The best strategies for potty training and toilet problems for kids with sensory issues, SPD, ADHD, and ASD. Help for refusing to go, withholding, frequent accidents and more!
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Was she losing her mind?
Surely potty training isn’t that complicated. All of her friend’s kids seemed to have no more than the usual amount of trouble getting their kids potty trained.
Her daughter was now 4 and had barely made any progress. Potty training her highly sensitive child seemed impossible. In fact, she seemed scared of trying, and cried even walking into the bathroom.
She couldn’t help but wonder if this was somehow related to her picky eating and strong dislike for getting messy…
And, it just might be.
How is picky eating, disliking getting messy, and having trouble potty training linked together?
The common denominator is sensory processing.
This is just one example of the many stories I’ve heard as an occupational therapist about potty training woes and toileting issues in kids, whether they are 4, 7, or 10 years old.
Kids can have trouble getting the hang of potty training for all sorts of reasons, but sensory processing is often overlooked.
Yet, it’s a factor for a lot of kids struggling to potty train and for kids that are trained but continue to have toileting issues.
Why Do Kids With Sensory Issues Have Trouble Potty Training?
The sensory system affects just about everything we do and that includes using the bathroom.
A child has to feel the sensation that they need to go to the bathroom (interoception), they need to be comfortable sitting on a toilet, know how to release their muscles, and experience the sensations of peeing or pooping, which may be painful or uncomfortable.
Sensory processing disorder and toilet issues often go hand in hand due to these complex sensations a child experiences when they use the bathroom.
If you already know that your child has sensory issues, Autism, SPD, or ADHD and your child is having difficulties with potty training, then it’s likely that those sensory needs are affecting their ability to learn to use the toilet instead of a diaper.
Sensory issues in general are often layered because they involve 8 different senses:
- Tactile (touch)
- Auditory (sound)
- Gustatory/Oral-Sensory (taste)
- Vision (seeing)
- Olfactory (smell)
- Vestibular (movement)
- Proprioception (body awareness)
- Interoception (sensations from internal organs)
Each of these senses can be linked to kids having difficulty with toileting. Your child could be refusing or unable to potty train due to sensory processing needs from one or more of these senses.
*If you’re not sure if your child has sensory needs, grab this 21 sensory red flags printable for a quick checklist of some of the common signs.
Child Toilet Problems – Already Potty Trained!
But what if your 5-year-old refuses to poop or use the bathroom? If he’s technically potty trained but still cries every time you enter a public restroom?
Or, how about a 7-year-old that pees a little bit in their underwear before realizing they need to go to the bathroom?
While this can be very concerning for parents, it’s common for kids with Sensory Processing Disorder or any sort of sensory issues to struggle with toilet awareness and toilet problems. Your child is not alone, unfortunately it’s often not openly discussed.
And, there’s a lot you can do to help improve your child’s sensory processing or provide some reasonable accommodations to help them with whatever toilet problems they may be facing.
But first, whether your child is struggling with learning how to potty train or they have existing challenges using the bathroom you have to learn…
Which Sensory Issues are the Cause of Difficulty Potty Training or Toilet Problems?
Let’s break it down a little further by each of the senses that affects toileting:
- Likes the wet feeling in diaper
- Can’t feel soiled clothing or that they had an accident
- Dislikes wiping
- Dislikes sensation of peeing/pooping while sitting on toilet
- Likes to feel/touch their feces
- Is scared of possibly getting hands messy while wiping
- Doesn’t notice when their diaper is wet
- Dislikes the cold or hard feeling of the toilet seat
- Dislikes feeling of underwear or other clothing on their skin, or removes all clothing to use toilet
- Continues to feel “wet” even after wiping
- Hates washing hands
- Dislikes sound of toilet flushing
- Dislikes sound of fan in the bathroom
- Dislikes sound of automatic hand dryers in public bathrooms
- Dislikes buzzing of lights
- Dislikes sound of urination or bowel movements the toilet
- Lights are too bright
- Distracted by possible bright colors, objects in the bathroom
- Difficulty discerning if done wiping
- Afraid of falling in, doesn’t feel steady, secure
- Difficulty sitting still because they want to be moving
- Feels like they’re going to fall off the side, doesn’t feel balanced
- Feels disoriented with reaching around self to wipe, leaning over to pull down or up pants
- Feels like toilet seat is too high off the ground
- Can’t tell where to wipe and may feel overwhelmed or confused
- Difficulty coordinating steps of wiping
- Difficulty coordinating steps of pulling down pants, sitting on toilet, or lifting lid and aiming
- Cannot climb up to seat using step stool
- Difficulty centering body over toilet seat comfortably
- Unable to “push” to go due to decreased coordination and muscle strength required
- Bothered by general smell of bathroom
- Bothered by smell of poop or pee
- Bothered by fragrances or cleaning supply smell
- Doesn’t notice the internal sensation that they need to use the bathroom
- Can’t tell if bladder or bowels are emptied, so may not fully void
- Cannot differentiate between need to urinate or have bowel movement
- Is sensitive to stomach upset or cramping, and associates negativity with toilet use
- Had a painful bowel movement or urination and now fears repeated pain
- Constipated from picky eating that results from sensitivity to eating/tasting different textures
As you look at the above list, consider which factors may be affecting your sensory kiddo. If you aren’t sure, ask them or begin to observe them more closely and when they seem to have difficulty. Then, check out the coordinating strategies below.
Strategies for Potty Training and Toilet Problems in Kids With Sensory Issues
As you begin to narrow down why your child is having a hard time potty training, choose some of the strategies below to help address those needs. Of course, the best way to address these sensory needs is by improving their sensory processing, whenever possible.
Learn more about how to do that in my free workshop: 3 Expert Secrets to Calm and Focus Kids with Sensory Activities, this absolutely applies to sensory related difficulties with potty training.
Strategies for Tactile Toileting Needs:
- Potty train naked (works well over a 3-5 day period where you shut it down and do nothing at home).
- Potty train in tight clothing to help them feel the wetness better.
- Begin by using timers and a schedule to create “toilet awareness” and provide ample opportunity for practice.
- Put a piece of toilet paper in the toilet to reduce risk of splashes.
- Use a warm baby wipe for wiping (gradually get used to toilet paper over time).
- Experiment with different toilet seats. A softer, padded seat, may be preferred by some kids.
- Play in sensory bins regularly to get used to different textures like toilet paper (this helps to improve the overall processing of the tactile system).
- Play in sensory bins regularly so they can don’t seek out touching feces.
- Use body brushing under the guidance of an OT (also may help with decreasing desire to touch feces).
- Allow child to wear disposable gloves if keeping hands clean is a major concern.
- Use a bidet if one’s available or consider installing one like this budget friendly attachment if your child hates the sensation of wiping.
As an OT, I have heard several instances of children, mainly young girls, who hate feeling wet so much that their parents have resorted to using a blow dryer to help their child feel dry.
This is obviously a more extreme reaction of the tactile system, but is not unheard of in sensory kids. The hands and genitals have a high number of sensory receptors, so it makes sense that many children have more sensitive responses to being wet.
Using natural fibers in underwear fabric to help decrease moisture retention, allowing time to air-dry when possible, and encouraging a long-term plan of tactile desensitization through sensory play, can all help a child who experiences this to better tolerate and move past this aversion.
However, it’s also important to make sure that your child is not experiencing true urine incontinence or dribbling.
If this is the case, they are not just perceiving wetness from their tactile senses, but are actually dealing with a more complex medical issue that can be professionally addressed through specialized care.
If your sensory child seems to be dealing with frequent urination or any of these issues listed, it is worth consulting your pediatrician to rule out a medical diagnosis.
Strategies for Auditory Toileting Needs:
- Tell your child to cover their ears when it’s time to flush or you flush after they’ve left the room, although they need to get used to this sound eventually.
- Play soft music or upbeat music depending on what’s motivating or relaxing for your child.
- Turn off fan and other noises if bothered by noise.
Strategies for Vision Toileting Needs:
- Be aware of sensitivities to overhead or noisy lights. Consider a night light only or some other soft lighting.
- Clear clutter and visual distractions from bathroom.
Strategies for Vestibular Toileting Needs:
- Use a toilet seat cushion with handles like this one if your child is afraid to sit on the toilet.
- Support their feet with a stool so their knees are bent and feet firmly planted on stool.
- Try a toddler toilet that’s close to the ground.
Strategies for Proprioceptive Toileting Needs:
- Create a visual schedule for the steps of toileting to put in the bathroom (or grab this one on Amazon here).
- Teach your child to stand and wipe, which may be easier for them to coordinate.
- Practice labeling body parts, including private parts for more accurate wiping.
- For boys, use colorful tape or stickers to label where to stand to pee.
- Use a rolled-up towel behind your child, to show them how far back they should sit on the toilet seat, increase awareness and provide a feeling of security.
- Practice clothing and fastener management frequently so your child knows how to pull down and up pants when it’s time to use the toilet.
Strategies for Smell Toileting Needs:
- Ventilate the bathroom as much as possible by opening a window/turning on fan.
- Use an essential oil diffuser in the bathroom or an air freshener before your child goes into the bathroom.
- Swipe an essential oil across your child’s wrist and encourage them to smell their wrist while toileting.
- Use neutral cleaning supplies as much as possible to decrease harsh chemical smells.
Strategies for Interoceptive Toileting Needs:
- Describe what it feels like to need to go to the bathroom, ask your child to start noticing when they feel that way.
- Tell your child when you need to go to the bathroom.
- Choose a time frame for your child to try and go to the bathroom on a consistent basis (every 2 hours, after eating/drinking, etc.).
- Have them flush poop down the toilet with you from their diaper so they can see they had a bowel movement and begin to make a connection to what their body is doing.
- Use visual reminders, timers, phone alarms or a vibrating watch as an indicator to go to the toilet.
Strategies for Oral-Sensory Toileting Needs:
- Use picky eating strategies to increase tolerance of textures and tastes. Get a boat load of ideas in our picky eating guide.
- Encourage your child to play with their food to help get them used to new foods and expand to vegetables and higher fiber foods.
- Encourage adequate hydration to keep stool soft and decrease need to strain or push too hard.
General Toileting Strategies that are Helpful for Kids with Sensory Issues:
- Pick a time frame when you’re really going to be focusing on potty training. Try to clear your schedule as much as possible so it can be your primary focus.
- Remind yourself that potty training takes time and that for kids with sensory needs it’s usually a process.
- Be consistent about regularly putting your child on the potty. Sensory kids need a lot of repetition and tend to do best with routine.
- Keep your attitude neutral and positive as much as possible. “Share your calm” with your child when they seem overwhelmed or anxious.
- Provide as many opportunities to practice and take small steps as possible. Do not try to address all issues at once.
- Provide a basket of toys, books, and activities to help distract and relax your child in the bathroom. Here are few of my favorite books or videos:
- Build in more opportunity for movement activities in day to day life for calming, including bouncing on therapy balls, wheelbarrow walks, doing push-ups against walls or things that the child can fiddle with. This is a long term strategy but benefits sensory kids in all areas!
What to Do When Your Child Refuses to Go to the Toilet?
For many children, sensory toileting problems go so far as to keep your child from wanting to use the toilet all together.
Whether it is fear, anxiety, or overwhelm from the sensory experience, some kids, even older children at 5 ,6,or 7 years old will withhold their urine or feces and refuse to use the toilet.
Child toilet problems (sometimes referred to as toilet refusal syndrome) can be very stressful for both parent and child. It can be easy to lose sight of the underlying sensory issue when wondering “Why does my child not want to go to the bathroom?”
It can also feel like the whole ordeal is mostly behavioral. You may be tempted to think, “is my child withholding poop or pooping their pants for attention?”
After all, as adults, this is such a natural and thoughtless part of our day to day routine.
The key to answering this question is to approach your child’s concerns with empathy and compassion.
Sensory needs are real for all people, and for sensory sensitive kids, sensory issues can make the sensations involved with using the toilet frustrating, scary, or even painful.
The likelihood of them engaging in extreme seeking or avoidance behavior intentionally is low.
Instead, try to view the toilet issues through a problem solving lens.
Help, My Child is Withholding Poop!
If your child is withholding poop, are they constipated? Did they have a painful bowel movement that caused them to fear having another one?
Can you take a step back and remove one stressful component at a time while addressing another?
For example, if tactile, vestibular, and proprioceptive sensations make it difficult for your child to use the bathroom then begin by tackling them one at a time. Use the list of strategies above to decide which you’ll try first to help them.
It can feel like this all has to happen at once, but these strategies are meant to be slow and steady and many of these are long term.
Toileting with Sensory Issues in Public
Keep in mind that any public restroom or Port-a-John has a ton of different sensations that may bring new challenges for your child. Your child may make great strides at home but need more time to get the hang of it in public.
Consider carrying sunglasses, an essential oil roll on, and noise cancelling headphones if lights, smells, or sounds are triggers.
Another trick is to bring a pack of sticky notes in your purse to cover the sensor on a public toilet to ensure it doesn’t flush before you’re ready.
If you have a van or SUV, you also may want to carry a portable kids potty in the back as an option too!
Get the Potty Training Toolkit for Sensory Needs
Because potty training can be such a beast we created a huge Potty Training Toolkit for kids with sensory needs, whether they are 2 or 8 years old, learning to potty train or still struggling to use the bathroom consistently in some sort of way.
It includes a visual schedule, a checklist to figure out all the sensory needs your child could be struggling with, a detailed guide, and a tracker. Check it out in our shop!
There’s A LOT of tips you might want to reference here again…
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More Help for Kids with Sensory Issues
Alisha Grogan is a licensed occupational therapist and founder of Your Kid’s Table. She has over 18 years experience with expertise in sensory processing and feeding development in babies, toddlers, and children. Alisha also has 3 boys of her own at home. Learn more about her here.