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The provided sample questions and answers will give you an idea of what you can expect when you ask one of our therapists a question. This will also help you decide if your question requires a short answer or a long answer.
Example #1
Short Question ($15):
My son is five years old and has cerebral palsy. When can I expect him to be toilet trained?
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Short Answer:
Toileting is an important skill and can be taught. You cannot always rely on your child to show his interest or readiness. The first place to start is to do a toileting diary. Record the frequency and timing of wet/dry cycles. Do the same for frequency and type of bowel movements.
This will give you the information to decide how you want to proceed. If he is constantly wet or having loose stools, consultation with your doctor is indicated. If he has a definite frequency of soiling and wetting himself, you can proceed with a timed toilet routine that you establish. In my experience, some children with this sensory motor diagnosis are toilet trained within typical age ranges. We also see children who continue to acquire this skill up into the teen years.
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Long Question ($60):
My son is 5 years old and has cerebral palsy. He can walk independently and can even help with dressing and undressing. We have tried to get him to use the toilet and he resists. In fact, he hides in his room when he is going to have a bowel movement. He also hates sitting on the toilet.
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Long Answer:
Learning to control their bowel and bladder function is a significant mastery skill for children. It is worth the effort to evaluate how you can assist your child in gaining this important skill. Skin integrity and improved hygiene are some of the basic benefits. The caregiver also gets the great bonus of not having to manage diaper clean-up and hygiene, as well as the reduced cost of diapers. It is also significant that as children become older many extended caregivers are reluctant to do diaper changing routines.
So with that incentive you can evaluate and plan how you want to proceed. Be advised to take your time to attend to the stumbling blocks to this process.
The first step is to make a toileting diary. This should be done over a week's time to get a good inclusive look at the patterns that develop.
- Monitor wet/dry cycles, recording frequency, amounts and comments
- Monitor bowel movements, including frequency, amounts and comments
This will give you the information you need to determine if he has the beginnings of bowel and bladder control. If no pattern can be established you would check with your doctor to determine if other health issues are part of the problem. When you note comments, you may begin to see telltale times where he is actually showing you readiness. This might be pulling at the diaper to indicate wetness, seeing that he urinates consistently as soon as he has a meal, or hiding when he has a bowel movement.
If you determine that he is experiencing periods where bowel and bladder are controlled, you can proceed with a timed toilet program. Please know that you will need to be consistent and proactive in establishing the frequency of trips to the toilet. Do not start this until you and your son are prepared to follow it through. A haphazard approach will be frustrating for both of you and it will not be successful.
- First step is to make sure the environment is right. Make sure the toilet seat fits. You can get a step stool, a reducer ring for the seat, or a grab bar on the wall. All of these items need to be very secure. Also pay attention to any distracters or fears you may have noted on your comments. If he is afraid of the flush, don't flush. If he hates the lights and noise of the fan, don't turn them on.
- Set up the particular of clothing and diapers. Do not have your child wearing difficult to manage clothes, as this will hamper speed and become tiring. I would tend to favor underwear with possible pad/plastic pants. My experience has been that Pull Ups deter training.
- Set up the expectations. Before you start, let your child know what you want to do and what you expect. Ask for some feedback. Decide if you want to give some incentives. For some children, they might get a sticker for sitting on the potty. Others respond to praise. From day one, all toilet routines happen in the bathroom with your child standing and assisting. This means that if your child wet his pants, you would go to the bathroom for the clean up and clothes change. Even as you start thinking about what you want to do or are keeping track of his toilet diary. Bring all toilet routines to the bathroom. This means that he assists with clothing on and off; he can throw his diaper into a wastebasket and can help to wash himself.
- With a young boy, you must also determine the age-old "stand or sit" option for urinating. This is usually a personal decision of the family and even the child. But consider how steady on his feet he is, if he is easily distracted and can he aim and get it into the toilet bowl. If you decide to stand, give him some concrete guidelines, like put your legs up against the rim or mark out some tiles with tape for him to stand on.
- The timing is determined by being proactive to the patterns established in your toileting diary. It could be established that he does automatic toilet times at waking, before naps and after meals. You would also include other timed routines that related to the length of control exhibited. For example, if he is wet approximately every two hours, you might do toilet visits starting at an hour and a half. If he does not urinate, you would try again in 10-15 minutes.
- How long to try? This is harder to determine but in general I would try at least three to five minutes given his age. You can come up with a routine that helps to first just get sitting time established. This could be a toilet song or a toilet book, being careful that sitting on the toilet does not become a social event.
- You said your child goes to his room to have a bowel movement in his diaper. First determine that he is not having pain. Is the feces too hard? Is he just shy or trying to avoid sitting on the toilet? If you note the pattern and watch the behaviors, you can intervene and bring him to the toilet. Have him sit for 3-5 minutes and then get off the toilet. Continue to watch for his next attempt at going, and bring him to the toilet.
- It is important to be matter-of-fact in your manner and the words you use. I might say something like, "You are ready to go Poo, and you can do it in the potty". If you bring him to the bathroom to urinate and he does not go, you can say, "Good job sitting on the toilet. The toilet is where you want to Pee. We will try it again later". (Choice of words or terms for feces, urine, potty, etc are typically family determined.)
Many other details will still need to be considered as you move along on this adventure! If things are not going well, don't start changing everything up too soon. Ask for someone else's help. Sometimes Dads or siblings can be a great help in this task. You can decide to only tackle
bladder control and work on bowel movements later. In some instances, children catch on quickly. However, some parents continue to work on it for months. Good luck to both of you.
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Example #2
Short Question ($15):
My three-year-old tantrums when I go to the grocery store. Nothing helps!
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Short Answer:
Most three year olds are not great shoppers. The easiest out is to avoid the shopping experience for a while. It is just frustrating for both of you and it results in a power struggle. That is setting up a pattern or expectation of behaviors associated with shopping. For a break, get a friend or family member to watch your kids for all big shopping trips (Not possible? Consider the alternative!).
After the break, start taking your child on short trips. Go to a convenient store and get milk and bread. Run in and out of a different grocery store and pick up three items only, before the behaviors start. Then, praise, praise, praise! You can build up success by slowly increasing the shopping time.
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Long Question ($60):
My three-year-old tantrums when I go to the grocery store. Even before he gets in the door he is throwing himself on the floor. My family advises me to just let him scream as he is getting spoiled. It is frustrating because once we are back in the car he easily quiets down. I have tried bribing him with cookies and even that may upset him.
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Long Answer:
Best advice - take a break from shopping! Maybe that is not what you want to hear, but at this point you and your son, as well as the extended family, have gotten into a very negative pattern and attitude about the shopping experience. At this level of frustration, it will be hard to modify the experience.
Easier said than done, but find another way to get your shopping done. This might be doing it in the evening when your spouse is home, exchanging babysitting time with a friend, or asking relatives to give you the time to do some shopping.
After a break from grocery shopping, you are now ready for the mini grocery experience with your child. Before you actually make this trip, it is important to revamp your attitudes about what is happening with your child as it relates to grocery shopping. Are there factors that might be improved so that you can go shopping with your child?
- Are you shopping at the end of the day when you are both tired and really hungry? Some people (children and adults) don't function well when they are trying to function "on empty". Start the shopping experience when you are well fed and rested.
- Some shopping times are guaranteed to be hard! Of course, the worst times are on payday, Saturdays, or right after work. Plan your first trips when minimal crowds are expected.
- Lastly, is your child sensitive? Some children are more impacted by sensory environments that can overload their nervous systems. For those kids, the lights, the crowding, the crash of carts, and the public address system are over-stimulating. Maybe the cart is cold and digs into their skin. Perhaps every time you drop an item in the cart it can scare or startle your child. If these are factors for your child, you can soften the effects of the trip. HOW? You can bring a favorite blanket for the grocery cart, wear a brimmed hat to soften the lights, attach a favorite toy to the handle of the cart to distract him from the stimulation, or try out some earplugs to dampen the noise.
With this problem solving in place you are ready for the trip. Pick the best times and the easy store. Plan a grocery list that is short and highly motivating. Your goal is to have the quick in and out of a store with a positive completion of your grocery list. Once that happens a few times, you can grow the list by small increments. Go slow and steady. Do not stop and visit if you run into long lost friends. Your mission is to have multiple positive shopping experiences. Your sensitivity, timing and history of success with shopping will change the dynamics.
Lastly, if your child struggles in a variety of stimulating environments, you might want to refer to books about sensory sensitive children. Possible options might include:
- The Sensory-Sensitive Child: Practical Solutions for Out-of-Bounds Behavior
- Parenting a Child With Sensory Processing Disorder
- Sensory Smarts
Best of luck.
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