Potty training can be a stressful time for both kids and adults, but I truly believe that it doesn't have to be stressful. Mainly because we as parents have the ability to reframe our expectations and ease that stras. Below we'll go through a list of ways you can support your little one. BUT it's important to remember that each child is unique so it's important to take your child's lead, listen to their input, notice their cues and trust YOUR gut while potty training. If something feels off or doesn't feel right, you have every right to stop and try something new or wait a little longer to try again.
Please remember that just because your child is autistic, ADHD, a sensory kid, etc., it does not mean they will struggle with potty training. Some kids catch on quickly and potty training is easy for them. If you've potty trained one neurodivergent, you've potty trained ONE neurodivergent child. 😉 With that, some things might work great for your kiddo and others might be a total bust…that's okay! It doesn't mean you're doing it wrong, it simply means it doesn't work for them right now.
Potty Training vs Potty Learning
Okay, so this isn't technically a way to support your child as much as a reframe for you. Historically speaking, potty training has taken on a bit of authoritarian style practice where the parents or caregivers make a child pee on the toilet at specific times and the child is either rewarded or punished. If you're reading this blog,you've probably found that those star charts and m&m bribes didn't work for your little one. I believe potty training should be so much more than that. Potty Learning is about teaching your child about bodily autonomy, listening to their body's signals and recognizing what their body's signals/cues are asking and what steps to take next.
The Basics of Potty Readiness
When we look to potty train, there are five basic things to look for in your kid being ready. This is a baseline for readiness and doesn't encompass all aspects of potty training.
Child is dry for 2 hours
They don't like or show signs of being uncomfortable when wet or dirty
They show they need to go to the bathroom
They can dress/undress themselves
They show an interest in using the toilet
They notice when they are wet/dirty
They tell you (verbally, signing, pointing to the potty) when they need to go
They are willing to interrupt other activities to use the restroom
Why Can't My Child Just Pee and Poop on the Toilet?
You've probably asked this question a handful of times. And the answer is…it's complex. I like to see potty training as a developmental milestone. Potty training is rarely behavioral and almost always developmental. It requires a lot of earlier milestones to be reached in order for it to be successful. First, your child needs the physical capacity to sit on a toilet and support themselves upright and reach their hand to wipe which requires the coordination of a lot of muscles and 50% of ND kiddos have low tone which can make toileting posture harder. They need interoception to feel when pee or poop are coming and many ND kiddos are either over-responders (they feel more discomfort with the sensations), under- responders (they have a harder time feeling the urge to pee or poop) or they have trouble discriminating sensations (stomach pains, headaches or being thirsty may actually be signs they need to use the restroom). Kids also need to being emotionally ready and not afraid of all aspects of using the restroom from sitting on the toilet to flushing and washing of hands. Finally, they need brain development and nervous system regulation for the body to develop a micturition reflex between the brain and the bladder and the rest of the urinary system. This feedback loop is something developed over time and cannot be taught or rushed.
As simple as going to the restroom seems to us because we've been doing it for years, potty training is complex!
Setting Realistic Expectations and Timelines for Potty Training
Some kids are ready to potty train as early as 18 months while others aren't ready until 3 or 4. All of these are a range of NORMAL. If your child is 3 or 4 and not potty trained YET, it does not mean you or your child are failures. In fact, many kids are not developmentally ready until 4 and society just has unrealistic and unhealthy expectations for our kids. Unfortunately, in the US a lot of daycare require kids to be potty trained before they are developmentally ready. If this is the case, you may want to see if there are other options for childcare or education that will support your child where they are at now. I know that isn't always possible, so please know that whatever you choose is the best choice given your current situation and you're doing a great job.
Along with being 3-4 years old, it's important to note that we don't want to try and night train (or nap train) at the same time we potty train. Going back to brain development, it commonly takes an additional 10 months to night train after a child has been fully potty trained during the day.
Did you notice I capitalized the word “yet” up there? That's because it's pretty darn important. Oftentimes parents end up frustrated that their child won't use the restroom or potty train but really they can't do it yet. There's an amazing psychologist and author, Ross Greene, who says that kids do well when they can. Potty training before they are ready is like asking them to add and subtract numbers without ever teaching them how to count…we have accidentally set them up for failure because they aren't ready YET. But with time, refraining our mindsets and outlooks, deep diving into their needs, stressors and lagging skills, we can help them. I can't promise your child will be potty trained in three days, but I can promise they can learn while understanding bodily autonomy and getting better awareness of themselves…and that takes time.
“Setbacks” and “accidents" are a natural part of potty training neurodivergent kids. One common concern is that one day a kid might do great and the next they struggle to go on the toilet once. Neuroscientist Lisa Feldman Barrett explains this well with her “Body Budgets” concept. I first learned this in Mona Delahooke's book, “Brain Body Parenting” and it just made sense to potty training. One day a kid can do great and have no accidents, but the next day they have three or four seemingly out of nowhere. But that nowhere is actually because they are tired, hungry, thirsty, getting sick, sick or getting over an illness, getting too much or too little sensory input, constipated, or even going through a growth spurt!
Regulation Before Expectation…Taking the Stress Response out of Potty training
Have you ever been told to sit your kiddo on the toilet every 30 minutes to try and get them to pee? I'm not going to lie, thinking about doing that increases my stress response as the caretaker and it's just as stressful, if not more, for our kids. Our goal is to decrease the stress response while helping our kids understand their body's signals so they can learn how to use the potty. Removing strict timed voids can help decrease the demand and stress of potty training.
Along with decreasing demand, it’s important that our language matches our goal. Our goal with potty training is to help our children feel supported and better understand their body’s signals so they are able tonuse the restroom. Oftentimes people will say things like “only babies wear diapers” or “don’t you want to be a big girl/boy?” While the goal of potty training is the same, that comes comes shame and heartache and frustration for our kids. The Occuplaytional Therapist did an amazing post on just this and is a beautiful reminder that changing parental expectations may be the best support you can provide your child. https://www.facebook.com/share/p/W92uKj6tpGsX1PQS/?mibextid=oFDknk
Kids need to be emotionally ready for potty training before trying and that starts with understanding what goes on in the bathroom. If you feel comfortable with it, you and/or your partner can take your child into the restroom with you. You can then explain what happens. “First, I felt a little pressure in my lower tummy which is my body's way of saying I need to pee…” all the way from the first urge to washing our hands. It's human nature to be scared of the unknown because we don't know if it's safe or dangerous. By letting them see it and hear it, we can show them that using the restroom won't cause harm. If this is not something you are comfortable with, you can also role play will dolls or stuffed animals and show how they use the restroom.
Another way is to start early with potty books. Your local librarian may smile, but that's okay because you're showing your child how to use the restroom in a non-stressful way. There's also a ton of YouTube videos from Peppa Pig and Daniel Tiger to Steve & Maggie and Paisley's Corner which explains how to use the toilet and most have fun songs to go with it. This can help bring awareness of how the potty works and isn't demanding of your child.
Books
Everyone poops by Taro Gomi: https://youtu.be/HbPGXmAdovg?si=-GvuBLXMqAdJaFup
The Potty Train by David Hochman
I can't. I won't. No way. (A great book for PDA)
Potty Train Your Dragon
How do you know you need to go?
Where's the poop?
It hurts when I poop!
We poop on the potty!
Nervous Nolan Bison Goes Poopy on the Potty
What happens to your food? Usborne
Speaking of songs, who said potty training has to be boring? Music, mood lighting and stuffed animals can always be welcomed on the potty training journey to help our kids feel safe and secure while potty training.
For boys, if they are struggling to aim you can also make it a game. Something as fun as cheerios in the toilet for target practice can help provide a visual understanding of where they should aim as well as being fun.
I loathe speaking in absolute terms, but when it comes to potty training there is one absolute I agree with - never force your child to potty train if they aren't ready. Forcing potty training now usually ends in constipation, regressions, potty refusal, encopresis and frustration for both parent and child. If you try to potty train and your child isn't catching on, it's not only okay but healthy to table it for now and come back to it later!
What if My Child is Still Afraid of the Toilet?
Fear of the toilet is pretty darn common in all kids, not just our ND kiddos. I'm going to list ideas below but again, we are not forcing the child. If they are open and receptive, you can try these ideas but they are not meant to increase stress! If you notice your child seems anxious or starts to look around the room or the seem to shut down, please do not continue.
If they are afraid of getting flushed in the toilet, you can blow up a balloon and place it in the toilet (a banana also works). Depending on the child, you can have them try to flush the balloon or stand by the door and watch. They will realize that the balloon, like their butt, isn't going to fit down the drain. There's also this video explaining where poop goes: https://youtu.be/OCgY77yLqOs?si=OdHskBvvWjEQJ-0Q
If your kiddo is afraid of the toilet because of the loud noise you can either change the demand and tell them it's okay if they don't flush right now or you can offer noise canceling headphones. If they struggle in public with the hand dryers, you can offer alternative forms of hand drying whether it's paper towels or even your pants because that's what's available.
If they are afraid of the toilet and you aren't sure why, you can draw a silly toilet. If you're a Harry Potter fan, think of it like the Prisoner of Azkaban when Professor Lupin had Neville change the boggart from something scary (Professor Snape) to something funny (Snape in his grandma's clothes). By taking something we fear and meeting it with laughter, we can conquer the meanest boggart, err toilet. https://youtu.be/3PWKFyhJ2h4?si=aMKs6sQBv6iv6Ayx This can be something as simple as dying the toilet water their favorite color or doing a science experiment of vinegar + baking soda to make the toilet a fun place.
If your child likes the toilet but isn't sure about the bathroom, you can always move a little training potty seat around the house to areas where they normally go (behind the couch, in their closet, in a corner under the kitchen table). Nobody said the toilet has to be in the bathroom during potty training! It's okay to move the toilet to where your child already feels comfortable going pee and poop.
If your child is also not comfortable with the toilet yet, you can have them sit on the potty seat with a pull up or diaper on. This way they start to learn they peeing and pooping are done on the toilet. After awhile you can again offer to remove the diaper while they try to pee or poop on the toilet.
The Basics of Potty Training Timed Voids
Let's step back to having your child sit on the toilet every 30 minutes to an hour to have them try and pee. Our kids are smart, many will start to notice that they can get off the toilet if they just push a little out. Unfortunately this pushing or straining over time can cause a hypertonic or tight pelvic floor which can cause constipation, hemorrhoids and even rectal prolapse.
Setting your child down on the toilet frequently can also interfere with the micturition reflex, making it harder for your child to feel the urge to pee or poop. Down the line, this can cause encopresis, chronic constipation or diarrhea, leaking or dribbling of urine or feces or decreased sensitivity to urge (I have to go NOW or they never feel the urge to go).
Instead of having a set time of 30 minutes to an hour, you can sit back and watch your child for a week. Make note of when they normally pee and poop. The bowels are frequently most active 30 minutes after a meal or after warm liquids. After learning their normal bowel habits, you can have them go to the bathroom around that time so they can start to connect what they naturally feel and what the next steps are.
Finally, have you ever heard of JICing or “Just in case” peeing? You know…”we're getting ready to eat dinner, better go pee just in case.” “Were going to school, you'd better try and go just in case.” Well, unfortunately those JIC pees can also interfere with the normal feedback loop and cause “overactive bladder” because their brain has been trained that it is “full” when it isn't and now perceives the urge to go more frequently.
Interoceptive Awareness & Sensory Processing for Potty Training
Interoception is our ability to sense our internal signals. It's what lets us know we are hungry vs thirsty vs need to use the restroom.
I frequently recommend sensory based OT to improve interoception and sensory regulation. This is a way to safely feel what is going on in the body and increase awareness of what it means. When it comes to potty training, the lack of urge with both pee and poop can come from decreased interoception or constipation that has stretched the rectum enough the nerves aren't able to fire at the right time.
Interoception can be first learned away from the pelvic floor. Improving awareness of sensations anywhere in the body will help us become more aware of different sensations. Kelly Mahler is a phenomenal resource for all things interoception and she even has support around potty training! When it comes to potty training, you can help your child connect the dots you've likely already connected. “I notice you are dancing, what do you think that means?” “I see you're standing on your tippy toes. What do you think your body is trying to tell you?” “I see you're squatting down. What do you think is going to happen next?” A good book for kids is, “Listening to My Body” by Gabi Garcia or “Interoception: How I feel inside and out” by Cara Koscinski.
Play based OT is also great for sensory and nervous system regulation. Autistic kiddos are also frequently sensory kids who need more or less input, depending on your child. Working with an OT can help determine what those needs are. If you dont have access to one locally, https://www.instagram.com/courtneyenglish.ot? May be able to help you better understand of your child's sensory needs.
You may be wondering how play is related to potty training. If a kiddo needs 40x the vestibular input or a lot of proprioception and those needs aren't being met, their body and nervous system are more likely to be in a fight or flight mode because it doesn't feel safe. This is visually expressed beautifully in the Pyramid of Learning. By meeting their foundational movement needs, we can build on the motor planning, coordination, and postural security needed for learning how to potty train.
Play is also one way we can naturally learn wet vs dry. We can incorporate this into our natural day-to-day adventures. The tricky part here is that many autistic kids are also very sensory oriented so they may not feel comfortable with it. You can offer these options but do not force them. Items that can be both wet and dry: sponges, sidewalk chalk, etc. Here is a great article on sensory play that can help a child learn wet vs dry so they can better understand those feelings before trying to connect it to potty training. https://www.fantasticfunandlearning.com/o-is-for-opposites-wet-and-dry-sensory-play.html
If your child can tell you when they are wet, but not quite to full potty training yet, you can also try Gerber training pants. They are little covers that go over any underwear. The big catch here is the texture and sound, which may make them non-viable options for many ND kids who struggle with auditory and clothing textures.
Physical Readiness for Potty Training
Have you ever thought about how much core stability it takes to sit upright on a toilet? How much stability and coordination it takes to wipe? I feel we as adults frequently take it for granted! But here's the thing, it's no coincidence that developmentally kids get the coordination, stability and pelvic floor strength to stand on one foot around the same time kids learn to potty train. Both take a lot of work!
If your child has low tone or needs more coordination, it might be a great time to connect with a pediatric PT. If they struggle with constipation or diarrhea, a pediatric pelvic floor PT can also help. The PTs (or OTs or chiros trained in pediatric motor development) can help teach you and your child ways to stabilize the hips, low back and core to improve toileting posture.
Setting your kid up for successful potty training is also supporting their physical needs. Newer toilets are made so adults don't have to be physically active and it's easier for them to get up and down from the toilet. The problem is, this leaves most of our kids' feet dangling from the toilet and not supported. Getting either a portable potty training chair or a potty training insert with a squatty potty can help ensure that your kiddos knees are above their hips which relaxes the pelvic floor muscles for both pee and poop.
One thing I commonly see is kids that slouch on the toilet and then struggle to go to the bathroom. If thisbis your kid and they look like they are almost folded over on themselves, you can try another reframe. This time, teach your little one to sit on the toilet backwards. This provides more base of support as they can put their arms on the toilet bowl and also helps relax the pelvic floor. There's a reason this position is called the birthing throne in labor…it helps both babies and poop come out!
Now, I mentioned a tight pelvic floor a couple of times. A few signs your little one might need some pelvic floor relaxation include: skinny poops (pencil-thin), large poops (if you frequently wonder how such a large poop came out of such a small child), leaking or pain. If bowel movements are hard, relaxing the pelvic floor may help ease those. A few exercises you can try as a family to make it fun are happy baby, butterfly pose, feet up the wall, circles on a an exercise ball, cat/camel, all fours tail wag (act like a puppy and slowly lift and tuck your tail),or child's pose. One of my personal favorites is to have a kid sit on an exercise ball or yoga and breathe into it. You can turn it into a game by setting if they can make the ball move with their breath. If your child has a “big round belly” you can also have them roll on their tummy on an exercise ball, peanut ball or yoga ball. Any of these will help provide a little more support to the abdomen and can help increase interoception and decrease constipation.
Your child also needs to be able to physically pull their pants and underwear down as well as reach behind in order to wipe. If they have difficulty dressing, pediatric OT can help.
Another reason ND kids may struggle with potty training is If they have a hard time wiping. You can also consider a built-in bidet for the house and portable one for school. It’s also okay to let them use wet wipes instead of toilet paper, just do your septic tank a favor and remind them to throw them away.
Nutritional Support for Potty Training
This section could be an additional 3 info dumping blogs all on its own so I'm going to try and keep it short.
One of the best things you can do to support a child's potty training is making sure they stay hydrated throughout the day and avoid constipation. Water is a great source of hydration but other options include herbal teas, fruit/vegetable flavored water, or broths. Other foods that have high liquid content are cucumbers, celery, lettuce, tomatoes, squash, asparagus, cauliflower, cabbage, strawberries and watermelon. You can also add electrolytes from LMNT or just ingredients. Staying hydrated will also help decrease the risk of constipation which can delay the body's ability to feel the urge to pee and poop.
Speaking on constipation…chronic constipation can cause the rectum to enlarge which allows more stool to get backed up. The stretching of the rectum can cause the body to not respond in a timely manner when your kid needs to poop. If your kiddo says they can't feel the urge to go, they aren't lying! You might be thinking, “but my kid goes poop everyday or almost everyday, they can't be constipated!” It's important to look at the quality and quantity of those bowel movements. If your kiddo has large/wide poops or you frequently comment on how “such a small child can have such large poops” then your child is most likely constipated. On the other side, super skinny poops that look like pencils are also a sign of constipation and pelvic floor hypertonicity. Stool texture can also tell us a child is constipated as chronic loose stools (Bristol stool chart 6 or 7), hard lumpy stools (Bristol stool chart 1, 2,3), and sandy/gritty stools are all possible signs of constipation.
If constipation is an issue with your child, along with water you can look into the MOPs diet, glycerin suppositories, Magnesium oxide, probiotics or diet changes. As this isn't my area of excellence, I recommend finding a functional medicine provider in your area who can help you come up with a clear plan of action for your child's findings and needs.
Breathing for Potty Training
You may be thinking “breathing for potty training, how does that work?” And the answer is…a lot of different ways.
First, there are a few studies that link autism and open mouth breathing. Now, we don't know if there is a true correlation for this, just that there's a connection. And honestly, my best guess is that there isn't one reason they are related but that's a blog for another day. Until then, let's look at breathing and potty training.
Open mouth breathing is linked to increased risk of infection, decreased carbon dioxide tolerance (feeling of shortness of breath), and increased sleep disordered breathing. All of these impact potty training.
Remember when we talked about decreasing the stress around potty training? If a child is open mouth breathing, has difficulty sleeping at night or has decreased CO2 tolerance, this can naturally shift the body to a stress response. If the body is stressed because of disordered breathing, it isn't going to prioritize peeing and pooping, nevertheless learning the new task of potty training!
What we currently know is that autistic kids are frequently chest breathers meaning their shoulders move up to breathe rather than their bellies, backs and pelvic floors moving outward. From a strictly musculoskeletal point, this decreases the normal peristaltic movements of our intestines. You can think of that as the constant little waves in the intestines that pushes food through the digestive tract and keeps things moving. Fun fact, with a deep breath in the adult pelvic floor can move down almost 1.5 inches. This helps create a constant wave of digestion to reduce the likelihood of constipation which can make potty training harder. To help with breathing, I like a two-prong approach or myofunctional therapy tonwork on breathing at the mouth level and chiro, PT or OT to help work on breathing at the diaphragm, core and pelvic floor.
We know why breathing is important, it is important to see how we can adapt to make it more functional for our kids. Instead of reinventing the wheel, you can check out https://buteykoclinic.com/buteykochildren/ for breathing exercises you can practice anywhere and anytime. These will help regulate your little one's nervous system and improve that gut mobility.
Now when it comes to breathing during pee and poop, you can having your child sit on the toilet and blow bubbles or blow on pinwheels. You can also pretend to be dragons and do “Dragon breathing” where they are trying to make the biggest flame ever by breathing out.
Although it's slightly different, we can also use our breathing and tongue to help our kiddos potty training. If your little one's struggling with potty training, you first want to make sure they are breathing through their nose with their lips gently closed and their tongue on the roof of their mouth slightly behind the front teeth. If they aren't able to do this, you may want a bodywork provider trained in peds motor development to help them get stronger and use more of their core.
Finally, we can use the breath and voice to our advantage during potty training. If your little one is okay with things in their mouth, an electric toothbrush can help them relax their jaw and pelvic floor to make peeing and pooping easier. You can also try low tones and moans…make it a game and pretend you're a cow and moo, roar like a lion, woof like a puppy, neigh like a horse, quack like a duck, oink like a pig, grr like a bear.
Whew…you made it. I know that was a lot. I wanted it to be pretty comprehensive so you had the information available to you. BUT I equally want you to know you don't have to do it all right now. If you tried, you would probably end up burnt out and that's not helpful for either you or your child. Take the parts that resonated the most with you and your current experience and try those first. If it doesn't work it's a sign that your child may not be ready YET or you need to try a different tool. Remember, potty training is a developmental process and it will come when your child is ready interoceptively, physically and emotionally.