Saturday, July 16, 2016

Potty Training 101 for children with Down syndrome

Image result for a potty for me   

I am not an expert, but I hope this information will give you some ideas and help you with the endeavors of potty training. 

We initially began putting Presley on the potty around age 3 just before bath time.  We just made it part of our routine with no stress about it, sometimes she went, sometimes she did not.  Then when she was four, "I decided" she was ready and went for it.  It went horribly wrong, she became very constipated and refused to make "brown".  After ten days, I called it off and had to work on correcting that issue.  So for starters, encourage regular predictable bowel movements.  If this is an issue, read more here for ideas to help with constipation.  Observe for those subtle clues and predicable patterns, such as going off to another room by themselves, after a certain meal, pulling at shorts, squirming, etc...

Next, establish what you will call going to the bathroom.  For us, we called it "yellow" and "brown" to identify with what color she obviously saw.  Everyone in the family or who works with your child should be aware of your choice of words so there is consistency and your child is not confused by others.   These are also words that Presley could easily say.  If your child is non verbal, then consider using the sign for potty or maybe have a picture they can point to when they need to go.

Our second attempt only a few months later went great and 12 days later, Presley was potty trained.  Below is a list of what worked and what did not work for us. 

*  Buy at least two small children's potties that play music when they sense wetness.  One for the bathroom and one for your vehicle.  Here is an example on amazon.  It gives them a reward to hear and also lets you know when to cheer.

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*  When you begin placing your child on the potty, try putting their feet in warm water to help them understand what it is that you are wanting them to do.  Give praise as soon as the potty plays music and announce the word you have chosen to use.  We would say "Yay for yellow".   This is also a great trick when you want them to leave the house with an empty bladder and they can't go yet.  Presley would even say "warm water please" when she couldn't go.   I used one of our small plastic step stools and just turned it over to hold water.

*  Plan some time on the calendar to stay home as much as possible.  I am retired, so other than their dance class, piano, groceries, and church, we stayed close to the house.  This is when the children's potty in the vehicle comes in handy. When we have to leave, I have the potty in the third row of the vehicle ready with paper towels, plastic bags, wipes, and homemade sanitizer.   We called it "truck yellow".   We would also use the restroom before we left, when we got to our location, possibly before we left, and again when we got home.  She didn't always go, but we offered often.     I truly believe staying home, watching for cues, watching the timers, being consistent, and keeping it low stress was the biggest key for us.

*  I kept Presley in a t-shirt or just underwear when at home.  Presley is a typical size 4 year old, so disposable diapers were getting tight.  So, I spent money on fancy cloth diapers since I thought we would be using them for awhile.  However, they didn't fit well  either and left a rash on her bottom when used overnight.  Next, I tried Good nites trainers which look like underwear that you place an absorbent pad in.  Again, a little snug around the legs.  Then I bought the lining and water resistant material for a cloth diaper at a local fabric store and sewed it into the bottom portion of some of her panties.  This was ok, but failed at night.  Finally, I ended up purchasing a lot of panties her size with characters she picked out herself.  She knew immediately when she was wet and so did I.  For those  "brown" accidents, well some of those just got thrown away.   I wish I had just gone straight to panties in the beginning.

*  A bidet/diaper sprayer such as these were very helpful to rinse out panties and eventually little bottoms.  It also helps rinse out the children's potty.  A worthy investment and very easy to hook up.

SmarterFresh Cloth Diaper Sprayer, Premium Stainless Steel Diaper Sprayer for Toilet - Diaper Washer Hand Held Bidet Sprayer for Cloth Diapers

Squatty potty - this places your child in an position that encourages full bowel movements and doesn't let them "hold it in" when using the regular toilet. I used a small step stool on the floor to elevate her legs when she was using the children's potty on the floor.  


*  A reward or potty chart.  I made this one, because she loves Minnie Mouse.  I made a word document, added pictures and names, then laminated.   I cut out smaller pictures and put Velcro on them instead of stickers.   I made one for my other daughter (age 6), so Presley could see her using the chart and encourage her to use hers.   I tried offering chips or a special snack when she used the potty, but that has never been a great motivator for Presley.  Some have recommended using a bag of small toys and letting them pick a new one each time they get it right.

Timer or potty watch - I used a small timer and set it for every 15 minutes initially then increased the time.  A few times I tried staying in the bathroom for an extended period until she used the bathroom.  We played on Ipad, watched videos, etc.. but that did not work well for us as I found it difficult to stay still in one room with so many things needing to get done and a 6 year old needing my attention too.  Instead, we ended up going into the bathroom every 15 minutes.  If she couldn't go, I would either use the warm water or just wait for another 15 minutes. I took away all the distractions (ipad, toys..) and we focused on the task at hand.   A friend used the potty watch.  She put it on her daughter and while she went to mother's day out, therapy, or at home, whoever was around her when it went off knew to take her to the bathroom.  I could also see it beneficial for the mom to wear a watch to remind her in case the child is playing in another room when it goes off.

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*  Leave the light on in the bathroom, this encourages Presley to go in there on her own when she needs to go.  We typically turn the light on when we use the restroom, so this invites them into the room even if there is adequate light from a window already.

*  Place your hand on their lower abdomen.  This worked for teaching how to put "brown" in the potty.  I sat on a stool in front of her and put my hands on her lower portion of her belly and said "push that brown out".  She would instinctively push back against my hand and therefore learned exactly how to use her muscles to push it out at her command.

*  Potty videos and books - we read and watched many of these.  Signing times has a cute video here that has catchy songs you can sing together while waiting. We also had a lot of fun making our own videos using her older sister and their doll Minnie. Presley likes to read so we used flashcards to establish a certain routine in the video, but you could use pictures too.   The flashcards were like this:
        - Do you need to go to the potty?
        - Yes
        - Go to the potty.
        - Panties down.
        - Go pee pee or yellow.
        - Wipe.
        - Pants up.
        - Wash hands with soap and water.
        - Dry hands

Here is one of our videos:

Make it fun.  Each time we headed to the bathroom, I would sing a silly song or phrase to try to make her laugh so she would have a positive association with going to the bathroom.  I still sing (imagine Beach boys surfing song)  "Let's go potty now, everybody potty now, come on and go potty with me.   How about "1 little, 2 little, 3 little browns....."  I won't bore you with the others, but sometimes Presley now says "Mom stop".   I also told Presley we were having a "brown party" and she needed to make brown so she could add it to the potty party.  She thought she was a big girl doing this.  Let them flush also since this isn't something they ordinarily get to do.

Auditory processing - a minimal 3 or 4 was recommended by our neurodevelopmentalist at NACD.  This ensures they truly comprehend the task you are asking of them.  See here for more information about auditory processing.

Reflex integration - we initially did rhythmic movements and learned about reflex integration from Play Move ThriveIt seemed to wake up her body and let her feel all the sensations easier.  Some moms are having success using the QRI laser to integrate reflexes and produce results much quicker in many different areas.   Before using the laser, Presley would make yellow in the shower as soon as the warm water touched her, but after a week of using the laser, she stood up and asked to get out and go to the potty instead.  We were not using the laser when she was potty trained though. 

Accidents - I carried extra underwear, pants, and a baggie everywhere we went.  We had lots of accidents in those 12 days, but she caught on that we weren't turning back and we stayed consistent.  One time at a 30 minute piano lesson for big sister, we changed outfits three times.  When she had an accident at home, I would walk her over to get the paper towels and cleaner and she had to help clean up the mess.  She then had to take her underwear off and put them into the washer by herself.  She did not think this was very fun.  I tired my best to be unemotional when there were accidents, but hey, I am human.

*  Some parents have had good results using this 3 day potty training method.  I have best success when I incorporate a variety. and the Bridget Murphy 4 day method seen here.

*  As with everything, keep diet and environment consistent without changes as possible when starting potty training.  Don't add any other stressors to them or yourself.    Always a good, clean diet with adequate sleep.   Good luck!

Many blessings,


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