Guest blog by Louise Marsland. #Bogblogger #boglady
We have previously featured Child Health Visitor and Paediatric Continence Advisor Louise Marsland on our blog and she has given us some fantastic advice on how to get poo in the loo, and how to help children who are struggling to master potty training.
This week Louise is sharing her ideas on how to help children with additional needs find the toilet a less scary place:
Many children with Additional Needs and/or Autism are influenced by the toilet environment due to their sensory processing differences. If the bathroom is a scary place to go they are not likely to want to sit on the loo never mind do a poo!
Here are some ideas to think about when you are planning to toilet train your child. There are EIGHT senses that we currently know about that influence us when we go to the toilet. I have written a checklist below to help you with each one of them.
The Sensory Checklist
1.Sight– is the bathroom light too bright?
You may need to have a soft glow light bulb or a dimmer switch.
Has your bathroom got lots of distractions like shampoo bottles and other toiletries?
You may need to put everything away in the cupboard before they can concentrate on sitting on the loo!
Are there mirror tiles that reflect/distract them from sitting on the loo?
If they like to look in the mirror this may help them to sit on the toilet whilst they are having a poo.
2.Hearing – is the bathroom too noisy with a fan or hand dryer which can be distressing to children?
If you are out and about use a RADAR key that can be purchased from fledglings.org or other websites to be able to use the disabled toilet. This avoids noisy environments and hand dryers.
Do they like the flush of the toilet or does it distress them?
You may need to leave flushing the loo until they have left the bathroom. If they like to flush use it as a reward for sitting on the loo!
3.Touch – is the toilet seat too cold or too hard?
Padded seats can be bought to go inside the big adult toilet seat to make children feel more secure on the toilet.
Do they like the texture of the toilet paper or is it too hard for them?
Using flushable toilet wipes can help with this.
Is the floor a different surface than other rooms in the house? Shiny tiles can be cold and a change in texture can be upsetting for children. You may need to use a soft mat to cover the cold tiles up.
Do they like the feel of poo or playing with it?
Try play dough or another distraction toy to help put them off playing with poo!
It may be that they are constipated which is very common in children with additional needs especially children with Autism. They may be trying to pull it out of their bottom if they cannot push it out.
Pain on passing poo can stop them wanting to sit on the loo. If they have split their bottom or made it bleed they will be reluctant to go for a poo. This can lead to withholding poo and make the constipation worse!
Laxatives are available to help soften the poo and push it along the bowel. The faster the poo moves along the bowel the less chance they have of withholding their poo. www.thepoonurses.uk can help you with using laxatives correctly.
4.Smell – are the smells in the bathroom overwhelming for them?
Strong air fresheners and toilet cleaners can put children off going into the bathroom. Some children may actually feel sick smelling the mixture of fragrances. They may also feel sick at the smell of poo and putting it down the toilet may make them wretch. It may on the other hand be pleasurable to them to smell poo and smear it with their hands.
5.Taste – some children like to eat non- food products, and this can include poo!
Eating non food items is known as Pica and may be a sign of deficiency in the body. They may like to eat soap and toilet paper so other distractions may be necessary to avoid this.
6.Balance -can your child sit comfortably on the toilet without wobbling or falling down the loo?
This can be scary for children especially if they cannot touch the ground. Children with Autism may suffer from Gravitational Insecurity which means they need to have their feet safely on a stool or firm ground to feel safe. A stool also ensures the correct position on the toilet with the hips above the knees, to relax the muscles around the rectum and let the poo out easily. Children may think that they will disappear down the loo or get flushed away! An Occupational therapist can help to assess your individual child’s needs.
7.Proprioception –Does your child know where the toilet is to sit on without looking behind them?
How you make sense of the world and space around you is known as proprioception. You may need to put stick-on foot prints in front of the toilet for your child to place their feet in. They may need a hand rail to help them feel safe and guide them onto the toilet. Some children like to sit right back on the toilet and may wee or poo on the seat. If they need to feel safe sitting against something a soft tube like you use for swimming can be fixed onto the back of the toilet to lean against.
8.Interoception – the eighth sense that is not talked about very much is probably the most important one to know about!
Interoception is the understanding of the internal working of your bodily functions like thirst, hunger, temperature, pain and for toileting when you need the toilet.
If you are not given the message that you need a wee or a poo it is often too late when you realise you need to go! Some children will have “accidents” because the message came too late and it is NOT their fault.
This is where timed toileting comes in useful. We know that after a drink or a meal the gastro-colic reflex pushes food along the bowel and we are more likely to need a poo. So, 20-30mins after food is the best time to practice sitting on the toilet. As children get older and need to be more independent in school you can purchase a wobble watch they can wear that vibrates when they are likely to need to go eg every two hours. Most children can be trained to use the toilet with habit training if they do not get the feelings themselves unless they have a neurogenic bladder or bowel. This may be the case for example in severe Spina Bifida where the messages are not sent from the brain.
An Occupational Therapist can help you to devise an individual sensory profile for your child around toileting. They can help to identify the issues and provide equipment that may help with your child’s position on the toilet. Ask you HV or SHA to refer you to OT for a sensory profile assessment.
Equipment can be purchased from