10 Tips To Control Bedwetting In Children And Adults

 10 Tips To Control Bedwetting In Children And Adults

10 Tips To Control Bedwetting In Children And Adults

Bedwetting is a common issue among young children as well as incontinent adolescents and adults. There are many issues that bedwetting can cause, including embarrassment, discomfort and messes. In addition, bedwetting individuals are at risk of damaging their skin by lying in a wet or soiled bed throughout the night. Bedwetting is therefore an issue that must be dealt with properly, rather than accepting it as fact.

With the proper steps, bedwetting occurrences in both children and adult can become less frequent or even stop altogether.

The following 10 tips offer effective ways to stay dry at night.

1. Monitor fluid intake

Although it is important to stay hydrated throughout the day to avoid dehydration, which can irritate the bladder, try to limit fluid intake during the last few hours before bed. This will help ensure that the bladder isn’t working too hard during the night, which can lead to bedwetting.

2. Cut back on caffeine.

Caffeine has been found to increase urine production rate, and it is therefore recommended to decrease intake of caffeinated products including coffee, tea, carbonated drinks, energy drinks and cocoa, especially close to bedtime.

3. Use the bathroom before bed

Before going to bed, empty your bladder fully to help avoid nighttime accidents.

4. Ensure easy access to the bathroom

For many bedwetting individuals, it may be a simple issue of getting to the bathroom in time. This problem is especially likely when dealing with young children, disabled or mature adults, as well as mentally impaired individuals.

The following are several tips to provide safer and easier access to toileting at night:

  • Clear the path between the bed and bathroom to avoid tripping or falling
  • Use night lights to help your loved one easily locate the bathroom
  • Install a raised toilet seat to make it easier for adults with mobility issues to use the bathroom independently
  • Provide a bedside commode, urinal or bedpan to give immediate access to bedridden adults or those with limited mobility

5. Monitor bowel movements

Constipation can get in the way of effective bladder voiding, so monitor bowel movements to ensure that your loved one is not suffering unnecessarily. If constipation or irregularity is suspected, speak to your doctor about the best way to relieve this issue and thus help avoid nighttime overflows.

6. Use a bedwetting alarm

Bedwetting alarms are an effective way of training incontinent children as well as adults who have primary enuresis (bedwetting since childhood).

Do not use bedwetting alarms for adults who wet their beds at night due to any of the following issues:

  •  Secondary enuresis caused by a disease or condition
  • Degenerative diseases
  • Inability to sense when the bladder is full
  • Physical difficulties getting to the bathroom

Bedwetting alarms sound on detection of urine during the night, which can successfully train adults and children to associate the sensation of a full bladder with getting up to use the bathroom. This method has been proven very effective if used consistently for several weeks.

7. Wearable protection

Until your loved one is trained or cured of their bedwetting issues, you can help keep their skin and their beds comfortably dry throughout the night with wearable protection such as incontinence pads, youth or adult diapers and absorbent underwear, also known as pull-ups. Disposable incontinence products – especially those designed for overnight use – can contain a high amount of liquid and are easily disposed of when soiled.

8. Bedding protection

When wearable protection isn’t sufficient for keeping the linen dry during the night, bed pads can go a long way to protect the part of the bed most likely to get wet or soiled. Purchase cost-efficient and environment-friendly reusable underpads or conveniently disposable bed chucks that offer reliable absorbency and waterproof backing to minimize clean-up after an accident.

9. Mattress protection

Mattress covers and mattress pads won’t keep the bedding dry, but it will protect your mattresses from liquid damage and is an important step to consider if your loved one has bedwetting issues. These products are waterproof and usually easy to wash, and offer reliable protection that will allow for longer mattress life. Keep in mind that although thicker mattress pads do provide better comfort for the user, the thickness also means that washing and drying these pads will take longer.

10. Speak to your doctor

Although bedwetting may be uncomfortable or even embarrassing to discuss, it is important to consult your doctor about your issue. This is crucial because a medical professional can help discover the underlying cause of bedwetting issues, which will make treatment easier and more effective.

Bedwetting can be difficult and frustrating for any caregiver, but it is important to remember the feelings of the incontinent individual as well. Always avoid teasing, blaming and punishing loved ones who suffer from bedwetting issues. Not only will this approach be ineffective, since the problem is out of the child or adult’s control; this may actually make the problem worse. Instead, focus on encouraging and supporting your loved one through this difficult time, and with the help of the above tips, you will be well on the way to dry, stress-free nights becoming the new normal.

About The Author: Hanna Landman lives in New Jersey with her husband and child. She works for AvaCare Medical, an online medical supply store servicing seniors and the homebound across the US. She specializes in adult incontinence solutions and writes for their blog on all topics related to incontinence, caregiving, senior living and more.

Bedwetting In Teens - Possible Causes And What To Do About It

 Bedwetting In Teens - Possible Causes And What To Do About It.

Bedwetting In Teens - Possible Causes And What To Do About It.

Do you have a teen who is still wetting the bed? You’re not alone. Many teens struggle with nocturnal enuresis, a fancy term for nighttime bedwetting. And while it can be frustrating and emotionally draining for both you, and your teen, most of the time, they will grow out of it.

There are several reasons a teenager may be struggling with staying dry at night:

  • They have a small bladder.
  • They are deep sleepers.
  • They are constipated.
  • There is a family history of bedwetting.
  • They produce too much urine overnight
  • They are experiencing a stressful situation or a big change (new school, change in family dynamic, trouble with friends, etc.)

All of these things may contribute to a teens bedwetting problem.  So, what can you do to help them?  The first course of action is to contact a physician as soon as you can to help set up a treatment plan.  Be supportive of your teen and try not to make a big deal out of it – it’s very likely that your teen is already extremely embarrassed about wetting the bed. Talk with them about it, and show them how to clean themselves, and their bedding when they have an accident. You don’t want to encourage them to hide their problem, but constantly having to ask you for help may make them feel even more embarrassed. 

Below are options to consider if your teenager is still wetting the bed.

Try a bedwetting alarm.

These alarms detect moisture and can alert a teen if they are starting to have an accident. Over time, this can help condition them to wake up and use the bathroom when they need to go.

Bladder retraining.

Just like other muscles in the body, the bladder can be trained to empty at specific times. Learn more about how to retrain your bladder here. 

Medications.

There are several medications that can help with bedwetting in teens and adults. Talk to your doctor to see if this may be a good option for your teen.

Limit fluids before bedtime.

Try to avoid drinking too much about an hour before bedtime, and always be sure to empty your bladder prior to going to bed.

Try the NAFC Dry Night Solution Kit.

Sometimes, the right protection can make all the difference. NAFC's Bedwetting kit allows you to try out several products at a very low price, making it a great way to find out what works for you. Learn more here.

Patient Perspective - Teen Bedwetting

 Patient Perspective - Teen Bedwetting

Patient Perspective - Teen Bedwetting

I’m sharing this story as an adult, but it is really about my childhood. I suffered from bedwetting when I was young and it lasted until I was almost a teenager.  I was lucky enough to have very supportive parents, but that didn’t stop the shame I felt every time it happened. It never felt like a big deal until I was around 7. Then I started getting invited to sleep overs, which were always very stressful for me. I was constantly scared of wetting the bed at someone else’s house and of my friends learning my secret. I started to turn down invitations simply because of my fear, and the problem began to effect me emotionally. Luckily, my bedwetting slowed down a lot after I was around 9, but I still had an occasional accident through age 12.

I’m not sure what I would have done I hadn’t had such wonderful parents to help me through it. They never made me feel bad about it, and always were as discreet as possible when helping me clean up after an accident. Their support took a lot of the pressure off of me, which I think would have only added to my problem back then. I now have a 3-year old myself, and, knowing that they could possibly experience prolonged bedwetting (after all – it is hereditary) shows me how stressful it can be for a parent. If you are a parent of a young child reading this, please take this one thing away:  Support your child, even if their problem has caused you countless sleepless nights, extra loads of laundry, and profound frustrations. I can tell you first-hand that it likely pales in comparison to the shame they’ve felt themselves. And the support and understanding you can give to them during this time will do wonders for their self-esteem and sense of wellbeing. They will remember it forever – I know I have.

Terry B., Salt Lake City, Utah

Need a solution for nighttime bedwetting? Try NAFC's Bedwetting Kit, available here.

Bedwetting In Children - Tips For Managing And Overcoming

 Tips for managing and overcoming bedwetting in children

Tips for managing and overcoming bedwetting in children

Many parents often cheer once they’ve successfully trained their child to stay dry during the day – and rightfully so! This is a big accomplishment for both you, and your little one! But it can be frustrating for parents when their child is still unable to stay dry at night. It’s important to note that this is not your child’s fault – the functions that a child needs to stay dry at night take a bit longer to develop, and every child develops them at their own pace. Think of it as Potty Training – Round 2.  Parents should work with their children and support them in this sometimes-difficult next step of potty training.

Here are 5 things to remember when working with your child to stay dry through the night: 

It’s Not Their Fault. 

Wetting the bed is a common condition, and it’s in no way your child’s fault.  For a child to stay dry at night, several things need to happen, all of which are really out of their control. The signals between the brain and the bladder need time to fully develop. Their bladder capacity needs to be large enough to hold urine for the entire night. Finally, they need to be able to wake up when the urge to urinate strikes. All of these things take time to develop. Remember – bedwetting is normal in children up to 5 years of age, and is still quite common in children from 5-10 years old.

Don’t blame your child and encourage them when they do well. 

No child wants to wet the bed, and as we just discussed, they truly cannot help doing it.  Don’t make your child feel ashamed or guilty for wetting the bed as this may only prolong the problem. Instead, talk to them about how this problem is normal for kids their age, don’t make a big deal of it if they wet the bed, and offer plenty of praise and reward if they wake up dry.

Empty their bladder before bed. 

Always take your child to the bathroom before bed. You may even want to take your child to the bathroom once more when you yourself go to bed just to see if they can go one more time before a full nights sleep.  Limiting fluids an hour or so before bed can also help keep their bladder empty before a long night.

Talk to their doctor.

Talk to your pediatrician and rule out any potential medical causes that may be keeping your child from staying dry at night. Constipation, which can press on the bladder and reduce bladder capacity, is a common culprit. Other medical conditions, such as UTIs, diabetes, sleep apnea, and even stress can all contribute to bedwetting.

Try a bedwetting alarm.

A bedwetting alarm senses moisture and then alerts the child – through an actual alarm, or through a vibrating sensor. There are several different types that make it easy to choose one that works best for your child, and they can help condition your child to wake up when they feel like they need to empty their bladder. 

Take protective measures.

Make it as easy as possible to clean up any accidents when they happen. Use a waterproof mattress to protect the bed. Have an extra set of pajamas ready to change into just in case.  Put a waterproof pad down on top of the sheets, which is easy to switch out if an accident happens. And don’t be afraid to use pullups if you need to.

Remember, it is completely normal for a child to experience bedwetting accidents – even up to 10 years of age. But rest assured that the majority of children will grow out of this phase. Being supportive and encouraging their successes will help make the process much easier for both you, and your child.

Potty Training: What's Normal And What's Not

 Potty Training: What's Normal And What's Not

Potty Training: What's Normal And What's Not

Potty training can be difficult for both parent and child. Just when you think you’ve mastered it, your child may do something completely unexpected that makes you second-guess throwing out all those old diapers after all.  But most of the time, the things you may be worried about are completely normal and not a cause for concern.

Read on for explanations on typical potty training setbacks, and what you can do about them.

“My daughter was doing great, but recently has wanted had a lot of trouble staying dry and is asking to use diapers again. What’s going on?” 

This is called regression and is completely normal. There is no single cause of regression, but it can often happen in times of transition. Is there a new sibling in the house, new school, or other changes happening? These types of changes can cause a potential regression in potty training.  The answer could also be medical – many kids with constipation have bladder leaks. Talk with your doctor if you think your child may be constipated to see what you can do to fix the problem. Sticking with your potty training routine is key to reverse the regression – inconsistency will only cause the regression to last longer. So keep up the timed potty usage (every 2 hours is a good rule to follow), make sure to have your child go before going out and before bed.  Find ways to motivate her to use the potty again – sticker charts, treasure boxes, or other rewards usually work great. Be patient with her and before you know it she’ll be back on track.

“My son has been completely dry during the day from months but still continues to wet the bed at night.”

It is very common for children to master daytime use of the potty first. Staying dry through the night typically comes a while after that, sometimes even years after.  Nighttime training should be looked at as “round 2” of potty training. It is much harder for children to master than daytime dryness, and some children simply take a little longer to develop the physical changes needed to stay dry at night. 

Once your child has been able to wake up dry five mornings in a row, it’s a good time to let him try wearing underwear to bed (be sure to use protective bedding, such as plastic bedcovers or waterproof pads). But don’t pressure him, and don’t reprimand him if he has an accident – bedwetting is involuntary and not their fault.  And if he starts having more accidents at night, don’t be afraid to go back to pull ups. He may just need a little more time to develop.

“My daughter seems to have random accidents all the time, even though she has been potty trained for a while.”

Accidents will happen from time to time, and that’s completely normal. Many kids will actually put off going, or simply forget about it, because they are too absorbed with playing.  The easiest way to fix this is to keep her on a schedule – take regular potty breaks, and ask her periodically if she needs to go. You can also watch for cues that she may need to go - holding herself or dancing around - and take her to the bathroom if she’s demonstrating any.  Consistency is key and often just little reminders can help remedy the issue.

“My son is 3 and shows absolutely no interest in using the potty. Will he ever be ready?”

Every child is different and kids become ready for potty training at different times – there is no hard and fast rule that says a child should be potty trained by a certain age. Be patient with your child and try to encourage his interest by reading him books about the potty, taking him to the bathroom when you need to go (or seeing that Daddy goes too!) buying new “big boy undies” and even familiarizing him with a training potty. Don’t push him – it is harder to train a child who isn’t ready and will only cause frustration for you both. Don’t worry – he’ll get their in his own time.

Above all, with any of the issues above, try your hardest to not reprimand your child when he or she has an accident. Potty training is a huge milestone for kids and making them feel bad can cause real setbacks in their training (and resistance from your child). Be understanding when they have an accident, and praise them when they succeed. More than anything, they need to know that you are on their team and are rooting for their success.

NAFC's Top 10 Tips For Potty Training Your Toddler

 NAFC's Top 10 Tips For Potty Training Your Toddler

NAFC's Top 10 Tips For Potty Training Your Toddler

Teaching your child to use the potty is a big challenge, but it also comes with big rewards. No more diapers, more independence for your little one, and maybe even a bit more sanity for you at the end of the day.

But where do you start? And when? These answers will vary from family to family because (as we’re sure you know by now, every child is different) what works for some kids may not work for everyone. But, as long as your child seems ready to start trying, (2.5 – 3 is an average age for kids to start, although some may be ready to start as early as 18 months) give some of the tips below a try. Before you know it, you’re little one will be a pro on the potty

Tip #1:  Make sure they are ready.

Look for clues that your child is ready to start this process. Things like asking to be changed, showing an interest in bathroom habits (even yours!), and telling you when they have to go to the bathroom are good signs that they may be ready to start trying.

Tip #2: Get them comfortable.

Some kids have a fear of the toilet –them their own training potty that is just their size will not only make it feel more comfortable for them, they can practice sitting in it in other, more comfortable places your home to really make them feel at ease and prepare them for the next step – actually going!

Tip #3: Let them go naked.

Part of the problem with potty training in a pull-up is that it’s not that much different than a diaper. And kids are typically so used to going in their diaper they may not even remember or think to tell you when they have to use the potty. When they’re naked, they have no choice. Start by letting them be naked for a bit before or after bathtime and encourage them to try to use the potty. Then, when you’re feeling brave enough, let them go for longer, extended periods when you’re home. (But be sure to expect a few accidents along the way as they get used to knowing when they have to go.) Most kids don’t want to have an accident so after one or two, they’ll typically start telling you when they have to go.

Tip #4: Schedule regular potty time.

This can be a time consuming process, but scheduling potty time every 20-30 minutes can be really helpful in helping a child learn. It gives them plenty of practice using the restroom and helps set them up for success by instilling mandatory potty breaks in short intervals. The more they are able to successfully go on their own, the more likely they will be to continue.

Tip #5: Rewards.

We hate to say it, but bribes work. Giving your child a small reward each time they successfully use the potty can be a huge motivator for them. Some families choose sweet treats (M&M’s are a favorite), but you don’t have to resort to sugar to make this work. Fill a box with small inexpensive toys (stickers, erasers, etc.) and let your child choose from the box after a pre-defined number of successful potty trips. Get some cool “big-kid underwear” as an incentive for getting out of pull ups. Kids also love to see their progress so using something like a sticker chart where they can track their success over time can be a great motivator.

Tip #6: Read to them.

It can sometimes be hard to get kids to stay on the potty long enough for them to actually go. Reading can be a huge help. Pick out some favorite books, or some get a few new ones from the library, and read to your little one during their scheduled potty times. They’ll start to look forward to going, and you’ll be getting in some extra reading time at the same time! Win-win!

Tip #7: Praise their progress.

Kids, just like adults, love to hear that they’re doing a good job. Praise their accomplishments and their efforts to keep their momentum going, and to encourage them when they’re feeling frustrated.

Tip #8: All or nothing.

Try just putting them in underwear for a long weekend and see what happens. Some parents swear by this method, although it’s not for everyone. This usually works best if you have a dedicated few days where you can commit to staying at home (and are comfortable with cleaning up a few messes).

Tip #9: Be prepared for a possible regression.

Sometimes kids can be doing great with potty training, only to have a setback after a few months. This is normal and shouldn’t be anything to worry about. Be understanding with your child – showing your frustrations can only make them feel worse and may lead to more accidents. Try to figure out why the setbacks are occurring (is your family going through a transition in any way or does your child have any medical issues, like constipation, that could be causing the regression). Once things have settled down or you’ve identified and treated the problem, your child should return to potty training again.

Tip #10: Be patient.

Remember that potty training is a process, and, despite some programs that claim they will potty train in a short amount of time, it often takes several weeks to months for your child to become dry regularly. Be patient with them as they learn to master this and provide as much love and support as you can to help them along.

Have any of your own potty training tips to share? We’d love to hear them in the comments section below!

When Should You Start Potty Training Your Toddler?

 When Should You Start Potty Training Your Toddler?

When Should You Start Potty Training Your Toddler?

Potty Training your little one is a big step, and one that can happen at different times for different kids.  There is no one magic timeline since each child is unique. Some toddlers are ready to begin the process as early as 18 months, although a very small percentage of children under 24 months are fully potty trained. Two and a half, or even three years old, is a typical age for kids to start.

Look for the following signs to see if your child is ready to start potty training.

  1. They show interest in the bathroom. Is your child telling you when they are wet? Do they want to watch you go to the bathroom? Are they asking to wear underwear or big-kids pants? These are all signs that they are may be ready to start potty training.
  2. Their patterns become more regular. They have bowel movements at about the same time each day, no bowel movements at night, and can go for at least a couple of hours at a time without having a wet diaper, which means their bladder muscles are able to hold urine.
  3. They are emotionally ready. Kids who have no interest in using the potty, don’t want to wear underwear, and generally don’t mind being in a wet diaper are probably not yet ready to start the process. 
  4. They are physically ready. It takes some coordination to use the toilet. Kids must be able to walk, sit down, remove clothing, climb up to the toilet, and tell their parent or caregiver that they need to use the potty.

It’s important to reiterate that every child is different and to follow your child’s lead. Girls are often potty trained faster than boys. And if you have multiple children, younger siblings may benefit from seeing their older siblings go through the process, making it go more quickly for them. But watch for the signs listed above - starting to potty train before your child is ready will cause frustrations for you both, and will often take longer than if you had waited for them to show more interest.  Also know that it’s common for a child to master using the potty during the day, but still have some trouble staying dry at night. Nightime training often takes a bit longer– sometimes even a few years after daytime dryness has been established.

Think your little one is ready to start easing their way out of diapers? Here are our best tips for successful potty training.

Incontinence and Autism - A Treatment Guide

Incontinence and Autism
Incontinence and Autism

Incontinence is a condition that affects over 35 million Americans of all ages.  Dealing with incontinence can be difficult at any age, but helping a child with a disability, like autism, learn to manage incontinence can be especially challenging. 

As a child, learning to use the bathroom is a normal part of development. And even in children who don’t have a physical, mental or emotional disability, the rate at which they develop this skill varies greatly.  However, for some children with autism, other factors can play a part in how they learn to use the toilet.  Autism is a spectrum disorder brought on by a dysfunction of the central nervous system. It is usually diagnosed in the first three years of life. Children with autism experience impairment of common social skills (making eye contact, interacting with other people or reading social cues), communication difficulties (delayed language development or complete lack of speech), and behavioral challenges (sterotyped and repetitive body movements, extreme attachment to routines, unusually intense or focused interests, and sensory sensitivities to environments including sounds, light, smells and textures.

When looking at these characteristics of autism, it’s easy to understand how some children with autism may have challenges when potty training or learning to remain continent.

Using The 5 Ps.

 Incontinence may come in many forms, but there are some common ways to approach the situation. We call them ‘The 5 Ps,’ and they can help make treatment more tolerable for caregivers and contribute to a real opportunity for improvement:

Patience  

We all know that patience is a virtue, but when it comes to incontinence, it’s often a virtue that’s hard to find. Try not to place blame for setbacks. Instead, provide positive encouragement and do your best to maintain a good sense of humor – it’ll pay off in so many ways.

Persistence

Progress may be slow, but don’t give up. Having a positive outlook and setting sensible goals can reduce frustration for everyone.

Planning  

Incontinence is all about surprises, and they’re usually not pleasant ones! Take the time to schedule activities – even simple ones that you do around the house – and make sure to stick to that schedule. Communications planning is just as important – make sure that teachers, caregivers and anyone else who shares responsibility for the child knows what they need to know about the child’s situation and is able to take appropriate action if needed.

Practice

You never know what will work until you’ve tried it – and in most cases, that means trying and trying again. Test out different treatments, ask healthcare professionals for recommendations and see for yourself if there are certain products or programs that work for you.

Progress Is Possible

It may not always feel like you’re getting somewhere, but there are thousands and thousands of families who can tell you firsthand that the effort you make today really can turn into results down the road. It may not always be realistic to expect a cure, but there are things you can do – tactics, treatments and products – that can make your loved one much more comfortable and your life much easier.

It’s important to note that many children with autism have no problems with incontinence, and for those that do the severity of their condition can vary greatly. In addition, many children continue to develop over time and can improve their condition with the proper help and instruction from a caregiver. 

For more help on addressing incontinence in children with disabilities, download our brochure, Incontinence Support For Children With Disabilities.

Toilet Training Children with Autism

 Toilet Training Children With Autism

Toilet training is a pivotal skill for a person with autism because mastering the skill can significantly increase a person’s independence in his or her home and community. It is also one of those skills that parents of children on the autism spectrum struggle with.

The good news for parents is that it becomes easier once you realize that you teach the skill just like any other skill -- through behavioral intervention techniques.

Prerequisite Skills

But before you can get started, there are prerequisite skills a child needs. Do not go strictly by chronological age and do not “wait for the child to be ready.” Your child is ready to begin toilet training once the following prerequisites are met. First, the child needs to be able to sit on a toilet for about three minutes. Second, their bladder should be able to hold urine for at least one hour. Third, serious problem behaviors should be at a relatively low level. Last, toilet training will be easier if the child has already mastered some basic self help skills such as pulling up their own underwear.

Urination Training

Initial urination training consists of four major components. Each component has its own purpose and is a necessary part of the treatment package.

You will be bringing the child to the toilet on a set schedule. Schedules teach the basic routine and behaviors associated with being toilet trained. I usually begin with a 30-minute schedule. Schedules more intense than 30 minutes will not allow for periodic accidents, which are also a necessary part of the training.

There must be positive reinforcement for success on the toilet. Reserve one highly potent reinforcer, just for the toilet training intervention. Each time the child appropriately urinates on the toilet, on their schedule, give them access to the reinforcer. This strategy increases the child’s motivation to have his urinations on the toilet.

Introduce a request. Use whatever form of communication is easiest for your child. Forms of communication can include a verbal word, a picture exchange, a manual sign, etc. Prior to bringing your child to the toilet each half hour, prompt them to make the request and then respond with a naturalistic phrase such as “You have to go to the bathroom? Okay, let’s go.” This request component will allow for future independence.

Without an accident correction component, your toilet training plan will not be effective. Whereas the schedule component teaches the routine of toilet training, correcting accidents teaches the child when they should be requesting to use the bathroom. You have two choices. Some plans suggest punishment-based procedures. Other plans use a prompting procedure in which the therapist uses a quick verbal statement to slightly startle the child thereby temporarily interrupting the urine stream. The child is then quickly prompted to the toilet where they are encouraged to finish urinating. Any urination in the toilet is then followed by a reinforcer. Typically, this is the procedure that I use for accident correction because it turns the accident into an effective teaching trial.

From the first day that the treatment package is implemented, data is collected on the frequency of appropriate responses, frequency of accidents, and percentage of urination on the 30-minute schedule. Treatment decisions and modifications should be made based on a daily review of the data. Keep in mind that toilet training is an intensive procedure that usually requires the dedication of a trainer for a number of hours each day. It is also helpful to conduct the training directly in the bathroom with the child wearing limited clothing.

Bowel Training

Often, bowel training is completed along with urination training. Sometimes, however, the child becomes urine trained, but continues to have bowel movements in a pull-up or other inappropriate locations. In this case, you first need to conduct an assessment of why the child is not bowel trained and then develop a plan of action accordingly.

There may be several reasons why a child is not bowel trained, the main reasons being medical issues, noncompliance, skill deficits, adherence to a ritual or routine, fear of eliminating in the toilet, and using bowel “accidents” to serve some other function (i.e., to escape demands, to gain attention from others, etc.). Whether or not you need a toilet training plan, behavior plan, or medical intervention will depend on the reason why the child is not yet trained, so an assessment period of at least two to four weeks must precede any training plan. During this time, data and information are collected and analyzed to determine the function of the problem. Obviously, if the cause is determined to be medical, seek the recommendations of an appropriate physician.

If the cause is determined to be a skill deficit, initiate a training package consisting of prompted toilet sits (limited to the most likely times of day when your child needs to have a bowel movement), positive reinforcement for success, visual cues to teach the child what they should be doing on the toilet, and once again either prompting to the toilet or punishment for accidents.

With a ritualistic behavior or fear of eliminating, try a gradual desensitization plan where you introduce appropriate toileting in small steps, offering reinforcers for success along the way. For noncompliance, the first step is often increasing the potency of the reinforcer being offered for success and initiating a punishment-based component for accidents. If that does not work, you can try a procedure whereby suppositories and enemas are used as prompts. For this procedure, always seek the advice and guidance of a medical professional.

If the bowel “accidents” are serving some other function, you do not need a toilet training intervention, but rather a more traditional behavior plan such as that which would target escape-maintained, attention-maintained, or access-maintained behaviors. Seek the advice and guidance of a behavior analyst in these circumstances.

Whichever plan you choose for bowel training, you must watch closely for any signs of constipation. Long-term constipation will not only result in a medical issue that will need to be corrected, but will undermine your treatment plan because the eventual bowel movement is likely to be painful, thereby punishing any compliance with going on the toilet. It is suggested that if the child does not have a bowel movement for three days past his or her typical schedule that the bowel training plan be temporarily placed on hold until bowel movements become regular. Then, it is time to start again, making modifications to prevent future episodes of constipation.

Keep in mind that with good behavioral intervention techniques, a commitment on the part of the trainers, good data collection and analysis, consistency, and some advice from professionals if needed, toilet training can be mastered relatively easily and rapidly.