Healthy toilet practices

Teaching a child to use the toilet can be a challenge for many families, regardless of whether the child is autistic or not. Since most advice is designed for parents of neurotypical children, you might find it helpful to read some more specific guidance here, focusing on the particular needs of autistic children.

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When to start

Autistic children often take a bit more time to learn how to use the toilet compared to children who are not autistic. However, the key for any child is to wait until they’re both physically and emotionally ready, whenever possible. Sometimes families might feel pressured to toilet train based on external factors. But if you have a choice, try to choose a relaxed time when you’re not feeling too stressed, and wait for your child to show signs of readiness. Here are some good signs to look for:

  • If they’ve begun to realize when they need to use the toilet.
  • If they start to show awareness that their diaper is wet or soiled, like fidgeting.
  • If they start telling you when they need a diaper change.
  • If they seem to know when they’ve started or finished peeing or pooping.
  • If they’re curious about using the toilet.
  • If they’ve started to control their bladder or bowel a bit, like avoiding accidents for an hour or two.

Starting a new toilet routine

Toilet training can take months, but keep in mind that the goal is for your child to use the toilet without your help. It will be a period of many small wins and setbacks, but in the end, it will mean more independence for your child and no more nappy changes for you.

Getting started can be especially hard if your child isn’t already interested. Autistic children are much less likely to want to copy other people in using the toilet, and they may not see the benefit in giving up nappies. You know your child best, so trust your instincts and find what works best for your family.

Autistic children do often prefer predictable routines. With that in mind, here are some ideas for building up a toileting routine:

  • Be careful to avoid any confusion in the instructions, such as showing a boy standing up to wee if you’re teaching your child to sit. Keep it clear and specific.
  • Start doing ordinary nappy changes in the bathroom to build up the association.
  • Consider going straight to the regular toilet instead of using a potty. This can help prevent a challenging transition if your child gets used to a potty and later needs to switch to the toilet.
  • Ensure everyone involved in your child’s care is aware of the approach you’re using. This helps them support your child and understand any behavioural changes during this period. Put strong communication lines in place, such as a home/school book.
  • Make sure everyone has the right equipment to support your child. Send in any necessary toilet seats to nursery or school. Send along extra clothing, wet bags, and wipes.
  • Before starting toilet training, observe when your child typically urinates or has a bowel movement. Understanding their patterns can help anticipate their needs.
  • Once you recognise their patterns, guide them to the toilet at the right times. Even if they don’t make it in time, encourage them to sit on the toilet and attempt to urinate a bit. Celebrate this as a success.
  • Visual cues near the toilet can be helpful. Break down the whole process into steps – trousers down, pants down, sit on the toilet, wee/poo in the toilet, wipe (you may need to show how many squares of paper to take), pants up, trousers up, flush toilet, wash hands. Use a style that makes sense to your child, either words or pictures. You could incorporate a favourite character or an intense interest to make it more appealing. It might help to have a way to cover or tick each step once it’s done.
    • If you think your child is ready to wee or poo, you can start the routine with a prompt like, “(your child’s name), toilet”. You might even keep a picture reference handy and use that as part of the prompt. Then take your child to the toilet and go through the sequence. Even if they don’t actually wee or poo on the toilet, go through the whole sequence as if they had. Not all children will be willing to go along with this idea, so if this is distressing for your child don’t force it.
    • If you have access to a laminator, that might be useful for the visual prompts in the bathroom. You might also consider a separate laminated visual prompt just for hand washing.
    • Rather than focussing just on the toilet, try to teach the whole process as a routine – recognising and communicating the need for the toilet, using the toilet and wiping afterwards, washing and drying their hands.
    • Keep the routine consistent and predictable as much as possible.
    • Autistic people can sometimes find praise intimidating, and often respond ambivalently to external motivators like reward charts. If your child does enjoy these things, be sure to pile on the encouragement! But if your child would only find that stressful, make the process worthwhile to them in a way they respond to. It could be that just having a calm and consistent routine and maybe something fun to do afterwards is plenty. But failing that, bribery is an entirely valid approach.

    Common challenges and ways to overcome them

    Here are some ideas for addressing specific challenges related to healthy toilet routines. Keep in mind that everyone is unique, so certain suggestions might be more helpful than others for you.

    Clothing
    Hand washing
    Should boys sit or stand?
    Bowel control
    Habit training
    Environment
    Overnight
    Schools and early years settings
    • If your child feels the need to use the toilet, time is of the essence. Make it as easy as possible for them by giving them comfortable clothes that are easy to pull down or up for the toilet. Elastic waistbands, not too much fussy fabric, nothing that will get in the way or bunch up too much.
    • Character-branded underwear can be a great motivator to wear pants.
    • For dressing and undressing, consider using “backward chaining”. In this approach, you teach a skill by going through the steps yourself, only leaving the final step for the child to complete. So, you could pull your child’s trousers up as far as their hips and let them pull them up the rest of the way. Then you leave a little more of the skill to complete each time, like pulling up the trousers only as far as their knees. It can be really satisfying for the child to complete the task, and encouraging as they only ever have to do a part of the task they’re already confident about.
    • As with the whole toileting routine, it can be helpful to follow a set and predictable routine. Roll up sleeves, turn on the tap, get your hands wet, squirt the soap, rub your hands together, rinse off the soap, turn off the tap, shake off excess water, and dry on a towel.
    • At first, your child may need a lot of supervision. You can stand there and guide them as necessary, following your visual prompt, until they need you less over time. Be aware that using verbal prompts for each step can cause issues down the line, as it’s easy for your child to start depending on those prompts. Just reference your visual prompt as much as possible.
    • It may be a good idea to teach your child to only use the cold tap. In some places the hot water can be too hot, so they might hurt themselves by accident.

    Your child will ultimately have their own preference, but as you begin toilet training consider these questions before teaching your child to stand and wee:

    • Can they tell whether they need to wee or poo?
    • Do they have the physical control needed to aim?
    • Is there someone in the house they can imitate?

    If the answer to any one of these is yes, you’re probably okay to teach them standing up. For aiming practice, you can float a piece of cereal in the toilet or buy a toilet target sticker set.

     

    Most children learn bladder control before they learn bowel control. Sometimes they can even find bowel movements on the toilet or potty frightening or gross. It might be worth finding a picture book or a video to explain what’s happening.

    • Some children actually like the feeling of a full nappy. If this is the case, try to find a good alternative, like a weighted blanket, and make it part of your routine.
    • You could try cutting a hole in their nappy and sitting them on the toilet like that. Make the hole a little bigger over time until they don’t need it any more.
    • If they are happy wearing pants and using the toilet to wee, you might let them request a nappy to poo in. This way they still learn to listen to their bodies, and they can feel confident as they use the toilet otherwise. Then they can let go of the nappy when they’re ready.

    Some children might not have the body awareness to learn to use the toilet when they need to go. If this is the case for your child, habit training may be a useful route. This can be helpful for children who might lack awareness or have decreased physical sensations.

    • Instead of focusing on the urge to wee or poo, habit training focuses on going at set times.
    • Start with watching your child for a few days to notice when they tend to wee or poo.
    • Then, take your child to the toilet at specific set times throughout the day.
    • Think about ways to help your child feel comfortable on the toilet. You could have the tap running, or give them a toy or a book that’s just for when they’re on the toilet. Anything that might help them relax enough to wee or poo.
    • If your child has trouble knowing when they’ve finished, you may need to teach them a strategy for that so they don’t accidentally wee on the floor. They might slowly count to ten after they’ve finished and before they stand up, or you could get a visual timer for them to look at.
    • As they get older and need to toilet independently, you could get them a watch that’s set to vibrate at set times during the day. Then you can teach them to go to the toilet whenever the watch vibrates.
    • Make sure the bathroom is a nice place for them to be so that they’re happy to use it.
    • Try to avoid distractions in the bathroom, so the focus is on the toileting.
    • Make it comfortable with stools, side rails, or a smaller toilet seat.
    • Make the bathroom accessible for your small person, so they can easily reach everything they need.
    • Consider their sensory needs, including smells, lights, sounds, and temperature. If they communicate to you that something is bothering them, honour that need and make the adjustment if possible.
    • They should be able to sit comfortably on the toilet with their hips and knees at 90-degree angles and their feet fully supported. A good stool of the right size should provide this.

    Most children don’t start night-time toilet training until they are reliably dry for most of the day. When you’re ready to start night training:

    • Keep your bedtime routine consistent, even on weekends and holidays.
    • Avoid food and especially drinks for an hour before bedtime. Make sure your child has plenty to drink for the rest of the day so they don’t feel thirsty at bedtime.
    • Plan a toilet trip before bed, and another once during the night (such as just before you go to bed yourself).
    • You might try taking them to the toilet at different times during the night, depending on what works for you.
    • There are many products available to help with the night-time transition. You can get waterproof mattress protectors, pull-up nappies that mimic underwear, and disposable bed pads. If your child finds the pads uncomfortable, you can put them under the fitted sheet so the mattress is still protected.

    Your child has the right to attend school, and any issues with continence do not change that right. If a school or other educational setting is refusing admission because your child is not toilet trained or needs help to use the toilet, this may be considered disability discrimination. If you have any concerns about this, contact your local educational support team or the National Autistic Society’s Education Rights Service.

    More tips

    • You might try giving your child a drink 10 or 15 minutes before using the toilet to increase the chance that they will wee. But don’t overdo it, as you want to avoid it becoming a permanent part of the toileting routine.
    • Think about whether you want to teach your child to always shut the door when toileting, or to only shut the door in certain situations.
    • Avoid baby-words for toileting or for genitals, as these might be inappropriate as your child grows up.
    • If toilet flushing is upsetting for your child, find ways to accommodate that. You can leave it until the end of the routine, or flush the toilet yourself once your child is at a safe distance. As with any sensory need, respect your child’s needs, communicate your concerns, and work out a solution between you. You could show them how flushing works, or see if music might help.
    • Be prepared for accidents on car trips. You can put a protector on the car seat and avoid drinks.
    • If a child still prefers using their nappy, they might hold their wee or poo until they know they’re going to have a nappy on, such as on a car trip.
    • You can find absorbent pants and swimwear for older children.
    • Your child may need to feel comfortable using the toilet at home before they’re ready to use toilets outside the home. Try to keep to the same routines, and bring along anything they might need.
    • If your child smears their poo, you can look up strategies to try on this website or on the National Autistic Society website.

    Further information

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