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Feel like you've tried everything to potty train? Me too. My son is developmentally delayed with a dual diagnosis of
Down syndrome and Autism. At 7 years
old, he was still wearing a pull-up to school every day. We went to countless classes and read
everything we could online, but potty training just wasn’t happening. Here is the method that finally worked!
Step 1 – SOUL SEARCH:
Really. This will take commitment. After we tried so many approaches to potty
training, we were exhausted. While I dreamed my kid would someday go to the bathroom on his own, trying just made me feel like a failure.
Taking pull-ups everywhere we went was, quite frankly, just easier than finding
bathrooms and cleaning up messes. A change in behavior means lots of cleaning and being exasperated while you work the process, so
be sure you are really ready to do this.
Regardless of disability or stubbornness, we both know your kid can find your breaking point.
Step 2 – GAME PLAN: Get
out your calendar and set aside 3 or 4 days that you and your child can stay
home and devote full attention to this system.
No projects that will take your attention. No excursions, not even a trip to the grocery
store until at least day 4. You will
need at least a week of advance planning before day 1, probably more. Keep reading.
Step 3 – SUPER REWARDS: You will need to save at least 3 rewards your child will be SUPER excited about. These
can be objects they really enjoy or special at-home games you can play together. A new toy is OK too, as long as you know the
child will really love it. For my son,
the rewards were the movie Star Wars (played on an iPad), a light-up musical
toy he was really fond of, a pretend drum set, and a game of "Duck Duck Goose" with me. Yes, I know -- the more annoying the toy, the
more they love it. Suck it up and take
one for the team.
IMPORTANT: You must
remove the reward items or games from ALL usage for at least a week, maybe 2 weeks,
before training days begin. No cheating. Don’t use comfort items like a favorite
blanket or book – exciting items are better. Food is also not a good choice. If
your kid cannot live without it for awhile, find another reward.
Step 4 – SUPPLIES:
You will need a few things, which you can gather during the waiting
period while the super rewards are out of circulation.
- Find a bedwetting alarm with a small sensor. The one we used is a Malem professional alarm, available on ebay for about $40. There are also several brands on Amazon from $30 to $100. (Review step 5 to get an idea of the design.) Order the alarm, and try testing it near your child. You want to be sure it really gets the attention quickly – the louder the better. Put the batteries in and follow testing instructions, or just touch the sensor with a wet finger. If the alarm is too soft or no one jumps to attention when it sounds, send it back and try again.
- Buy or gather up 18+ pairs of regular underwear. No thick padding or plastic allowed. They don’t need to be fun or cute. We started with 20 pairs of tighty-whities, but I say 18 because they often come in packages of 3 or 6.
- Be sure your child has at least 5 pairs of elastic-waist pants, shorts or leggings to wear over the underwear. Preferably these should fit fairly close to the body but not so tight that they are hard to remove. No snaps, zippers or complicated ties for now.
- You may need to do some basic sewing (see Step 5). You will need a needle and thread, plus 1 sheet of soft felt (a local craft/hobby store usually has 8.5" x 11" sheets for less than $1).
- Depending on surfaces in your home, you may need some heavy plastic sheeting. See step 6.
Step 5 – SECRET WEAPONS: Prepare the underwear to be an
alarm system that will sound as soon as any wetness occurs.
5a) Determine how to attach your alarm sensor to the
undies. The goal is that the alarm
sensor needs to be on the spot where the first wetness will happen. And, your child is going to wear it while
he/she is running around and playing, so it needs to be secure and
comfortable.
- POCKET METHOD: This is what we did -- it does require some very basic sewing. (All you need is a basic running stitch. The felt doesn't need to be hemmed and lasts well in the wash as long as you keep your stitches small.) Have the child try on a pair of undies, and use a sharpie to mark the spot where the peeing would start. Then, cut a rectangle of felt, sized a little bigger than the alarm sensor. Place the rectangle on the outside of each pair of the underwear in the strategic spot and stitch around it on three sides, leaving one side open to form a pocket. Obviously the spot is different for girls and boys, and it also varies from boy to boy or girl to girl. NOTE: I found it worked really well to have the opening on the bottom, which allowed the sensor wire to go from the alarm unit on my son’s back, between the legs and up into the pocket. You may have to think about this one a bit, based on the model of your alarm.
- CLIP or MAGNET METHOD: Most of the sensors have a clip, so if you use traditional boys’ underwear, you can clip it inside the front flap area. Just be sure it stays in place when you put pants over it. The down side: we found this to be less secure than the pocket and would fall off frequently when our son was moving around. Some models have a magnet -- so you put one magnet on each side of the material and they stay put. (No experience here. I can only assume the magnet is strong enough not to be removed and swallowed.)
5b) Determine where to attach the sound unit for the alarm. Many models come with an arm band, but my son had that sucker off and in the floor in a few
minutes. We ended up putting a large
safety pin on the back of his shirt
and then clipped the alarm there, where he couldn’t reach it. After a bit he forgot about it. NOTE: Some
of the more expensive models now are wireless, which is fine, but you still
want the alarm unit on the child, not
on a table where they can run away from it.
A pocket on the back of the shirt might also work if you want to continue the sewing exercise.
Step 6 – THE NIGHT BEFORE: As you prepare to begin, know that there will be accidents. Make cleanup as easy
as possible in the main areas where your child will be. Plastic sheeting over carpeted areas, on your
child’s chair at the table, protection on living room seating, etc. may be necessary. If you already have easily cleanable surfaces,
you may not need this step.
You will need to stay in the room with your child at all times, so be sure you plan accordingly.
Also, if you have not already, decide on consistent words to
use to describe the process. Pee,
Tee-Tee, Urine, Poop, BM, Toilet, Potty… whatever. It doesn’t matter what they are, but you need
ONE word for each thing. Some parents
prefer that kids with special needs use more adult words so they don’t grow up
sounding babyish. “I have to go potty,”
is not so cute when you’re a 25 year-old man.
Step 7 – BEGIN THE PROCESS: On day 1, as soon as your child gets out of
bed, take him/her to the toilet. Sit for
awhile and see if they will go. You can
tell them, “Today you are a big boy/girl, and we are going pee in the toilet -
right here.”
If your child goes in the toilet, praise them but no
dancing, whooping or hollering. “Wow,
Toby, great job. That’s where pee goes. Right there in the potty. Awesome!” Then allow them to play with one of the
rewards immediately afterwards. “You get your
piano!”
If they simply won’t go after 10-15 minutes, that’s OK. No disappointment, but no reward either.
Put on the underwear, attach the alarm, and put on comfortable
elastic waist pants or shorts over that. (Your child may not like the alarm sensor at
first, and the pants will help keep it in place.) Proceed with breakfast or morning
routine. Be ready to drop what you are
doing and jump up at any moment – see step 8.
Step 8 – SUCCESS or No WET PANTS: At some point, the alarm will go off as it
senses the beginning of wetness. When it
does, there are two possibilities – Success or No Wet Pants. Be ready to quickly grab your child’s hand
and RUN to the bathroom, saying “Toby has to go pee!” the whole way. Get
pants down quickly and plop the child on the potty, then turn off the alarm. Be animated and label what is happening. “You’re going PEE in the toilet!” Once
they are there, hang out for a little while.
The alarm may scare them at first, so it may take a few minutes.
SUCCESS: If the child
gets ANY urine into the toilet, even if the pants are also wet, it counts as
success.
Lots of praise, but no dancing, or yelling. “Yay, Toby, great job. That’s where pee goes. Right there in the
potty (pointing). Awesome! That’s where your pee belongs.” Say it like
you are teaching them to put a toy in the toybox. When urination is finished, quickly clean up, replace
dry underpants and put the alarm in place.
Then, allow him/her to play with one of the rewards immediately. “You get your piano!” Allow
play with the reward item for up to 30 minutes.
If the alarm sounds again during this play, RUN for the bathroom
again.
VERY IMPORTANT - NO WET PANTS: Don’t skip or modify this. If you reach the bathroom but all the pee is
out, and none goes into the toilet, it is not a success. The “No Wet Pants” routine occurs.
We pull up the same WET pants and walk back to wherever the child
was when the pee began and the alarm first sounded. Look him/her in the eyes. Don’t be angry, but no smiling. Say firmly. “NO wet pants.” Then RUN to the bathroom again, pull down
pants and sit on the toilet. Say, “NO
wet pants.” Again pull up the wet
pants. Go back to the first spot. Again say, “NO wet pants.” Run back to the bathroom, pull down pants,
sit on the toilet, say, “NO wet pants.”.
And one more time, for a total of three.
Go back to the first spot, say, “NO wet pants”, run back to the
bathroom, pull down pants, sit on the toilet.
After the third repeat, clean up the child and put on fresh undies and pants,
reattach the alarm, and proceed with whatever they were doing before the alarm
sounded. NO REWARD ITEM. It’s very important to keep a straight,
matter-of-fact tone. No yelling or
punishment, but no reward either.
Step 9 - CONSISTENCY:
Repeat Steps 7 and 8 for several days.
During this time, your child needs to be close enough to an adult so
they can be led quickly to the bathroom as soon as an alarm sounds. Each time, follow the procedures in Step
8. Talking about the steps and labeling while
each step is happening helps them to internalize the process. Try to get the child to drink as much water
as possible, but otherwise go about your day.
Don’t repeatedly ask about going to the toilet except for the first
trip of the morning and maybe a trip right before bedtime.
It is very important that you do NOT use pull-ups or plastic
pants during the day for any reason, ever again! I suggest you don’t plan to take the child on
any outings until at least day 4. If you
want to go on a short outing on that day, get them to go to the bathroom right
before you leave and then as soon as you arrive at the store, friend’s home,
etc. (We went to a friend’s home on day
4 and used the alarm there, too. Good-natured
friends only need apply.)
If your child is in day-care or school, take the alarm there
and teach them about how to use it. (This
includes the “No Wet Pants” routine.)
For my son, it took the 4 days at home, plus another 3 days
with his special education teacher using the method at school. After that, we were able to stop using the
alarm, but we continued the “No wet pants” x3 routine for accidents. Within 10 days, accidents were done and he
has been potty trained ever since. Such a happy day!!!
Step 10 – POOP AND BEDTIME: Your choices may depend on how
well it goes with Steps 7, 8 and 9.
We did not worry about poop during this process. Sometimes our son did go poop while peeing,
but if there is an accident with poop only (no urine or wetness) then just
clean up the child and don’t worry about the “No wet pants” x3 routine. Later, you can modify the method for poop. If they do poop in the toilet, praise them and
label what they are doing. “Wow, Toby,
great job. That’s where poop goes. Right there in the potty (pointing). Awesome!
That’s where your poop
belongs.” Poop gets a reward item
also. In my son’s case, the poop just
happened at the same time as the urination and both were taught together.
For bedtime, you can continue to use the alarm if you want,
and follow the same process. This will
involve you getting out of bed whenever it sounds and following Step 8.
Or, you can use pull-ups or plastic pants at night only,
WITH a bedtime routine. So for example
if you normally do a bedtime story, you would incorporate a trip to the toilet
right before, and put on the pull-up, and say, “Now it’s time for bed, so we
will put on our nighttime pull-up.” Put
on pajamas or different night time clothes as well, then immediately lay down
and read the story in bed – no playing in the pull-up. As soon as they get up, go straight to the
bathroom and then put on underwear. Once your child is fully toilet trained during
the day, you may decide to use the same alarm or a pad-type alarm to train for
night time.
Photo at top of page by The Honest Company on Unsplash
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