Becoming independent in toileting is a huge milestone in development. Some children have difficulties with being able to manage independence during toileting. This may be due to the following challenges:
- Accessing the toilet – are they able to manoeuvre themselves in and out of the toilet cubicle and sit/stand from toilet?
- Maintaining balance whilst sitting on the toilet – if the child is unable to place their feet flat on the floor, this could impact on balance whilst sat on the toilet – particularly when twisting to clean themselves. Use of a step would assist with increasing the base of support and balance.
- Manage clothing during toileting – are they able to pull their clothing down/up and manage fastenings on clothing? Activities within the dressing section can help with this. These skills could be practiced when getting changed.
- Cleaning themselves after toileting – are they able to manipulate the toilet paper; have adequate amount of toilet paper; and be able to complete the wiping sequence?
- Hand hygiene routines after toileting – are they able to access the sink; press down taps and soap dispenser; access hand towels or dryer? Using a visual timetable may assist with sequencing.
Help for children who struggle to wipe themselves effectively
- Try using wipes instead of paper, these can be easier and more effective to remove poo than paper.
- Cheaper toilet paper can give more tactile “feedback” than softer paper
- Practice folding paper
- Play reaching games reaching around the body and behind the back
- Gross motor activities to promote reaching and balance during co-ordination
- Use of a mirror to help work out where the hard to reach area is/ do a final check
- Standing up, you child may find it easier to stand up to wipe themselves.
Some children struggle to use their hands to manipulate the paper. Carry out the following activity on a daily basis to improve dexterity of the child’s “writing” hand. Shake hands between exercises: - A bandage is laid across a table. The child sits at the table trapping the end of the bandage between the wrist of the “writing” hand and the edge of the table. Using fingers only, the child tries to gather the bandage under the hand.
- As the child progresses, they can be timed. This can then be recorded and the child can try to beat these times during subsequent attempts.
- A bandage is laid along the edge of the table. The “writing” hand is held above one end of the bandage with the wrist resting on the edge of the table. Using fast thumb movements only, the child tries to slide the bandage under the hand until the other end of the bandage is under the thumb. For example, if the right thumb is used, the bandage is moved to the right.
- Try to roll bandage up using one hand only on a thigh.
- The child sits at a table and tries to move their fingers as if playing fast music on a piano (you could play piano music while this is going on!).
- The child sits with the heels of the hands together and fingers curled, fingertips apart. The child tries to touch corresponding tips one at a time then progressing to touch as quickly as possible. Repeat this with eyes closed.
Activities to support skill development needed for independent toileting
Click the drop down boxes below for details on activities:
Pinch and Pincer Grip
Developing isolation of finger movements with opposition to the thumb is an important prerequisite for pencil control and other fine motor tasks. When encouraging/practicing a pincer grasp it is essential to encourage the child to pinch using the tips of the index finger and thumb, so that the thumb and index finger are curved to create a circle shape i.e. the index finger and thumb should not be straight.
These activities should help to develop pincer skills:
- Playing with an old telephone with a dial; pressing cassette recorder buttons etc.
- Tearing paper for collages.
- Roll torn tissue paper into small balls then stick onto paper/cared to make collages.
- Picking up small objects such as counters/pennies/beans etc. and placing in jars/containers.
- Popping bubble wrap.
- Threading – using threading cards.
Find out more
Further information and advice is available from ERIC, the Children’s Bowel and Bladder charity