- 15 months – points to wet clothing
- 18-24 months – reports soiled nappies
- 2 years – occasionally announces need to wee
- 3 years – able to delay urination for some time
- 4 years – will use toilet appropriately
Toileting
Supporting Independent Toileting
Independent toileting is one of the most significant milestones in a child’s life and we know it can be confusing for parents to navigate this process with differing advice and techniques often recommended.
General development of toileting in children occurs over a period of time, and most children are fully independent with toileting by the age of 4.
General development of toileting in children
Typical childhood development:
It usually takes around 5 months to achieve reliable daytime continence* and girls tend to achieve continence 3 months earlier than boys.
Usually, children are out of nappies during the day for about 1 year before they are continent at night. So nighttime dryness is usually around 4 years of age.
Night time control is the hardest, and this step may take longer than the others to achieve.
It is normal to wet the bed until age six for a girl and age seven for a boy.
*Definition of continence:
Continence refers to the ability to control the passing of urine and bowel movements.
The word continence come from the Latin continentia which means "a holding back.”
What is a healthy bladder?
Watch this short clip to learn what is meant by a healthy bladder and get tips on helping children maintain healthy habits:
The Healthy Bladder Video Transcript will appear here shortly.
What is a healthy bowel?
The Healthy Bowel Video Transcript will appear here shortly.
Supporting children with additional needs:
There are several reasons why it may take children with additional needs longer to achieve independent toileting.
These may include:
- Underlying medical conditions: Conditions that affect the muscles controlling the bladder or bowel. Acute episodes may be due to a urinary tract infection (UTI) or chronic constipation, which can delay toileting independence.
- Developmental delays: Some children may struggle to sit upright on the toilet or perform complex motor tasks like flushing, wiping, or handwashing due to delayed overall development.
- Learning needs: Children with learning difficulties may need additional support to understand the steps involved in toileting, as well as planning and executing them effectively.
- Attention difficulties: Maintaining focus to complete the toileting process can be challenging for some children.
- Sensory differences: Sensory sensitivities can make toileting an unpleasant or challenging experience. Some children may not recognise or respond to internal cues telling them when they have a full bladder or when it is completely empty. They may find the toilet environment overwhelming or frightening or they may feel insecure if they cannot touch the floor with their feet when sitting on the toilet.
- Physical disabilities: Children with physical disabilities may require additional support, such as specialist seating or a toilet chair, to achieve full independence. Your Occupational Therapist can help explore options that suit your child’s specific needs.
When should I start toileting training?
There are two main approaches to achieving independent toilet training: habit training and independent toileting
Habit training:
Toileting for children with additional needs typically begins with habit training.
Habit training means the child remains clean and dry with adult support. They use the toilet when taken but are not yet indicating or requesting to go on their own.
This is the best way to start toilet training with all children at any age. It involves preparing the child for toilet training while they are still wearing pads or pull-ups.
By mastering the routine first, the child is more likely to succeed once the pads are removed.
About 80% of the training process occurs while the child is still in pull-ups, minimising accidents and keeping the child protected.
Independent toileting:
This then usually develops into independent toileting.
Independent toileting means the child recognises the need to go to the toilet. They communicate or take themselves independently and complete the toilet sequence by themselves.
Toilet training skills should not be delayed because of a disability
Children with additional needs are more likely to succeed if training begins early. Early intervention helps prevent the development of poor toileting habits and reduces over-reliance on continence pads or nappies.
Factors to think about before removing continence pads or nappies
- Are you ready to commit? Do you have time to dedicate?
- Do you have support from family members and school?
- Are you prepared? Do you have plenty of cheap underwear available and the means to wash them?
- Do you have supplies like wipes, protective mattress sheets, and nappy bags readily available?
How to start toileting training:
- Start with a consistent routine. Creating natural opportunities can be more effective than taking children to the toilet at fixed times, which could disrupt their play or learning. Natural opportunities include:
- When the child wakes up
- After breakfast
- Mid-morning, such as after having a snack
- After lunch
- Mid-afternoon, for example, before going out to play
- After dinner
- Before bed
- We know that the optimal time for a child to have a bowel movement is about 20 minutes after eating and 60-90 minutes after drinking. Building these opportunities and following the same patterns every day can help embed this into the child’s routines especially if they are not noticing other cues.
- Keep charts and logs to identify any consistent patterns in toileting. Use this information to schedule toilet opportunities during those times.
- Use consistent language for terms like “wee,” “poo,” and “toilet” to avoid confusion. Avoid using the word “dirty” for poo, as it can have other meanings.
- Encourage healthy habits by promoting regular fluid intake. Keeping a fluid chart can be helpful.
- Regular exercise improves mobility, posture, and bowel function.
- Explore various equipment options, such as steps and stools, to help the child feel more secure while sitting on the toilet.
- Support the child’s communication with systems they understand, such as pictures, symbols, or objects.
- Use visual schedules to help the child remember the steps involved in toileting.
- Assist the child with all aspects of toileting, including getting dressed and undressed, and washing their hands.
Other Top Tips:
- Involve your child in the entire process. Encourage them to flush the toilet, pull down their clothing, and sit on the toilet.
- For boys, use tighter briefs rather than boxers and encourage them to sit on the toilet rather than stand during toilet training.
- Give it at least three weeks of consistent effort before reassessing. Expect that the child will likely have several accidents during this period.
- Maintain a positive attitude. Learning a new skill takes time, and staying upbeat can help support your child’s progress.
- Reward successes, no matter how small. Some children respond well to earning points, stickers, or other small rewards.
- If an accident occurs, gently prompt your child to go to the toilet. If possible, redirect them before or during the accident.
- Avoid discussing challenges in front of the child. Remain positive and supportive to prevent them from feeling ashamed or anxious.
- Sometimes wearing underwear underneath the nappy can help the child if they are not recognising the wet sensation.
- Try to make the environment as ‘sensory friendly’ as possible, having a preferred toy they can play with during toileting, preferred smells, keeping the lights off if too bright, softer towels, flushable wipes instead of toilet paper.
When to Seek Help:
- Start by seeking support from your school nursing team. You can request this through your school’s SENCO (Special Educational Needs Coordinator).
- The ERIC website offers valuable information and resources: https://eric.org.uk/information/
- If your child is over the age of 5, you can apply for free nappies. Contact your school nurse to request this.
Last updated10 Mar 2025