If sensory information is not processed smoothly, we might pay too much attention to the unnecessary sensory information or not enough attention to the necessary sensory information, to perform an activity, feel calm or pay attention. This can cause us problems. We may not be fully aware of what is happening, be distracted, uncomfortable, confused or perhaps easily upset because the information we are receiving is not clear enough for us to understand what is really happening.
Possible Toileting Obstacles
- Your child may be sensitive to toilet tissue – try using moist toilet roll
- Consider visual and auditory stimulation around your child’s environment and keep it to a minimum
- Your child may not like how the toilet seat feels
- Your child may feel unsafe with their feet off the ground and sitting (consider small padded seat insert and a stepping stool)
- Some children may be unresponsive to sensations, such as the feeling of being wet/soiled
- Some children may find the sensation of urinating/bowel movements uncomfortable therefore they may withhold toileting to avoid these uncomfortable feelings
- It may be that your child has an oral/tactile sensation problem and therefore dislikes certain high-fibre foods which promote healthy bowel movements
- Your child may like the sensation of a nappy pressed against his/her body. Try using a waist belt instead of wearing a nappy to provide the sensory feedback your child may be seeking
The different senses affect toilet training in different ways. There is information below about how the different senses affect toilet training, with some suggestions for things that can be done to help. The suggestions will not be appropriate for everyone, but should provide ideas about what may be done to help.
The vestibular sense provides information that allows us to stay balanced and upright while we move, sit or stand. Children may feel that they have a problem with balance, but this might not be noticed by those around them. They may not be able to say that they have this problem.
Children with balance problems may feel frightened of falling off or into the toilet. This may be made worse if their bottom is not well supported by a toilet seat that is the right size for them and if their feet are not flat on a firm surface.
Space around the toilet may upset some children. They may prefer a cubicle or having a wall near them. A handle next to the toilet for them to hold may help.
Some children who are not getting enough feedback about their balance will try to move more to help them feel balanced. Children with this issue might find it hard to stay sitting still on the toilet or potty for long enough to pass urine or open their bowls.
Hearing – Our ears provide lots of information about types of sounds and where it is coming from. Bathrooms have lots of different noises and can be louder and more echoey than other places. This is because they often have fewer soft furnishings and have tiles or other washable floors. There may also be extractor fans, running water, pipes gurgling and in public or school toilets there may be other doors banging, flushes or hand driers. There is also the sound of wee or poo going into the toilet.
Children who are more sensitive to hearing may find the range of sounds in the bathroom difficult. They may make them feel anxious or frightened. Sudden and unexpected sounds, such hand driers and flushes may be particularly alarming for them.
Children who are under sensitive may want to be in the bathroom, but may want to make noises, or play with the flush. They may be distracted by the sounds in the bathroom and so not be able to focus on using the potty or toilet.
Although smell and taste are separate senses, they often work together. Children who are over or under sensitive to smell and taste may have more restricted diets, which can increase the likelihood of constipation. Children who are more sensitive to smells may struggle with all the different smells in the bathroom: different cleaning products, toiletries and any lingering smells of wee and poo can be difficult.
Children who struggle to filter out different information may struggle to process all the different smells in the bathroom. This can distract them and make it more difficult to focus on toileting.
Touch – Our skin has receptors that send information to our brain about touch. The receptors allow us to tell if something is hot or cold, hard or soft, rough or smooth, wet or dry. The most sensitive parts of our skin have the most touch receptors in them.
Children who are over sensitive to touch may find a hard toilet seat cold or uncomfortable. They may also struggle with the feeling of toilet paper, with any splashes from the toilet and they may struggle with the feeling of opening their bowels.
Children who are under sensitive to touch may like the pressure of their nappy on their waist and hips. They may particularly like the weight of a full nappy. They may like touching different things in the bathroom. They may not notice when they have wet underwear, which can be a useful learning experience for other children during potty/toilet training.
Vision – Being able to see helps is important for knowing where we are and for balance. Children who receive too much visual information may find the bathroom difficult because of the bright lights, reflective surfaces on shiny tiles and mirrors. They may be distracted by lots of patterns on the floor, walls, towels or from toiletries on the surfaces. Too much visual information may make them feel upset or anxious.
For children who are not getting enough visual information may focus too much on the extra stimulation they enjoy from the bright lights, reflective surfaces, colours, patterns and so on. This may be distracting so that they are not able to think about using the potty or toilet.
For more information and support ideas:
Interoception and toilet training
There is evidence that some children learn to recognise their body signals of a full bladder and bowel after they learn to use the potty and toilet and have developed a toileting routine.
Current thinking suggests that it is not necessary to wait until children show signs that they recognise they are weeing or pooing, but that a regular toileting routine can help them learn to use a toilet or potty and the awareness of their body sensation can sometimes be understood and responded to afterwards.
We can’t know exactly what a child is feeling, but we can understand a great deal by watching their behaviour and responses.
If children understand and notice how their body feels they can then begin to respond to their physical needs, including learning toileting skills.
Interoception and toilet training tips:
Understanding messages from their body helps children with toilet training. Learning how to link the signals from their bodies with their bowel and bladder actions can be really helpful for them.
Here are some tips for including this as part of your child’s learning process to get clean and dry:
Teach your child how their body makes wee and poo and how it tells them when it needs to come out.
Instead of asking if they want to go to the toilet, ask if they can feel any wee or poo that wants to go in the toilet? This will help them make sense of the messages they are receiving.
Pictures and videos on how the body works and the bowel and bladder are fun and make sense of why we use the toilet.
Include body awareness to help children understand the messages from their bowel and bladder
Identify if children are having difficulty learning Interoception messages and take this into account. A sensory assessment may be helpful.
Interoception and constipation
Constipation is very common in children. It can be uncomfortable and is often painful.
Children’s awareness of these sensations often can make them afraid of pooing. This can cause children to withhold their poo to avoid the discomfort and the frightening sensations. This makes the constipation worse.
It is important to treat the constipation effectively, but we also need to understand how a child is feeling and interpreting the messages from their intestine and body.
We need to evaluate and respond to their feelings and anxieties. We need to address the constipation, and at the same time include strategies to help with their understanding of body sensations and help the anxiety linked these feelings.