablewipesmaybemorehelpfulthanusingtoilet

paper.

Troubleshoo=ngMedical/Physical

Troubleshoo=ngBehavior•  Addressimpulsecontrolanda#en=onspan

•  Useavisual=mertoindicatehowlongachildhastosit.Startwithaverysmallamountof=meandgraduallyincrease.

•  Placetoiletpaperandotherdistractorsoutofreachorremove.

•  U=lizeamo=va=ngtoyorbookthatyourchildonlygetstohavewhentheyaregoingpo#y.Choicesworkevenbe#er!

Troubleshoo=ngBehavior•  Addressmo=va=on

•  Usea“first-then”direc=vetohaveyourchildearnarewardforfirstsiXngonthetoilet,thenproducingsomething,andeventuallyaskingtogo.The“reward”mustbesomethingthatcannotbeearnedanyother=me.

•  Ifachildisalreadyplaying,placeyourhandonthetoyandsay“firstpo#y,thencomebacktoplay.

•  Useavisualroadmap.

Troubleshoo=ngBehavior•  Addressoldrou=ne

•  Useavisualscheduletoestablishanewrou=neofwhentogo.

•  Keep=mesfortoile=ngthesame.•  Teachhowtouseapo#ywatch.•  Breakanoldrou=newithgradualchange.•  Giveminimala#en=onduringcleanuprou=ne.•  Asdevelopmentallyappropriate,havethechild

par=cipateincleanup.

Troubleshoo=ngBehavior

•  Addressparentalreadiness•  Askyourself,“WhyamIdoingthisnow?”•  DoIhavethe=metogivethismyfulla#en=on?•  Generally,howdoIapproachteachingnewskillsto

mychild?DoIgetnervousevenbeforestar=ng?•  HowwillIhandleobstaclesalongtheway?

Troubleshoo=ngBehavior•  Addressanxiety

•  Keepthingsinapredictablerou=ne.•  Usethesamelanguageeach=me.•  Don’tpushyourchildtodoasteptheyarenotready

for.•  Givechoices.Controlistheunderlyingfunc=onof

anxiety.•  Slowandsteadywinstherace!

Troubleshoo=ngBehavior•  Addresssensoryissues

•  Keepbathroomquiet.•  Avoidtoiletsthatautoma=callyflush.As=ckynote

worksgreatifyouareinapickle.•  Forhometoilets,youmayneedtogetadifferent

toiletseat.•  Wipescanbeagoodorabadthing.•  Avoidusingpotpourriorairfreshenerswithstrong

smells.

Troubleshoo=ngCogni=ve

•  Addresscommunica=on•  Useavisualschedule.Photosarebest.•  Whenyousayit’s=meforthepo#y,signpo#ytohelp

createanassocia=on.•  Startusing“first-then”direc=vesingeneral.

Troubleshoo=ngCogni=ve•  Addresscomprehension

•  Socialstory

________’sStoryAboutStayingDryatNight

•  Mynameis________andIamabigkid!•  Icandothingsthatbigkidsdo!•  NowthatIambig,Iamlearningtowearbigkidunderwearevenatnight!•  Onlybigkidsgettowearbigkidunderwearalldayandallnight!•  Everyday,Igotosleepinmybed.Some=meswhenIamasleep,Iwanttogopee-pee.•  Theruleis:WhenI’masleepandwanttogopee-pee,Iwakeup.•  ItakeofthehoseformybreathingmachineandIgotothebathroom.Ipeepeeinthebathroomonly.•  Then,Igobacktomybed,putthehosebackonmybreathingmachineandsleepagain.•  Inthemorning,myunderwearisdry.•  WhenIstaydry,daddywillwalkmetothebusalerIgetready.•  Iamabiggirlnow.Istaydry.MommyanddaddyfeelsoproudwhenIwearmybigkidunderwear!•  Ifeelsoproudtoo!

Troubleshoo=ngCogni=ve

•  Addressgeneraliza=on•  UsesimilartoolsinallseXngs.•  Helpothersunderstandtheimportanceofrou=ne.•  Usethesamelanguage.

Step6:

Tryitout!

QuickTips

ü  Haveyourchildsitfor2to4minutesü  IfyourchildcannottoleratesiXngthatlong,start

outwithsmallerincrementsof=meandbuildupü  Rewardshouldbegivenalertoile=ngsoasnotto

createadistrac=on.Toiletisonlyforgoingpo#y!ü  Ifyourchildhasanaccident,minimizeeye

contact,talking,andfacialexpressionsduringcleanup.

ü  Haveyourchildpar=cipateincleanupwhendevelopmentallyappropriate.

ü  Slowandsteadywinstherace!

FrequentlyAskedQues=ons….•  ShouldIonlyworryabouttoilettrainingwhenall

ofthereadinessskillsareinplaceandthechallengeshaveresolved?

•  ShouldIputmychildinunderwear?•  Howlongisthisgoingtotake?•  WhatdoIdoifmychildischronically

cons=pated?•  Shouldtherewardbeduringoralertoile=ng?•  Whatifmychildrefuses?•  HowdoIcreateconsistencyacrossseXngs?

NameYourChallenge

Thankyou!!!!!!

LinaPatel,Psy.D.AssistantProfessor

SieCenterforDownSyndromeChildren’sHospitalColorado

UniversityofColoradoHealthScienceCenter