Toilet Learning for Preschoolers
As a first step for all families, I recommend they discuss the concern with their primary care provider to rule out or treat any medical conditions such as constipation that may be contributing to the child not having learned to use the toilet. Most typically developing preschoolers are ready to use the toilet when awake, but may be resistant to the learning. Nonetheless, this is an important developmental milestone for children in terms of their confidence, social skills, and self-esteem.
The Vermont Continence Project has a video library of resources for families and schools. This resource is especially useful for families with older preschoolers who are resistant to learning or who are coping with medical and developmental challenges that impact their learning.
One evidence-based technique is for teachers to collaborate with caregivers around toilet learning. Teachers can ask:
What would be the benefits to your child learning to use the toilet?
What words do you use to describe toileting routines including the toilet and voiding?
What will your child wear while learning to use the toilet? Can you provide those for the classroom?
Are there special materials your child will use while learning to use the toilet (e.g. potty watch, insert on seat, stool for feet)? Can you provide those for the classroom?
How will your child communicate their need to use the toilet in different settings?
What are your expectations about the toilet learning process? How long do you expect it to take? How do you expect teachers to be involved?
How will you praise or encourage your child to use the toilet?
How can we communicate and stay on the same page about toilet learning?
Toilet learning will usually be successful if the medical needs are ruled out, and if caregivers can be excellent cheerleaders. Usually children have the most success with toilet learning when they move directly into underwear - especially if that underwear has appealing characters on it! Children usually experience more sensory feedback in wet/soiled underwear than they do in pull-ups, so it offers intrinsic motivation.
Teachers and families can help support the learning by increasing fluid intake and scheduling 2-5 minute periods of "trying" on the toilet at gradually decreasing frequency. Caregivers should stay with children who are newly learning to use the toilet. Any success is cause for immediate and enthusiastic celebration! Some families or teachers choose to offer stickers, stamps, or small food items to help reinforce toilet learning. These reinforcers can be faded over time.
In any process of learning, children (and adults) make mistakes. That will be true for toilet learning as well. When children have accidents, caregivers can respond in a neutral way and help the child change into new clothing to "try again".
Families or teachers might find the list of social stories here helpful - or choose to write their own. There are also a wide range of children's books about learning to use the toilet.
Finally, this document has additional information for schools about creating a toilet learning plan and the appendices have example goals and accommodations. If a child is headed to kindergarten and has not yet learned to use the toilet independently, preschool teachers and families should have a conversation with the new school about the child's needs and create a plan for kindergarten.
