Becoming dry and clean is an important developmental milestone for self help and independence.  Becoming continent opens the doors for further opportunities and helps children to socially integrate into the community.  In the absence of a relevant medical condition, continence is achievable for almost all young children with Down syndrome.

When do you start ?
Begin watching for signs by the age of 2 years:

Motor Development
Non –mobile child can sit with or without support
Mobile child- attempts to squat without losing balance; independent walking developing.

Cognitive development
Searches actively and appropriately for a toy, possibly by eye pointing.
Imitates an action
Engages in make believe play, for example sits a doll on a potty.

Language development
Understands a simple request, for example “where is Daddy?”
Is able to communicate needs by words, signs, or gestures

Toileting
Is able to stay dry for  at least an hour
Is aware of what a potty/toilet is for
May show awareness of when wet or soiled (although many children with Down syndrome do not show awareness or sensitivity to being soiled or wet)

Adapted from check list from PROMOTING CONTINENCE :THE CHILD WITH SPECIAL NEEDS, Rogers 1998

An important component of the readiness checklist is the assessment of bladder and bowel development and an overview of the physical skills a child requires in order to be toilet trained.   If the child is not able to stay dry for an hour at a time a couple times in the day, then the bladder is probably not yet mature enough for training.  If you are unsure, place a paper towel in your child’s nappy and check it every hour.  Make a note of whether or not the nappy is wet or soiled and look to see how many times the paper is dry a day. 

Preparing to start

• •    Put teddy or a favourite doll on the toilet
• •    Sing/ talk about toileting in a positive way
• •    Put child on the toilet with toilet seat down if necessary....Place mirror on front of toilet so child can see the BIG girl /boy sitting on the toilet.
• •    Read books on toileting/watch CD’s on toileting/ make your own book about your child going to the toilet
• •    Introduce an open door policy in toileting area in your home. Request that your child sees other children on the toilet in the preschool he attends.
• •    Ensure there is no major changes in your child’s life occurring e.g., a new baby, new school, etc. If starting a new school, allow the child to settle in first.
• •    Decide on which words/terminology to use keep it universal. 
• •    Discuss your plans with relevant others (e.g., nursery staff)
• •    It does not matter whether you use the potty or toilet, but make sure that whatever you choose has a footrest, a smaller seat, and preferably handles.
• •    Allow your child to practice sitting on the toilet in a pleasurable context.  NEVER force your child to sit, but bribery is OK :)

© Ann Haig Wheeler, DSC 2010

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