Before you start toilet training the child in your care, you need to understand what stage they’re at in the toilet learning process.  

Milestones has created a handy checklist called the ‘Getting Started Assessment’ which will help you consider the child’s medical needs, toileting history and skills, communication and sensory needs.  

You also need to recognise how your child or young person’s past experiences could influence toilet training. They may need to spend time with an ISP therapist first, before they’re ready to begin the process.  

Once you know where your child or young person is in toilet learning, you can begin setting realistic goals that help them take steps towards using the toilet independently.   

When you believe your child or young person is ready to start toilet training, the best way to stay on track is to create achievable goals to keep you both motivated. 

There is a sequence of steps that we all unconsciously use when we go to the toilet, from entering the bathroom and closing the door to sitting on the toilet, actually using the toilet, wiping, flushing, and washing our hands.  

Take things slowly, pick one skill in the sequence to work on first as a goal. For example, if they can use the toilet but struggle to pull their trousers up and down, you could focus on that first, while completing all the other steps in the sequence for them until they’re confident enough to start building the next skill. 

If the child in your care has sensory needs and is hyper- or hypo-sensitive to sounds, textures, smells and lighting, adjust the bathroom environment so they feel calm when using the toilet. Here are some ideas: 

• Use soft toilet paper that doesn’t feel too rough on the skin. 
• Make sure the bathroom is free from strong scents, such as air fresheners or diffusers.
• Try different types of soap to see which one works for them, such as liquid, foam, and bar.  
• Switch the light bulb so it’s not too bright or harsh on the child’s eyes.  
• Consider using white noise to drown out any background noise, such as a running tap or soothing music.  
• Make up a silly song or rhyme together to make the process more enjoyable for your child.  
• Read a book to distract them from what they’re doing.  

If going to the toilet hasn’t been part of your child or young person’s routine, then you can help them by making it an ordinary part of their day, building the habit until it becomes learned behaviour.  

You can do this by recording for a week or so when they wet or soil themselves. Milestones has an ‘Elimination Patterns Sheet’ that you can use to do this, or write it down in a diary or notepad. 

If you notice a pattern, then you can start encouraging your child or young person to use the toilet around the times they usually need to go anyway. If they don’t have a pattern, you can set a schedule for when they go, such as when they wake up, before and after they go out anywhere or have a meal, and as part of their nighttime routine.  

While your child or young person is getting used to this new part of their routine, you could create a visual schedule for them that shows them each step of the process, so they know what to do and when. You could even include other aspects of their day, such as getting dressed, brushing their teeth, and having breakfast, to reinforce the habit as a normal part of their new routine.  

The way you communicate during toilet training can influence success and a child’s relationship with it, especially if the child has been met with frustration and anger while learning to use the toilet in the past.  

If your child or young person has a mishap, don’t make a big deal out of it; instead, encourage them to go to the toilet and complete the rest of the usual steps. This will help reinforce the habit of using the bathroom rather than wetting themselves. If they’re embarrassed or anxious about how you may react, reassure them that it’s okay and that they’re safe with you.  

It’s also important that your child or young person knows how to communicate their toileting needs. If they’re non-verbal, you could encourage them to communicate when they need to use the toilet by holding up picture cards, pointing at body parts, or pressing a buzzer.  

Remember: acknowledge your child or young person’s efforts. Even if they don’t manage to get to the bathroom in time, praising them for completing the other steps will help build their confidence and view it as a positive experience rather than something to be scared or anxious about. 

Consistency is key to helping children with toileting difficulties build the habit of using the bathroom when needed.  

One of the best ways to stay consistent is by creating a toilet training plan that you can share with anyone involved with your child or young person’s care, so they can continue to encourage them when you’re not around. For example, you could share it with teachers at school, who can remind your child or young person to go to the toilet at specific times.  

Having a written plan can be especially helpful if you’re short-term fostering, so your child or young person can continue to take steps towards toilet independence when they move on.  

In your plan, you could include:

• Your child’s toileting schedule.
• The visual aids you use to help your child.
• How your child communicates their toileting needs.
• Any adjustments needed in the bathroom to meet your child’s sensory needs.
• Achievable goals for each step of the toileting process.
• Where your child is in the process, and any progress they’ve made.
• Whether you use anything to reward their efforts, such as putting stickers on a rewards chart, or organising an activity they love.

Once your child or young person has the skills to stay dry during the day, you can progress to nighttime toilet training. Here are a few ideas that could help them stay dry when they’ve settled down to sleep: 

• Make sure they don’t consume too much liquid before bedtime.  
• If they’re afraid of the dark, use motion-activated lights to help them find the way to the bathroom.  
• Make sure they have a consistent bedtime routine, which includes using the toilet before sleep. 
• If they wake up at night, ensure they use the toilet.  
• If they don’t wake up at night, you could set an alarm that wakes them up to use the bathroom.  

Some children may still struggle to remain dry at night, even with all the above steps, as the cause is often biological rather than behavioural. It’s always best to discuss concerns with your child’s GP and other professionals involved in their care.