Last week we featured the classic rebroadcast of, Autism Potty Training – When to Start and Steps to Take, and today I’m back with my community manager, Kelsey General, going over the top 5 questions about potty training we’ve heard in our online community.
1. When should you start potty training and what prerequisites does a child need to have?
Potty training is a critical life skill but it’s important to understand if you start too early you could be causing more stress, problems, and frustration than needed. If you think your child might be ready you can look for: staying dry for 2 hours at a time, noticing if the child is uncomfortable when wet or dirty, sitting for 2 minutes, pulling pants up and down, and if the child is comfortable with handwashing. If your child isn’t ready, it’s never too early to start pairing the bathroom and the toilet, introduce your child to the concept and get on the same page with the other adults in your child’s life with the words and terms you’ll be using.
2. I have decided to start potty training. What should I do next?
I recommend following these four important steps: Extra Liquid, Scheduled Sits, Reinforcement, and Data. All of these play a big factor in the success of potty training. The extra liquid is going to increase the need to pee and practice on the potty and scheduled sits are going to build going to the potty into their routine. A high reinforcement your child doesn’t have free access to daily is crucial so they can see good things happen when they go potty, especially for poop. Lastly, tracking data is going to help you know when things are going right even if it might not seem like it, and it will also alert you when your plan isn’t working and you need to change it up.
3. My child will go to the bathroom on their schedule, but only when I take them. How do I teach them to initiate and go independently?
Teaching, manding and requesting can be done during scheduled sits. Whether you’re using an image they can carry with them, saying potty on the walk to the bathroom, or signing for potty when they go potty all of these will get the child in the habit of telling you when they need to go. Fade the schedule away, and stop asking if they need to go!
4. What do we do about pee and poop accidents and asking for diapers, for pooping?
In potty training, your goal is to get daytime pee trained first, if pee accidents are occurring then you need to readjust your schedule. Take the child to try peeing more often and look at your data to find out their usual natural potty times. For poop accidents, firstly if they are a boy remember to train them to pee sitting to avoid accidental pooping while standing. Also, check out my episode with Dr. Steve Hodges all about constipation and its effect on potty training.
5. My child is doing well at home and during the day but won’t pee out of the house. What should I do?
Your child is not potty trained unless they are going potty daytime no matter where they are. I strongly suggest practicing this throughout the process by building in-store trips during your daily outings, getting to preschool early to use the bathroom, and trying different scenarios so it becomes part of the new normal.
For more information on potty training, you can check out my workshop or join our online community. I also have a chapter devoted to this in both of my books, The Verbal Behavior Approach and The Turn Autism Around Approach.
- Important potty training prep.
- Signs to look for in potty training readiness.
- Potty training steps and tips.
- Fading the potty schedule and manding for the potty.
- Handling accidents and poop holding.
- Is your child constipated?
- Learning to potty out of the house, steps to take.
- Are you having a hard time potty training a child?
- Classic Rebroadcast: Autism Potty Training – When to Start and Steps to Take
- Potty Training and Constipation with Dr. Steve Hodges – Autism Mom, ABA Help for Professionals and Parents
- Take a Free 10 minute Digital Assessment
- Mary Barbera on Facebook
- Mary Barbera on TikTok
- Mary Barbera on Instagram
Mary Barbera – Turn Autism Around Podcast Transcript
Transcript for Podcast Episode: 211
Potty Training Accidents: Top 5 Questions About Potty Training
Hosted by: Dr. Mary Barbera
Guest: Kelsey General
Mary: You're listening to the Turn Autism Around podcast episode number 211. Today we are covering the top five questions we get about potty training. This comes after last week's podcast episode number 210, which was a classic rebroadcast about all about potty. So today I have Kelsey General on the show. Thanks so much for joining us again, Kelsey, to ask the top five questions. Let's get to it.
Intro: Welcome to the Turn Autism Around podcast for both parents and professionals in the autism world who want to turn things around, be less stressed and lead happier lives. And now your host, autism mom, behavior analyst and bestselling author Dr. Mary Barbera.
Mary: Okay. Thanks for joining me, Kelsey. Let's start with our top question. We get about potty training.
Kelsey: Yeah, potty training is a big topic that everyone wants all the answers to. So let's get going right away. When should you start potty training and what prerequisites does a child need to have?
Potty Training Prep: When should you start potty training and what prerequisites does a child need to have?
Mary: Okay. Well, that is a great question. And just for the listeners to know is I am a registered nurse and a behavior analyst as well as a mom. And so I always worked as a nurse in the neurologic field, working with patients with stroke and head injuries, spinal cord injuries, brain tumors. So potty toilet training and retraining was actually a big part of my job and incontinence was common. So when I became a mom and then when I became a mom to a son with autism, I mean, potty training didn't freak me out. I still had no idea how to potty train little kids, especially someone like Lucas, who was more difficult. So in general, I would say that we shouldn't be looking at intensive potty training for kids that are certainly younger than two. If they are, though, if they are able to sit like, say, 18 months or newly turned to, I would start pairing up the potty whether they have autism or not. Because sometimes what happens is people wait too long and then on their third birthday, they pull out this potty and it just hasn't ever been talked about, hasn't ever been paired up. And so especially kids on the spectrum, if you introduce the potty too late, they could have their mind made up that it'll be different, more difficult to pair up. So in general, we want to look at chronological age or real age, but we also need to look at developmental age and developmental level. So if you do the new digital assessment, which we've talked about at length now and in the past several months or in past few months, anyway. Podcast 198, we can link in the show notes here is all about the digital assessment and why I started it. But the digital assessment will give you three scores and one is in self care and some of that scoring is related to potty training. So in general, we want to potty train kids. We want to start pairing the potty as early as possible, as early as they will sit, whether that's a little freestanding potty or whether that's a potty, a toilet ring around and you hold the child there very gently and make it fun and make it appealing, maybe hold them there when you're changing their diaper, when they wake up first thing in the morning, when they can sit on the potty before bath time, you know, just make it natural and just a part of their routine. But for intensive potty training, I usually don't recommend you start until maybe three ish. But you, you know, if you have a three-year-old that really isn't speaking at all and they're not sitting at the table and they're not responding to reinforcement and you haven't learned all of those other things, then I probably would push back more intensive potty training until you learn. So there's so many resources, so I have a free potty guide. MaryBarbera.com/Potty we will link that in the show notes. Chapter 12 of Turn Autism Around is all about potty. I also have in my first book a whole chapter on potty and those will really help you get started in chapter 12 of Turn Autism Around too Dr. Mark Sundberg's self care checklist is there. And he has several and four areas where. He does a self-care checklist and toileting is one of them. And the difference with the self-care checklist for toileting is it doesn't really start until 24 months of typical development. So some of the prerequisites you asked about Kelsey are like responding to reinforcement. Following simple directions seems uncomfortable and soiled diapers remain dry for 2 hours at a time. Bowel movements are predictable and regular. The child can pull their pants down and up. They can pull them up with some assistance and can sit still for 2 minutes at a time. So that's where I get back to. If you're not able to pair up the early learning materials at a small table. And they won't sit for meals and they won't sit for a circle time at daycare, then they're probably not going to run to the potty and sit there nicely either. And then around 36 months is requested for the toilet canon button and unsnap, sits on the toilet, urinates, defecates, wipes with some assistance, pulling pants up and down. All that kind of stuff. And hand-washing is a big part of the prerequisites, not that they have to be perfect with hand-washing, but handwashing is a lot easier to prompt and teach and reinforce than potty. So if you're out there listening and you have a two or three year old who is not doing these initial responses to reinforcement, follow simple demands, sits happily at a table with you and participate in the early learning materials. It's probably too early. You probably need to read more and also pick a time when it's like you're going to have access to the child for maybe a couple of weeks. You don't have anything really happening like the child's not going to undergo surgery for his tonsils in next month, or you're not having a new baby come into the house next week, or you're not moving homes a month from now. Like pick a time when not only the child can concentrate and do the procedures, but that you're not completely stressed and overwhelmed. So that would be my answer. Most kids, I did a survey way back and most typically developing kids are fully potty trained by three and a half to four. And sometimes I think the majority of kids with autism aren't fully trained until five. So it's a good year and a half just from my little survey I did years ago. But it does tend to come a little later.
Kelsey: Yeah. Yeah. I think those are all good points. And I think another thing that we need to assess when we're looking, especially we talked a lot about readiness in younger kids, but I know some people listening do have older kids that maybe not verbal or not speaking and they think, oh, well, I can't potty train because they don't understand. And I think once you're at the age of above five, even if you're not talking, even if you may need to start working on potty training, except if you have a lot of severe problem behaviors, if you have kids who are a danger to themselves and potentially others, we're not going to want you know, you want to work with your team, with a behavior analyst. You want to look at how you can prevent those problem behaviors before jumping into a potentially stressful thing like potty training. Yeah.
Mary: I agree. I mean, Dr. Fox and Azrin and who wrote potty training in a day back in 1972, I believe they said a child at five, regardless of IQ or developmental level, any child older than five can and should be potty trained. Now, there are exceptions, there's medical issues or whatever, but in general, kids over five, yeah, we don't want to wait for them to talk, but we do want to have them be able to sit at the table and again be able to accept reinforcement. Maybe they have some motor limitations. You know, I've worked with clients with cerebral palsy and those sorts of things, wheelchair bound kids. I mean, that complicates the situation. But potty training is among the most critical skills to lead a more independent life, to be more able to get babysitters and be included in general education classrooms and bring kids on planes and in pools and go to restaurants. So potty training is super, super important. And definitely if you have a very young child like Kelsey, you said the other day, you got a question, how do I train my 19 month old? It's like now don't but keep them dry. Monitor, are they staying dry for 2 hours at a time? Have them sit on a small potty and pair that up, like helping them with washing their hands and tolerating gentle prompts from behind for washing hands and pulling pants up and down. And the other thing I will say is my online course and community is whether you have a child under six for the toddler preschooler course or over six. For anybody over six that isn't fully conversational and also struggles with potty like I see that a lot like we'll get social media comments like if I just potty train it's like I'm sure you have a lot more than just potty training going on. If you have a 12 or 15 year old or a eight year old that's not potty trained, I'm sure you also have problem behaviors, I'm sure you also have language issues. I'm sure you have lots of other things. And so coming into our course and community where potty is, one of the things we cover might be a really good idea.
Kelsey: Yeah. Yeah. And that's a great point about starting too early, Mary, because potty training is in a race and sometimes if you do start too early, you'll end up just on a long, long road of battling it, which can cause a lot of other issues. So definitely picking the right time is tricky, but it is good to really assess before you just jump in and say, I'm going to potty train because my child is ex age. So assessment is really important. So that brings us to our next question. So I have decided to start potty training. What should I do next? Yeah.
Potty Training Steps: I have decided to start potty training. What should I do next?
Mary: So it's important that, you know, everybody be on the same page. So if you're a mom listening or if you're professional listening, if a child's going to school and home, if you're going to start at one place or the other, which is okay, like I've seen that work, I've seen potty training happen at home and then, you know, not happen at school. I've also, you know, I feel like the Fox and Azrin book has been kind of your classic behavior analyst model to use, but it was written in 1972. There's actually punishment involved with that. It's just positive practice, which is actually a punishment procedure. Back in 1972, people were doing things way differently. So now we want to have a positive approach. It doesn't have to necessarily be like from my perspective, it doesn't have to be an all or nothing. We are potty training starting on Monday. We are going from all diapers to all underwear during the day. Like to me that is as a mom and as a Behavior analyst and a nurse. But like when you do that, kids. Have bowel movements on the sofas, in their car seats like it's punishing the parent to have disaster happen. So I am also on the thought process that we can say we're going to potty train from nine until 12 when I have the therapist coming over to keep a close eye, when I can keep him gated in the kitchen area with tile floor that can be easily cleaned up, or a shower curtain liner laid out on the family room floor underneath the table and chairs where the child's going to sit. We are going to put on a pull up to go in the car. We're going to put on a pull up to go to school. We're going to put on a diaper at night. So I think that's very different and I don't even know if I mentioned this in Chapter 12 of my book, but I am all about like, let's not go crazy here. Yeah, we can do it systematically. I mean, some people I had this one mom of were not even three years old, and I was usually with the dad. The mom was a nurse and the dad worked evening shift or night shift or something. So usually the dad was there and the mom was there. The week I went and I was like, Oh, you took, you know, some time off. And she said, Yep, I took this week off. I'm going to potty train Johnny. And I'm like, But you're really. Oh, okay. Well, you know, and I'm thinking I wouldn't have picked that for a goal, but she took the week off. And I mean, I gently, like, guided her for the couple of hours I was there. And sure enough, by the end of the week, he was potty trained. So it's not to say this is going to take you months. In my experience, even intensive potty training has taken weeks or a couple of months, but it should not take years and you should not have false starts and lots of disaster. So. So here's some of the steps to actually start. Pick the words you're going to use if I'm calling it poop and Kelsey's calling it bowel movement and somebody else is calling it poo poo poo and I'm calling it potty. She's calling it a toilet. She's calling the loo, you know, whatever. So pick the words to use for everything. Pick your reinforcement. Reinforcement needs to be usually very direct, immediate and high. Like I remember this one child who was like 12 and I don't know if I said this in the solo show or not, but like. This child was very impaired. He was 12. He had no language. He had very few reinforcements. He would just sit on this ball and bounce. And the parents and the staff really said, like, let's try to potty train them. And I'm like, well, we need something in the bathroom that's reinforcing. And I'm like, Is there anything? You know, for some reason, I don't think the child liked to eat anything, you know, whatever. And so some of the aides are whispering, well, now, don't tell her that. Don't tell her. Don't tell me what? What's the reinforcement? What's the idea? And they're like, he loves it when it rains and you pull out an umbrella. He loves to see a twirl. I'm like, Well, that's perfect. You get a little tiny umbrella. We could pop it out and we could twirl it. Like after he peed. Like that would be, you know. So think out of the box. What would it be? Usually for kids on the spectrum, stickers are not going to be reinforcing enough. They have to like cash in the stickers to buy something. It's more immediate. But you can't afford to be presenting presents every single time. But for the first time that a child pees or poops, it might have to be something like a bigger thing. I have seen people where they buy something really that the child really wants and put it on a mantle and be like, Well, since you pay, you get that and they get it. You know, that I think is more extreme. I would just do something sometimes. One of the steps here is extra liquids. So if you can find ice pops or lemonade or something that the child really likes, then you kind of kill two birds with one stone where you give the reinforcement and it actually provides extra liquid for more trials.
Kelsey: One thing you told me once, Mary, that I'll add in and I think one of your clients did this was a gumball machine. I got this little gumball machine for like $10 and we would have coins and they would get a coin. They put it in and get a gumball. And the funny thing is, my one son with autism didn't even want to eat the gumball. He wanted to put it in the toilet and watch the color so we would flush the toilet, get our gumball or flush the toilet, wash our hands, get our gumball, put the gumball in the toilet and watch the color fade off the ball.
Mary: Ahh I've never heard that. We also wanted to decide on the schedule. Usually I recommend scheduled sets of like 45 to 60 minutes apart, maybe 30 minutes, but we're going to be doing extra liquids. People were like, Well, I don't want to do extra liquids. They don't like anything. If they like fruit liquid, you know, this is this is going to be a short term thing, too. So even if you don't like them to have soda, but they love it like maybe four ounces of a soda after HP or something like that just for the beginning process, lemonade, those sorts of things. Ice pops, really good idea. The scheduled sites are going to be, like I said, 30 to 60 minutes apart, but you're going to have extra liquids so that they're going to have to be going more. And the reason for that is you want to get a lot of trials, and especially if everybody's on top of it, they're you know, you're only potty training for this period and everybody's on it. And you want a lot of going, a lot of trials, and then you're going to have to decide on reinforcement for staying dry, sitting on the potty and paying some kids. And this is a common question we get. Well, my child cries when you bring them into the bathroom. So what should you do? Well, that means that you have to pair or repair the thing they're crying about. You may have to repair the bathroom. You may have to go into a handicapped bathroom that doesn't have automatic flush toilets or something. If something is making them cry about a certain bathroom or sitting at the party, you're going to have to kind of go back to the basics and repair everything which you can't bring a child in a bathroom and work on potty training if there's crying like you just can't. There's not going to be learning. There's not going to be success if the child's crying. And then the fourth step, so it's extra liquids, scheduled sits, reinforcement, and then the fourth thing you're going to have to decide on the plan is what data you're going to collect in the potty training free guide I have I do have some recommended data sheets that you can use, can adapt data sheets. You do need data if you're going to use intensive potty training and you are going to get to the end of this, you're going to need some data. And I find that if you can graph the data, that can really give you a lot of insight, too. I remember one family, I showed up and they were like four days into potty training and they're like, It's not working. It's not working at all. So well, okay, well, let me see your data. And I ended up just taking a piece of paper and a graph roughly graphing the data. And all of his peeing was going up, his accidents were going down. And once they saw the graph, then they were like, it is working. So data is really important when you're, especially when you're first starting out. So those are the basic steps and you might want to appoint a potty manager. Or if you're the mom, I usually think it's the mom or if you're on a specialized school where you're going to take charge of potty training. Appoint the teacher as the potty manager. And the potty manager would coordinate and make sure that the parents are on board. Or if you're the potty manager and you're the mom, you'd make sure the team at school is on board or a preschool. And you may just decide, like if they go to a typical preschool or whatever, you may just decide that you're going to diaper there and and just work on potty training at home.
Kelsey: Yeah, those are all the steps we followed for both my boys and both boys were potty trained. One thing that you mentioned that you told me was that it doesn't need to happen all day long at the beginning. And that helped because I had two boys 18 months apart working and it just wasn't going to work to do it all the time. And Brentley was also at a daycare with a one to one, but they weren't super strong. And so I was worried they were going to have to deal with problem behaviors if they did it. So we just did it for a couple of hours at home every day and we would increase the liquids, go on a schedule. And then when he was in diapers, all I asked them to do was when they changed his diaper to say if it was wet or dry to show him, oh, it's wet now. Okay, we'll put it in the, you know, oh, it's dry. Wow, you stay dry and just talk to him about it. And that was what we did and that worked really well. And I've also seen when people do make a schedule, sometimes you might say, okay, I want them to wait 60 minutes and then you're having lots of accidents and you might have to go, okay, well that schedule's too long and shorten it until you find a successful spot. So remember, your plan can change. Yeah.
Mary: And there can even be more intensive potty training. If that doesn't work, you could sit on the potty for 10 minutes off the party for five. I mean, there's a lot of things you can do, but this is the you know, I think the one that's...
Kelsey: What you want to start with.
Mary: And then see how it goes. You know, they take off and make sure when you're taking data, you're also monitoring and recording how much extra liquids you're getting to. An extra four ounces an hour is probably a good idea. You don't want to overload like I remember this one boy, he would drink like two big pouches of Hawaiian punch at lunch. And then, sure enough, a half an hour later, he'd have an accident. And that's the other thing. If they are on, say, an hour schedule and they don't pee, you can't go like a whole nother hour. So then it might be an hour-long schedule. They don't pee, then they go back in 15 minutes. They don't pee and they go back on in 15. You know what I mean? It's because 2 hours, especially if you're pushing that amount of liquids, is going to probably not be enough.
Kelsey: Yeah, it's the same as what we say with problem behaviors too. You want to catch them being good. You want to catch the pee before the accident? We want to keep things fun and really positive. And what Mary said about reinforcement is really the key. If you have a child who's eating blueberries all day long. Blueberries can't be a reinforcement, even if they love them. You need something that's special for potty training, and they're not going to have it all day whether they pee on the toilet or not. Something special for potty training is really key. And finding that can take some time.
Mary: And they and if they go to school or daycare and they are diapering and changing their diaper, if they are dry, you could ask them, hey, could you? If Brentley is dry? Could you make a fuss? Say you're dry? Let's sit at the party and see if you can go just because if they're dry, that's going to be prime time to try the potty.
Kelsey: Yeah, I would agree with all that. And I think, you know, being flexible and following what your data shows you is, is really key to not wanting to stick to a plan that is not making things better. Which brings us to our next question, which is now my child will go to the bathroom on their schedule, but only when I take them. How do I teach them to initiate and go independently?
Manding and Requesting for Potty: My child will go to the bathroom on their schedule, but only when I take them. How do I teach them to initiate and go independently?
Mary: Yeah. So a big thing that I am always shouting from the rooftop is that boys need to sit on the potty until they are fully trained. So when you take them, on their schedule or if anybody's taking them on their schedule in school or at home, you want to take them on the schedule. But you say it's time for the pottty. And some kids, if they use a picture system or even if they don't, even if they're verbal, you might have a picture of the potty that they could you could point to or you could move that potty picture from their table to the outside of the bathroom, kind of like as a transition. Okay, this is what's next. This is on my schedule, party time and bring the potty. Then also, as you're walking to the potty, you might stop the child if they're verbal or if they're a signer, they can time for potty. You might want to stop them a couple of times on the way, make it fun. Be like, Hey, where were you going? Potty. Good. A couple more steps. Hey, where do you have to go? Potty. So they're practicing Manding. Again. You don't want the child to be miserable, crying, upset. You know, this all has to be paired up so that they're actually excited about going. Some kids need reinforcement just to sit just for requesting along the way, even though it's kind of like a preemptive request. So that's part of it, is you're going to want to get Manding going, requesting, going for potty while they're still on a schedule. And then once they're on a schedule and they're remaining dry and we're working on daytime pee trained first. But one of the main reasons we have to have boys sit is because a lot of times they'll have a bowel movement kind of while they're peeing. And I have had numerous cases where it's a 12 year old boy, pee trained, but not poop trained because nobody's sat him consistently. And so he never learned to have a bowel movement on the toilet, never was really comfortable on a regular basis doing that. So you want to practice, you want to have the kids sit. They might need reinforcement along the way even without pee. So they might get for sitting, they might get a tablet to play with or a special potty book or special activity they could do while they sit and relax. And also a step stool. Super important. You want their feet. We've even had Squatty Potty, but Squatty Potty, it's like a step stool thing. We need their feet to hit something that's really important for bearing down, to have a bowel movement and sometimes to pee too. But the bowel movement is going to be important for that. And then once you get all that, so now you start fading out the schedule. But keep on pushing the liquids. So if I was taken to the bathroom every half an hour, I wouldn't have to go, right? I probably pee a little bit. But if I was given a lot of liquids and then it went from I was taken every hour to now I was taken every hour and 15 now every hour and a half. Now every 2 hours. Now every two... We usually don't push it more than 2 hours, maybe two and a half hours. But you're going to keep going with your fluids. So as the child is staying dry, you are fading out the schedule. And then it might be just pointing to that picture or you see the signs of them kind of wriggling around, do you need to go to the bathroom or do you need to go potty, whatever word you're going to use. And then they start going more. You might want to stop them again, potty reinforce them for requesting or sitting for peeing. And that's basically what you do is you gradually fade out the schedule, but it still requires data collection, still extra fluids, still a lot of time and energy. Probably graphing the data if you're really going to be successful as quickly as possible. So it's still a lot of work and people are like, oh, god, just get potty trained for it, you know what I mean? And it's just like it's hard.
Kelsey: Yeah, it's hard. And also I would start, like Mary said, starting that initiation really early and saying it when they go and fading your schedule as quickly as possible, or else you have a child who's a lot more dependent on a schedule. And also you might need to change the reinforcement to have a higher reinforcement as you start reading the schedule. So it's more motivating to go. And the other thing I would say is we should do what Mary said and tell them to say potty or sign potty. But I've also seen people that are like, well, they'll go to the bathroom, but they won't say potty. That's like unless they're in a classroom where they need to ask to go or it's not that. But like if you're home and the child just walks and goes to the bathroom, it might not be necessary for them to necessarily ask to go. We should always pair that up, but as long as your child's going praise and praise and give reinforcement instead of correcting them to necessarily speak, to go.
Mary: And if they do have accidents, I don't agree with positive practice or those sorts of things. In my first book I do talk about positive practice and that did work for Lucas. And if you have a behavior analyst and you've tried all the positives and you want to try it on your own, like I just don't agree with it and I don't especially agree with it in a classroom setting. We also have to think about dignity and the age and the age appropriate. And I mean, back in 1972, there wasn't all the the, you know, child abuse. Well, there was child abuse, but it wasn't like mandated reporters and and all of that stuff. And it's like, you know, I have seen well, I haven't personally seen, but I've heard about classrooms who, you know, take a 12 year old. And because the Fox and Azrin books say, well, just put them in there in their underwear with their shirt up, like so that you can see their underwear having an accident. And it's like doing positive practice at a school like that is not appropriate. Like kids need to have their pants on at school. I mean, at home, if you want to just do the underwear only, but then at home you have to worry about your sofa and your car seat and all those kinds of things. So I do recommend putting sweatpants or putting waterproof pants on top of the underwear or even a underwear and a pull up on top so the child can actually feel the underwear getting wet if you're kind of in between, but protect the dignity of the child and also protect your furniture. And so you don't have to be doing all this wash. But I do think kids should have pants on top of their underwear. And I think that the procedures of the past have been updated and should be updated across the board. And my whole approach is very positive. And I think because I have a nursing background too and it's helpful.
Kelsey: Yeah, yeah. Keeping on a schedule is definitely helpful to keep things positive instead of and prevent accidents instead of dealing with them. But accidents do happen. Which brings us to our next question, which is what do we do about accidents? Accidents. And then once after training is poop training. So what do we do about poop accidents and asking for diapers, for pooping?
Handling Accidents and Poop Holding: What do we do about pee and poop accidents and asking for diapers, for pooping?
Mary: Yeah. So a big thing I learned since I wrote my first book and did a lot of my early potty training work and publications, is that the number one cause of accidents? Nighttime accidents? Daytime accidents. Failure to potty train easily is actually constipation. And I read this really great book in 2011 written by Dr. Steve Hodges, who is a pediatric urologist. So pediatric urologist is a childhood pee doctor, and he wrote a book called It's No Accident All About Constipation. And he has a clinic down in North Carolina and we did a podcast episode with him. It's fabulous. We'll put it in the show notes. This is episode 211. So MaryBarbera.com/211 for all the show notes. She wrote this book. It really did change the way I thought of things. Then I investigated more, sent a lot of people to this book, and then they found that Dr. Steve Hodges went on to write a few other books. One is called the Pre Mop Plan and one is the MOP book and it's how to resolve constipation and babies and toddlers and overcome potty training struggles. That's the pre mop book. And the mop book is a proven way to stop bedwetting and accidents in toddlers to routines. What he found in his clinic was 90% of the kids that came with any kind of pee or poop issues and failure to get through toilet training. And these are not kids with autism. These are typically developing kids or kids with any kind of learning differences. People that were brought down there, even though their parents said they were not constipated or they didn't think they were constipated. 90% on x-ray were completely clogged up and backed up, not just temporarily, but for years. And so some common signs that your child is actually constipated and withholding a stool include not going every day the consistency, not being like mashed sweet potatoes and also having unusually large stools. Like I do remember when we were potty training, some parents would send me pictures of the poop in the potty. I did not ask for this. I was like, okay, stop that thing. I don't know. And they were all like texting me poop pictures. I'm like, okay, stop this. But like, large, like adult sized poops for a three year old and and even at the time, I thought that was good. That's actually bad. That means they're holding stool and the bowel and bladder are pressing against each other, causing accidents and also causing little balls of hard stool to come out. Meanwhile, you're impacted the whole way up. So lots to discover there. But his books are a great resource. He also has some Facebook groups, some paid Facebook groups that if you're really struggling with potty and you've tried our little, you know, extra fluids, scheduled sits, reinforcement, and you're struggling. And especially if you have an older child like to get in, I would pay to get in that Facebook group. I would get his books and I would really tackle this in a big way. So that's what I have to say about pee and poop. The regular poop training is just, you know, schedule sets, higher reinforcement. I remember talking actually to Dr. Fox when I was how I got Lucas pee trained. And at the time it was like, put him in underwear, no diapers, you know, and then he'd go behind the sofa. That's another sign that the kids are holding. They go behind the sofa, wait till the room is empty, and then they squat and they poop in their underwear. That is a sign that they're holding. And so I called Dr. Fox because he actually is pretty local to me. And I met him at a conference and I called him and I said, Lucas is pee trained but not poop trained, what should I do? And one of the things that he recommended was like enemas to keep them cleaned out. And enemas and cleaning kids out is a big part of the MOPS book. And one of the things he recommended was Get the Reinforcer is something that he would go nuts over. And so I think I sat him on the toilet and I said, If you poop, we're going to, you know, because he was pooping in his underwear, he knew what poop was at the time. Like, if you poop right now, we're going to go drive through McDonald's for some fries. And he pooped and we got in the car and we went. So that was the first poop in the potty or the first time when I was like, okay, we need stronger reinforcement. So, but you know, like for my younger son, he wanted to play hide and seek really badly. He was like, I wanna play hide n go seek. I'm like, First you poop, then I'll play hide and go seek. So it could be and it could be flushing gumballs down the toilet. It doesn't matter. You just have to figure out what's going to really motivate.
Kelsey: Yeah. Then and also again, going back to your step, one of your steps is to look at the data. If you have a child who's pooping after breakfast every morning, let's not wait for them to initiate or wait like we're just going to the bathroom and we're going to poop.
Mary: Make it part of their routine.
Kelsey: Yeah, yeah.
Mary: If you think at home from preschool and the deal is that they wear pull ups to preschool and right away, as soon as they get home the ritual, it should be to get off the pull up and set on the body. And if the pull ups dry, they have a very good chance that they're going to go, you know, make it... Be a detective. Use your data.
Kelsey: Yeah, user data. And I've had kids who will wait until the pull up for nighttime because they're not nighttime train and poop and that and it's like, well, they're not getting we'll get a nighttime pull up in the reinforcement after after they poop and enemas or can really help we we poop trained Brentley who is my son with with moderate to severe autism in one day with an enema just because that gave he was only pooping standing up as a routine child with autism. That was his routine. He had to learn to sit down and so pooping had to be a lot easier if you think about it. So he had to be able to sit down. And so once it was easy enough to poop and sit down, he realized he got all these good things. He was like, Oh, okay, that's what you do on. But we do have to teach and sometimes you need to use safe tools to help make the process easier.
Mary: As part of that question was, what do you do if kids ask for a diaper to poop, kind of your example there. A lot of kids will wait until they get their nighttime diaper on to poop. But if a child is asking for a diaper, they're probably constipated. They're able to hold it that long. And we just need to pair up. If they're not sitting on the toilet for all pee, then that might not be realistic. Maybe the child can pee standing up, but then at every time, or at three key times a day when it's more likely to poop, everybody's more likely to poop first thing in the morning. It's the ortho colic reflex. When you stand up, that's a high probability or gastro colic reflex is after big meals. So maybe he stands to pee and then he sits and relaxes and has a squatty potty and has a reinforcement to sit and he gets a really good reinforcement to poop. But maybe it's okay. You can have a diaper. But first, we have to go through the routine of you sitting with the squatty positive step stool. You sit for 10 minutes. When he's a visual timer, you can have this really great reinforcement to actually go. If you don't go, you can get your diaper. But guess what? Now you have to stay in here with your diaper on. As in the bathroom, and then that'll be the next step. Then you might have him sit or squat near the toilet and then, you know, you can gradually fade that out. But if a child has the wherewithal to ask for a diaper, they're ready to be better trained. You just have to do it.
Kelsey: Yeah. Yeah. And and it might be a hard process, but you can do it lots of slow steps towards your goal. So the last question is, my child is doing good at home and during the day but won't pee out of the house. What should I do?
Pottying Out of the House: My child is doing well at home and during the day but won't pee out of the house. What should I do?
Mary: Yeah, we've had this. And also there are, you know, steps to like, when are you done being independent? And sometimes wiping is an issue. And in our online course in community, we actually show videos of my son learning to shower, learning to wipe. Of course, we don't show any private parts or anything like that, but there are systematic procedures to teach all of this. And so you want to make sure that as you're doing it at home, you're not having the child stripped down, come out, not wiped, run around. So that's why you have to be involved with the potty training steps and not stop data and not stop focus until you're really done. And done means going into the community and asking to use the bathroom, like if I were on a schedule. You know, sometimes you just have to go. You're in the middle of the grocery store and you have to go. And, you know, sometimes you get sick and you have to go more often or whatever. So it's important that you teach children how to go to school. So that might involve getting to preschool early, going into the bathroom that they would go to as a class. Helping your child learn to just sit and try. Maybe it would be going into Target, which you go to a lot and say, we're going to go to Target. We're going to get, you know, three things on our list. Here's a list or we're going to go to the potty, we're going to try to go in there. And then, you know, if you go, we're going to buy something special like or maybe even if you go and try and sit, you're going to buy something special. Like it might be a process. I know one little girl I worked with, she was really afraid of automatic flashers in toilets. We found this store that had like, nobody in every other quick in and a quick out, a store bathroom. So we would go there. It did. I don't know if it had automatic, but whatever it did, it was like the next step. And we would just go as part of our therapy.
Kelsey: Yeah. You can also take post-it notes and stick them over the sensor so that automatic flusher doesn't flush as a first step and then the child can actually have the control taking the post it off and then it flushes.
Mary: Oh nice! Yes. So and maybe in the beginning, it's on a schedule where every time you go to a store, you say you're going to practice going to the party. And if you go over to somebody's house, make sure you show the child like, okay, we're we're in Susie's house. Here's the potty. Do you want to try? You want mommy to help you, you know, make sure they know there is a bathroom and and maybe first those things, if they're not close to being done, maybe you do put a pull up on top of their underwear, you know, just to, like, save any stigma to the child, save any hassle to you save and they upset. It doesn't have to be an all or nothing. I think that's the big thing is it's a process. Use your data, make games if it's more than just potty, which it almost is, always learn more. Join our online course and community. You know, improving table time and reinforcement and problem behaviors is all a part of improving.
Kelsey: Yeah, yeah. Because when you're going in the community and stuff, rent reinforcement everywhere is really key. There's something a child is scared of going for a short period of time and for the exposure and reinforcement. And yes, like you said, Mary doesn't have to be all or nothing for even a year. I think after Brentley and Lincoln were potty trained, I would put pull ups over their underwear when we snowboarded. I did not want to deal with accidents in snow pants. It was hard to get to the bathroom. You were far from the bathroom of the hill. It was just I knew that that was setting us up for success. And then the next season I faded that out. But it was like, I am not dealing with pee in a snowsuit and camping too. Even when they were overnight trains pull up when we're not dealing with pee in a tent so these are situations.
Mary: Also pools, if you're In a pool, you know it's a different feeling if you don't have underwear on. So I would always take Lucas to the bathroom before we got in the pool. After we got back in the pool. Take him again, wear underwear under your bathing suit just to have that extra layer of feeling of, you know, it's just all of these things and.
Kelsey: Yeah, and, and the key is just keep things successful, keep things positive, provide tons of reinforcement when things go, how you expect.
Mary: One more thing before we end. When kids go from classroom from first grade to second grade, from three year old to four year old class, if they are potty trained, I would say make sure, you know, they know, the child knows and the staff knows not to just go back to well, we all go in first grade three times a day, make sure the child gets to practice. Being spontaneous with asking isn't just placed back on a schedule isn't reminded like parents. People that don't know might over ask Do you have to go to the bathroom? Do you have to go to the bathroom? Stop asking Lucas if he has to go to the bathroom like he's potty trained. He can request it. But if you over ask, the child may get back into a schedule. So if there are sudden accidents, first check constipation and don't just rely on “I don't think they are”, really reading Steve Hodges book lesson about podcasts because nine times out of ten they will be constipated but also ask school, especially if it's like a camp or new school. We got to get them on board with what the child needs in terms to continue on their success path of potty training.
Kelsey: Yeah, well, thanks for that, Mary. It's super helpful.
Mary: Yeah, I think this is a good one, so hopefully everybody got something out of it. Thanks so much for joining me today, Kelsey, and always a pleasure to get together to talk about our top five questions. So next time.
Kelsey: Have a good one.
Mary: If you're a parent or an autism professional and enjoy listening to this podcast, you have to come check out my online course and community where we take all of this material and we apply it. You'll learn life changing strategies to get your child or clients to reach their fullest potential. Join me for a free online workshop at MaryBarbera.com/ workshop where you can learn how to avoid common mistakes. You can see videos of me working with kids with and without autism, and you can learn more about joining my online course and community at a very special discount. Once again, go to MaryBarbera.com/workshop for all the details. I hope to see you there.
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