Selected articles are available in text format. 2017 Fall Newsletter
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Toilet Mastery for Every Child

By Claudia Quigg and Ann Coleman Stadtler

When one parent shares that “toilet training in a day really worked for us,” most parents slump in discouragement. Like every other step in your child’s journey to learning self-regulation, gaining toilet mastery may represent a steep challenge.

Toilet training is actually a series of small steps that each child takes at her own pace. But toilet training doesn’t just happen to a child, it happens to a whole family. Your little one is part of your family system, and whatever is going on in the life of your family is an important consideration for toilet training. Your commitment to your little one will empower her to achieve success when the time is right.

Recognizing that it will take some time and energy to support your child through this process might make you wonder whether it is a good time to start. If there’s a new baby in the family, a new job, or a new child care provider, toilet training may need to wait. However much you long for the end of diapers, it may not be worth the upheaval in your home during an otherwise demanding time.

Understanding your child’s basic temperament also will help you get started. Is your child very active? It may be difficult for him to sit still on the potty. Is your child slow to approach new tasks? You may have to give him time to get comfortable with the idea of toilet training.

For most families, toilet training occurs gradually in a sequence of small steps. Consider the series of learning tasks we are asking children to achieve:

  • Feel it coming
  • Hold it back
  • Get to the right place
  • Pull down their clothes
  • Sit down
  • Relax and go!

Parents can set their kids up for success by noticing their child’s mastery in small steps, like playing with their stuffed animal by having it “sit” on the potty. These steps show children’s emerging interest and serve as building blocks toward the ultimate goal. Sometimes, when children have health or developmental challenges, these small steps are overlooked because so much else is going on. Recognizing a child’s small effort will contribute positive energy (rather than a sense of failure) to the process.

All toilet trainers have to get comfortable sitting on the potty, and engaged parents notice what their child may need for comfort. A very active child may need activities such as books and toys to help her stay engaged to be comfortable on the potty.

A child who may be somewhere on the autism spectrum will especially benefit from consistency, so the potty may always need to be in the same location for him to be comfortable. He may also need to sit on the potty at the same time each day. If your child is on the spectrum, you probably have already discovered that rewards and consistent routines help him gain new skills, and that same approach will support toilet training. Reward any small step toward mastery.

A little one with sensory integration issues may not like the feeling of the hard plastic toilet seat, so she might be more comfortable with a padded seat.

Sometimes health concerns contribute to challenges. Constipation is a major problem for many toilet trainers, but a child with low muscle tone may need his parent to be especially vigilant about providing a high-fiber diet to support regular bowel movements. Children who have regular sleep disturbances may have a more challenging time learning to stay dry throughout the night.

Every parent of a toilet trainer must expect some regression. Progress is never a steady upward path, but instead it’s a series of developmental bursts, plateaus, and regressions before the next burst.

There is a natural tendency to overreact from the stress we feel when our kids seem to slip backward. But recognizing these regressions as a normal part of the process encourages us to instead pause and wait while our children gather steam for their next developmental leap.

Months of living with your beloved child have given you insight into what she needs to grow and learn. Toilet training is just one more in a long chain of skills your child will learn with you supporting her at every step.

Claudia Quigg, MEd, is the founder of Baby TALK and serves as an adjunct assistant professor at Millikin University in Decatur. Ann Coleman Stadtler, DNP, RN, CPNP, is a pediatric nurse practitioner with a doctorate in nursing practice.

Both authors are affiliated with the Brazelton Touchpoints Center.

Learning Body Care Routines: Take It a Step at a Time

Very young children need support and opportunities to learn to carry out body care routines. The amount of support they need varies by the child’s age, skill level, and the amount of opportunities they have had to practice a particular skill. They begin learning the routines of body care even when they are young infants.

Caregivers can describe the steps and actions they are taking as they carry out diapering, dressing, and feeding cleanup routines. Saying, “I am wiping your chin with a washcloth to clean the applesauce dribbles” helps a child learn the words and actions associated with a body care routine. As an infant grows older, a caregiver might hand the child the washcloth and encourage him to wipe his own face.

Body care routines are wonderful times to practice skills. Young children use motor skills for manipulating washcloths, toothbrushes, combs, and other body care items. They use their thinking or cognitive skills to remember the steps in the correct order. They use language skills to describe the steps or ask for help. When they learn to do these things independently, they build confidence in their abilities and determination. This enhances their social and emotional development.

Teaching the steps and sequence involved in a body care task and mastering the motor skills to do each step can seem overwhelming job for caregiver. It often seems easier for adults to do these tasks for very young children. However as children grow bigger, it is important to remember that their desire for independence also increases. With planning and consistent effort, even very young children can participate in body care routines.

Your EI team can help you develop strategies to break down body care tasks and adapt them for your child’s ability. There are tools such as adaptive spoons or toothbrushes that can help children who need more motor support. Picture directions with a sequence of steps or teaching the final steps of a routine first and working backward can help you and your child feel a sense of success and be able to say, “You did it! Good job!”

A child does not have to be able to do every step of a body care routine by himself to participate. For example, let’s consider Laura, a 2-year-old who is learning to use a walker.

Her mom and her developmental therapist list out all of the steps in Laura’s handwashing routine at home. They decide who will do each step. Laura cannot climb up on a stepstool to reach the sink, so she will need an adult to help her get onto the stepstool to reach the sink. The faucet is also hard to turn, so mom will do that step for now.

Laura wants to pump the hand soap herself. She still needs some hand over hand help from mom to push the pump. She loves rubbing her hands together to make bubbles, and this is a step she can do by herself. Laura builds independence and confidence when her mom encourages her to try the steps in the process she can do, even though she may not be able to do the whole handwashing routine by herself until she is older.

Take it one step at a time and involve your child in daily care routines. Trying small steps can lead to big gains in independence and skill.

Steps for Handwashing Who Can Do This?
1. Climb up on the stepstool to the sink Laura, with help
2. Turn on the water Mom
3. Wet your hands Laura
4. Pump soap on your palm Laura, with help
5. Rub hands together to make bubbles Laura
6. Rinse bubbles from hands Laura
7. Turn off the water Mom
8. Dry hands Laura
9. Climb down from stepstool Laura, with help

SSIP: An Update for Parents

Families play an important part in supporting their children’s development and helping them learn new skills. The State Systemic Improvement Plan (SSIP) is one way that the Bureau of Early Intervention is trying to help a child’s team improve its support to the child. Three local leadership teams are working to support early intervention professionals in our pilot areas. One emphasis has been on the Child Outcomes Summary (COS) process.

This process allows us to understand children’s development between entrance and exit in our system. The change gives us an idea of how well the system is supporting children and families. Parents are an important part of both the COS process (with their unique information about their children) and the change that children experience (in how they support their children’s development). The ability to accurately document your child’s progress is critical to understanding how well our system works.

Improving the accuracy of the COS process was a primary focus of the SSIP during the first implementation year. Resources are being developed to help address the areas needing improvement and, as a result, we are seeing some really positive changes. Over time, these improvements may help families better identify where their children could benefit from additional support and help teams understand how their child has benefitted from this support.

If you have questions about the SSIP, please e-mail them to cguillen@illinois.edu.

Volume 30, Issue 3 (Fall 2017)
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