Since writing my first e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, I have fielded a ton of questions about the later stages of potty training. One stumbling block for most children appears to be “potty fatigue”. They lose the early excitement of mastery, and they get wrapped up in whatever they are doing. What happens when you combine the effects of low tone with the inability of a young child to judge the consequences of delaying a bathroom run? This can lead to delaying a visit to the bathroom until it is too late. Oops.
Kids with low tone often have poor interoceptive processing. What is that? Well, interoception is how you perceive internal sensory information. When it comes to toileting, you feel fullness in your bladder that presses on your abdominal wall, in the same way you feel a full stomach. This is how any of us know that we have to “go”. If you wait too long, pressure turns to a bit of pain. Low muscle tone creates a situation in which the stretch receptors in the abdominal muscles and in the bladder wall itself don’t get triggered until there is a stronger stimulus. There may be some difficulty in locating the source of pressure as coming from the bladder instead of bowel, or even feeling like it could be coming from their back or stomach. This leads to bathroom accidents if the toilet is too far away, if they can’t walk fast enough, or if they cannot pull down their pants fast enough. You have to work on all those skills!
Add in a child’s unwillingness to recognize the importance of the weak sensory signals that he or she is receiving because they are having too much fun or are waiting for a turn in a game or on a swing. Uh-oh. Not being able to connect the dots is common in young children. That is why we don’t let them cross a busy street alone until they are well over 3 or 4. They are terrible at judging risk. Again, this means there are skills to develop to avoid accidents.
What should parents do to help their children limit accidents arising from being “too busy to pee?”
- Involve kids in the process of planning and deciding. A child that is brought to the potty without any explanations such as “I can see you wiggling and crossing your legs. That tells me that you are ready to pee” isn’t being taught how to recognize more of their own signs of needing the potty.
- Allow kids to experience the consequences of poor choices. If they refused to use the potty and had an accident, they can end up in the tub to wash up, put their wet clothes in the washer, and if they were watching a show, it is now over. They don’t get to keep watching TV while an adult wipes them, changes them, and cleans up the mess!
- Create good routines. Early. Just as your mom insisted that you use the bathroom before leaving the house, kids with low tone need to understand that for them, there is a cost to overstretching their bladder by “holding it” Read Teach Kids With Ehlers-Danlos Syndrome Or Low Tone: Don’t Hold It In! to learn more about this. The best strategy is to encourage a child to urinate before their bladder is too full, make potty routines a habit very early in life, and to develop the skills of patience stretching Stretch Your Toddler’s Patience, Starting Today! from an early age. Creating more patience in young children allows them to think clearly and plan better, within their expected cognitive level.
Looking for more information on managing daily life with your special needs child?
I wrote three e-books for you!
My e-book on toilet training, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, and my e-books on managing pediatric hypermobility, are available on Amazon as read-only downloads, and on Your Therapy Source as printable downloads. The JointSmart Child: Living and Thriving With Hypermobility Volume One: The Early Years and Volume Two: The School Years are filled with strategies that parents and therapists can use immediately to improve a child’s independence and safety.
Your Therapy Source has bundled my books together for a great value. On their site, you can buy both the toilet training and the Early Years books together, or buy both hypermobility books together at a significant discount!