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This information sheet explains how Occupational Therapists can help children with toileting training.

Occupational therapy promotes the participation of children and young people in everyday activities they find meaningful.

Occupational therapists work with young children and their families to promote participation in everyday tasks including self-help skills (e.g. sleeping, going to the toilet), play and participating in preschool and school.

Occupational therapists can work alongside other health professionals in your child’s life including a paediatrician, speech pathologist, physiotherapist, and teacher.   

All children develop at different rates and the age your child starts toilet training can look different to other children. 

The average age for day time toilet training is 3 years and night time toilet training is up to 7 years. Some signs your child may be ready to start toilet training include:  

• Telling you or indicating they have a wet/soiled nappy  
• Trying to remove their wet/soiled nappy themselves 
• Fewer wet nappies throughout the day 
• Ability to stay dry during the day for 2 or more hours 
• Being dry after waking from a nap  
• Showing an interest in using the potty and toilet 

Toileting is often a concern for families with young children and it can be challenging to know the best way to tackle this issue. 

While wetting commonly occurs because the bladder is not working properly, it may also be due to a delay in your child’s development.   

Occupational Therapists can assist children with toileting, developing goals to help increase functional ability and skill in this task.

How an Occupational Therapist can help your child with toileting:    

• Help identify if your child is ready to be toilet trained.  
• Set specific and achievable goals that relate to the child’s difficulties:  
• Sensing the urge  
• Getting on the toilet  
• Hygiene tasks (e.g. wiping, washing hands)  
• Fear of the toilet   
• Adjusting clothing/pants up and down  
• Educating parents/caregivers on toileting strategies to use at home.  
• Toilet set up: identify possible equipment or products that can help your child with toileting (e.g. bed wetting alarm, toilet seat inserts, continence liners or underwear).   
• Liaising with school/day care to provide toileting strategies that can be used at school to support your child.  

Toileting is often a main concern for families of young children with or without developmental disabilities. The process of toilet training can be challenging for children with ASD. Below are some common reasons why your child may be having difficulty with toileting: 

• Physical: there may be a physical or medical reason for your child’s delayed toileting skills, this is best to discuss with your doctor.  
• Sensory: Children may be sensitive to loud noises (e.g. toilet flush) or other sensory experiences which can impact engagement in toileting. 
• Language: Some children have difficulty understanding and using language. For example, your child may not be communicating when they need to use the toilet or their cues may be misinterpreted.   
• Dressing: Your child may have difficulty adjusting clothing.   
• Body cues: Some children may not register that their body is telling them they need to go to the toilet or that their clothes are soiled or wet.  
• Need for routine: Learning new routines or building new skills can be challenging, especially if they are used to doing an activity a particular way.  
• Using different toilets: Using bathrooms that are not part of the usual routine (e.g. outside of the home or school) can be challenging as they are unfamiliar. 

Additional toileting strategies you can use at home to help children with ASD 

• Continence: the ability to control movements of the bowel and bladder.  
• Urinary incontinence: accidental or involuntary loss of urine from the bladder.  
• Bowel incontinence: accidental or involuntary loss of faeces from the bowel.  
• Overactive bladder: this occurs when the bladder has trouble storing urine, the child has urgency and may leak urine on the way to the toilet.  
• Underactive bladder: this occurs when the child goes to the toilet infrequently. Sometimes urine escapes without any warning as the bladder overfills.  
• Leakage: if the child puts off going to the toilet and wets when the bladder is overfilled.    
• Constipation: A condition where an individual has difficulty emptying the bowels.    

You can find a local OT via the . 

The cost of therapy can vary depending on the therapist and whether you are paying privately or using a funding scheme to assist with payment. Most therapists charge by the hour.  

You can chat to your doctor about accessing limited subsidised therapy sessions through a Chronic Disease Management Plan (CDMP) or Better Access to Mental Health Care Plan (BAMH).