Toilet Training Guide for Children with Down Syndrome

Step One: Assessing Your Child's Readiness

Many parents wish to begin toilet training before their child is truly ready. Starting a training programme before the child shows the necessary readiness indicators prolongs the time it may take to acquire the skill and reduces the chances of success. Early attempts can also lead to additional problems, including an increase in undesirable behaviours related to toilet use and greater frustration for the parents.

To make toilet training as smooth and positive an experience as possible for everyone involved, it is recommended that parents first assess their child's readiness according to the following criteria:

• Age: Age alone should not be the deciding factor, but it is recommended to wait until after the child's second birthday before considering training. For children with Down syndrome, researchers have found it helpful to wait until after age three.
• Bladder control: The child must be able to fully empty their bladder when using the toilet and remain clean and dry for at least one and a half hours during the day.
• Predictable bowel patterns: The child should follow a regular and predictable pattern of bowel movements.
• Motor skills: The child should be able to walk to and from the toilet independently, and be able to pick up objects.
• Behaviour: The child should be able to sit comfortably on the toilet or potty for two to five minutes. You may allow the child to look through a favourite book or play with a favourite toy while sitting.
• Ability to follow instructions: The child should be able to follow simple instructions (for example: "sit down").
• Expressing needs: The child should be able to communicate their need to use the toilet — whether through facial expressions, body movements, gestures, pictures, or words.

Step Two: Assessing Parental Readiness

Before beginning, parents need to be prepared and committed to dedicating the necessary time and effort to implement an effective programme. If your child is showing readiness indicators but your schedule does not allow for a consistent daily training routine, it is better to wait until you have sufficient time available.

To assess your child's readiness, check their nappy every 30 to 60 minutes and mark down each time they indicate a need to use the toilet. Keep this data for two weeks. If the chart shows that the child regularly remained clean and dry for at least one and a half hours, and regularly expressed their need to go, they may be ready to begin training. If not, you can choose to continue recording or stop and try again later.

Readiness Tracking Chart

D = Dry  |  U = Urine  |  BM = Bowel Movement  |  U, BM = Both

Time	Day 1	Day 2	Day 3	Day 4	Day 5	Day 6	Day 7
6:00 AM
6:30 AM
7:00 AM
7:30 AM
8:00 AM
8:30 AM
9:00 AM
9:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
3:30 PM
4:00 PM
4:30 PM
5:00 PM
5:30 PM
6:00 PM
6:30 PM
7:00 PM
7:30 PM
8:00 PM
8:30 PM

Step Three: Ready, Set, Go!

Once your child and you are ready, follow this daily routine:

• Wake up → Remove soiled nappy → Use the toilet → Put on underwear
• Take your child to the toilet as soon as you anticipate their need to urinate or have a bowel movement, referring to the readiness tracking chart.
• Make it fun: allow your child to read their favourite story or bring their favourite toy to the toilet.
• Use a visual picture schedule to reinforce verbal instructions.
• Use motivating rewards, and vary them from time to time to keep your child engaged.

Source: The information in this article has been reproduced under an exclusive agreement with the National Down Syndrome Society. Available at: ndss.org