Toilet training is clearly one of the most challenging task for any parent out there to try and successful execute. There are so many issues around this very topic that most parents need help with addressing. Amongst these very many issues that often arise are the following subject matters; withholding of bowel movements, toilet readiness, fecal smearing, constipation, continued use of diapers, elimination of the floors or even in the most appropriate places and how to overcome these problems with proper toilet training.
Well these are all very valid concerns that need answers to yet there are no real answers specific to these questions. Why is that you may ask? simple, every child is unique and each have their own problems unique to just them. Some kids will master the training fairly quickly whilst some may struggle up to the age of at least 8years old.
Problems they often encounter include withholding their bowels which leads to smeared feces and constipation, all this can be quite frustration to any parent because of all the clean ups that need to happen in the process of all this. The key to overcoming this uphill battle is to be calm and patient while being as consistent as possible with the training. Remember Autistic kids learn through repetition because they are generally slower than other normal kids.
You need to understand why fecal smearing happens and all the other toilet issues that may arise during the training exercise.
In as much as these issues can be quite upsetting and off putting you need have a clear understanding of why they happen for you to find a better way of dealing with them. All these issues have a ripple effect as they are some how connected to each, for an example if a child withholds his bowel movement this could lead to constipation if he goes on for days without using the toilet. The constipation can lead to itchiness in the anal canal causing the child to keep at their bottom as a way of trying to get relieve from the irritation and hence the fecal smearing.
What could help you alleviate this problem is having clear communication lines with your child, because most autistic children can be late bloomers meaning some of them may be late talkers try to find a way of having him communicate to you the need to go to the bathroom when the urge arises with sign language that is simple enough for your child to understand. Helping to develop their cognitive skills can go a long way in reaching the successful milestone in potty training.
What could be the contributing factor to all these toileting problems you may ask?
There are two known factors that may aggravate these problems and they are;
- Giving your child a very limited diet and low liquid intake. little on fiber in your child’s diet can lead to constipation, but the major factor is the low liquid intake because this ca lead to colonic mobility slow down caused by the dehydration. Which can also lead to drier bulkier and harder to pass stool making your child wanting to hold back from releasing a stool because of the pain and discomfort they may be experiencing.
- The other problem may be due to underdeveloped receptors. These receptors are found inside our bodies, in our organs, under our skin, in our muscles and bones they are responsible for gathering information in our bodies and sending messages to our brains. In autistic children though this function may weak, the brain is not fast enough in delivering the message to the brain that the bladder is now full or its time to eliminate any other waste products. So the is no sensation for the urge to go use the toilet until it is too late.
How to measure toilet readiness?
A lot of people think that toilet readiness is somehow connected or corelated to age, but that is definitely not the case. It all boils down to whether has the developmental skills to handle potty training. Is he ready or not. There are signs and signals to look out for that will indicate whether or not your toddler is indeed ready to be trained.
Here are signs that your little one is ready for toilet training;
- He may inform you that he needs a diaper change by hand you a fresh diaper to change him.
- He will often disappear to a quiet spot where he can relieve himself undisturbed.
- He ask you for a diaper change once his diaper is wet or soiled.
- You have observed and now established his pattern of pooping or peeing.
- Has managed to stay dry all through out the night.
After having observed all these signs you can then plan your training be sure however that there are no major changes in life before you go in for the plunge. changes such as an illness, divorce between parents or a new sibling on the way because all these changes can overwhelm your child. You also need to psych yourself for the challenge up ahead. Be emotionally prepared that there will be some setbacks which will come with a lot clean ups too in the early stages of the training process.
Earlier on in this article we spoke of fecal smearing as one of the toilet problems that parents mostly face in the early stages of their training. well let us now address this upsetting , messy and unhygienic behavior which can be a nightmare more especially if it happens outside of the home. However the is very little no research that shows how common this issue is with children suffering from autism and other related disorders. Just because you may not find information on this subject doesn’t mean that other children don’t go through it, so dear mom please don’t feel embarrassed or even think that this is a part of your child’s disability so therefore you have to live with it as nothing can be done about it.
So what is fecal smearing you may ask?
There a whole lot of behavioral actions that can characterize smearing such as the following;
- He will roll up the feces in his hands then tuck away a few pieces in hidden places.
- He will remove the feces from the toilet paper just so he can play it or smear it on the toilet seat and surroundings.
- He will isolate himself from others so he can play around with the feces.
- After using the toilet at school, he will smear himself all over, get dressed then go back to class.
- He will shred and smear his diaper all at the same time.
- You will find that he has defecated in the bath and smeared all over his surroundings.
So What could be the source of this smearing, what causes it?
This kind of behavior is quite complex, the may be a variety of things that could lead to it which may include the following;
- It could be that your child is suffering from constipation.
- Your child may have some mild psychiatric issues such as exposure anxiety, a behavior therapist would be able to give you a proper diagnoses after assessing him though.
- He could be facing challenges around the whole toilet training process.
- You need to properly check out his diet as this could be the source, remember a diet deficient in liquid intake and fiber can lead to constipation.
- Your child could be harboring some emotional problems or issues such as dealing with anxiety, or looking forward to the reward of a hot bath after messing himself, or this gives him a sense of autonomy he may possibly be under-stimulated so this could be a way of dealing with his boredom or it could just be a way of expressing his anger too.
- It could also include sexual factors, it could signal possible abuse too.
How to deal with or manage smearing.
This can be a physically and emotionally draining period for all parents or caregivers. Support from the professionals such as behavior therapists can help parents to understand and develop proper toilet training skills. This is very vital as it can bring to the surface the exact underlying issues that you as a parent may have not picked up yet.
It is very possible to reduce or minimize smearing no matter how long it has been happening or even how it has occurred in your child’s life. You just need to come with a unique strategy to deal with this that is directed strictly at your child because, let’s face it individuals may have varying reasons for their smearing.
You will also need to work closely with the other potty pals such as the caregivers, school teams and or family members to get everybody using the same structure that you have created for the child so you are on the same page. Don’t forget that if you punish the child for smearing that will not help him stop this behavior it may just make it even worse because the child may want to fight back at you!
Be as emotionally neutral as possible, what this means is that you should on neither side of the fence. Don’t react positively or negatively too!
Ways in which you can do this include;
- Remaining extremely calm and collected prior to when to go clean up any mess the child has created.
- Be very subdued all through out the cleaning, don’t utter a word.
- If you feel the need to vent out your frustrations then be sure to do it in secluded place away from your child.
- Make sure your child is not around you when you clean up the mess, so they don’t hear express your frustrations and anger.
- Try to remain as calm as possible when bathing the child, try to contain your anger emotions because you don’t want it coming out through your actions now.
Smearing when it occurs, what to do.
The first thing to do when living with or caring for a child that smears is to seek medical assistance from your doctor so he may rule out any psychiatric problems or behavior issues that you are not aware of. Before you can take a course of action against this emotionally draining habit you need to get down to the root of the problem, find out the source or cause of this.
Knowing the source or root of your child’s problem can help you come with an action plan that can work you both. in most instances the cause of smearing is chronic constipation, a child will pick at their anus just to relieve themselves of the pressure and itch that comes with being constipated.
Children living or suffering from autism are most likely to suffer from chronic constipation due to low fluid intake and a lower intake of fiber rich foods. You will need to closely monitor your child by keeping a diary of all his bowel movements which you can then present to your physician to determine what is actually going on with the child.
Once you have been given a clean bill of health by the doctor then you need to clear assess your child for a proper diagnosis it could be that this is just a behavior thing and most probably a sensory issue. ( It could be that your child just enjoys the sensation of the touch, or the smell may be intriguing to him or he just enjoys the texture of the poop).
In this case you can quickly divert his attentions from this by offering him alternatives substitutes that will stimulate his sensory such as;
- For the touch – give him warm play dough, toothpaste, shower gel, clay and or a sandy water mixture.
- For the visuals- get his face painted, put shaving cream on his chin and moustache area give him clay or even bread dough.
- For the smell- vinegar, marmite, essential oils or scent lotions, any thing with a pungent smell.
- For sound- it could from squeezing a bottle all kids love the sound of that.
Have your child play with these alternatives all through out the day consistently until it becomes a daily routine.
Other distractions that may occur and disturb your child’s toileting
Accident often occur around screen-time for most toddlers because they literally postpone all impending trips to the bathroom all because they are so consumed by either a tv game they are playing or just watching their favorite cartoon. He may come extremely distracted to the point that his brain doesn’t register that signal about his bladder being full or that crapping effect from an impending stool movement.
This is a very common phenomenon amongst kids with autism, however it is nothing to worry about as this can easily be corrected.
Here are some way you can help your child stop playing and use the toilet as needed;
- Be sure to make your toddler take that bathroom trip before he begins any activity, if he comes to you asking to go on the tv game, tell him to go pee and poop first. you need to do this with much consistency so that it becomes his daily routine that he starts with a bathroom trip before engaging him onto any activity.
- Create a bathroom card for him with all the bathroom to do visual steps and keep it close by or in a place where your son will see it during his play time. This will serve as a reminder to him that he needs to use the bathroom at some point.
- Alternatively you can set him a timer with an hour’s interval in between just as a way to remind him about his bathroom visits. This will help him not get too engrossed in his activities that he forgets to use the bathroom.
- You will need to teach your son how to pause his tv game but don’t forget to reassure him that he can always resume the game once he is done with his toileting, tell him that it will be as easy as pie to get back to his game once he done.
- Have sound and clear house rules that he will understand, such as ”we will pause our games and tv shows during bathroom breaks. Make sure that he understands the importance of doing this. Tell him the reason for these breaks is so he has less to accidents around the house. You could maybe put up a big sign by the tv so that he sees it as often as need be or until he has picked up the routine of bathroom breaks.
- Often times a reward system works a charm at keeping these young people on check. Create a reward system for your son to encourage him to take those bathroom breaks and sure to instantly reward him after every successful bathroom break. An example of a good reward would be for you to allow him choose the upcoming dessert for dinner, but don’t forget to clearly explain the importance of this token. Make it a bit of a celebration so that he is amped up about and will want to continue with this good behavior.
- This is a routine that may take a bit more time for your son to fully master so until then be sure to keep a watchful eye on him, so you don’t miss any impending signs and signals that he needs to use the bathroom. This can give you peace of mind knowing that you have reduced the risk of accidents happening and the wont be any clean up thereafter.
- Given all the control measures that you may have put in place, accidents during screen-time are inevitable. So if your son has an accident during that time quickly end the screen-time and ask him to get a change and clean up, this can be quite annoying and understandably so but try to maintain your cool and don’t get super irritated about it.You don’t want to create a hostile environment between yourself and your son as this may derail all th time and efforts you put into this particular activity. Remember on this journey there will be good days and bad days too. So just keep you eye on the ball for a successful smooth road to independence.
Toilet training is not complete until your toddler can independently and effectively wipe his bottom. This may take a while for him to fully master so don’t be upset if he doesn’t do a good job. Just get back on the bandwagon and help him practice until he fully gets. There are many ways in which you can teach your child to master this skill; beneath I have included a step by step approach on how you can teach your son to wipe his bottom.
A step by step approach to wiping;
If your son still hasn’t quite started wiping himself because you are there all the time to wipe him then you need to consider re-introducing this skill to him. At first you can have a visual chart that depicts all the steps he needs to follow down to pulling up his trousers.
Your wiping step should also include you actually handing over to him the toilet paper or wipe flatly placed in the palm of his hands then you take him through the wiping technique. With this technique you are gradually weaning yourself from being your son’s caregiver but shaping his behavior or prepping for his own independence.
Next step would be to offer guidance on the amount of toilet paper that is suitable for wiping, you don’t want him rolling up the entire toilet roll. guide him by inviting him to count out the proposed number of squares he can roll up. You can also help your son learn how to wipe by making it a bit more practical, remember most children especially those suffering from autism learn quicker if you stimulate their visual. So have him wipe of a marker pen ink from the writing board.