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Occupational therapy advice: Toileting (Sensory Differences)

Toileting is a complex task requiring motor planning and co-ordination to get to the bathroom, fine motor skills to undo buttons and remove clothing, body awareness to wipe and clean and good sensory awareness to recognise the ‘need to go’.

General information

Toileting is a great step towards achieving independence and each child will vary in terms of what they are able to achieve. Signs of being ready to start toilet training are children recognising when they become wet, need to toilet or have opened their bladder or bowels, and they should be able to remain dry for around two hours. In order to toilet train they will need to be able to get on and off and sit on the toilet. They will also need to have a routine (going to the toilet at regular and predictable points such as after meals) and lots of encouragement.

Toileting difficulties

Sensory differences can impact on a child’s ability to become independent with toileting, for example a child with movement difficulties could find it hard to keep their balance in sitting on the toilet, the child with tactile (touch) processing difficulties may find toilet paper too rough and avoid wiping, or if they have poor body awareness (proprioception) they might not be able to clean themselves accurately. Another difficulty could be with the internal awareness, or that ‘need to go’. These children often present with a wide range of indicators such as difficulties with regulating their body temperature, respiration and recognition of thirst or even hunger e.g. always eating or not being aware they are thirsty.

  • Ensure the environment is calm and quiet. Some children may prefer increased light, whilst others may find some lighting too bright.
  • All training or development of toileting skills should be relaxed and calm, it will take time and not work every time. If your child is not progressing after a few weeks of trying, leave it for a couple of weeks and try again later.
  • Offer a reward for opening their bladder or bowel on the toilet or even when the child asks to use the toilet. The reward could even be a simple high-five or making a really big fuss of success.
  • Make it fun; show them the colour in the toilet changes colour when they have successfully opened their bladder, or get a toilet training ball for boys to aim at!
  • Ensure your child is able to get on and off the toilet easily, you may need a non-slip step or handle for them to hold onto. If you are unsure liaise with the Occupational Therapy team for further advice around equipment.
  • Ensure your child has a step or stool under their feet when they are seated; this will help them to feel stable and may reduce anxieties if they have problems with balance.
  • Get a soft ring reducer to ensure they feel supported and comfortable and don’t fall through the toilet seat.
  • Read children’s books or social stories about toileting with pictures to outline the sequence.
  • Role play the toileting sequence with dolls, giving dolls lots of praise for trying.
  • Speak to nursery or school about their pattern for toileting/nappy changes and work together to set up a toileting programme.
  • If the noise is too much, place sound absorbing towels in the bathroom, or try earplugs, music or running water.
  • With smearing of faeces, try your child on a fixed bathroom routine and increase experiences of strong smells.
  • Use distractions like books, songs, music and pictures on the walls or have bathroom sensory tools such as fidgets, chewy tube or textured things to pull and stretch.
  • If they find some elements difficult then try using some proprioception or deep pressure activities prior to toileting to enable your child to better tolerate the sensations.
  • Help your child gain awareness of stomach muscles by resting your hands on your child’s lower tummy.
  • Engage in therapy ball activities- lying over the ball, crossing midline (arms or legs reaching to the other side of the body). This is believed to increase registration and help individuals recognise internal sensations. If your child isn’t keen on a therapy ball, you could encourage them to lie over the arm of a sofa instead.
  • Play bubble blowing games to work stomach muscles in preparation for toilet training.
  • Start with the child sitting on the toilet or potty (in the bathroom/toilet where possible) in a flexed position, for five minutes at a time. Leave the tap running if this is helpful.
  • When on the potty/toilet encourage your child to play blowing games e.g. bubbles, this will encourage the stomach pushes required for your child to use the toilet.
  • If your child doesn’t seem to be aware that they are urinating, let them go naked – they will see when they urinate and connect the sensation with the consequence.
  • Engaging in regular body awareness activities such as yoga (Cosmic kids is good) and body scans (scanning each part of the body for sensations) can increase awareness of a child’s body.
  • Modelling behaviour such as telling your child when you need a ‘wee’ or ‘poo’ how that feels can be a good way to teach them about internal body sensations. Practicing with them how they feel before and after, focusing on their lower body (bladder, tummy and bowel) can support this learning.
  • Increasing awareness of internal body sensations (interoception) is key to encouraging recognising the body sensations of needing to use the toilet. See the interoception handout for more information.
  • This can be tricky if a child has poor body awareness. Increasing their proprioceptive input, e.g. pushing the wall, will wake up arms and hands and give the brain increased information about body in space.
  • Using wet wipes can increase tactile input thereby increasing information about where the body is in space.
  • You could try having a mirror next to the toilet so that your child can see where their hands are, but they may struggle to adjust their body in space.

Some children may have poor fine motor skills; this could be due to a number of reasons.

  • You could try giving your child a toy to fidget with whilst on the toilet – this may increase feedback to the brain to encourage fine motor skills.
  • Where possible, put a long mirror in the toilet so your child can see if they have adjusted their clothes properly.
  • Loose fitting elasticated clothing, to make it easier to pull up and down.

Some children dislike water, making hand washing very difficult.

  • Try novelty soap with a toy in the middle – get your child to wash the soap away to get to the toy. You could also try a visual timer so they can see how long they have to wash for.
  • Using the right temperature water may help, try using warm water rather than cold or hot.
  • If your child will not hand wash, then try hand rub, baby wipes or even a flannel.


Building Bridges Through Sensory Integration: Therapy for Children with Autism and Other Pervasive Developmental Disorders by E. Yack, P. Aguilla and S. Sutton.

A group of young people playing a board game