The Daytime Potty Training Process

Updated: 3/24/2015 See bottom.
Potty training....just those two little words can bring up such emotion.  This is a VERY complex process.

This was our journey for daytime potty training which was interrupted a LOT, because my child was on chemotherapy for a leukemia diagnosis.  I hope you can find some helpful tips here.  I have a LOT of links to products that really helped us.

Yes, it IS messy and often not a lot of fun, but it MUST be done.  I think the earlier you start the better. Somewhere between two or three - chronological NOT developmental age - is ideal.  There are a LOT of steps to learning to use the potty. I made this process VERY gradual.

Here are the steps your child will need to master:
 1. Recognizing when you need to go
 2. Walking to the bathroom
 3. Pulling pants/skirt/shorts and underwear down
 4. Getting onto the toilet
 5. Doing the business
 6. Getting the right amount of toilet paper
 7. Wiping
 8. Pulling pants/skirt/shorts and underwear up.
 9. Getting off toilet
10.Flush
11.Doing all the above steps completely independently - all on their own.

This is a LOT of steps.  The GOOD news you don't have to master them all at once.  They can be learned over time AND often with kids with special needs, #1 comes in LAST. If you wait until they are interested in going, you may be waiting a LONG time.  There truly is no need to do that.

Before you even start the potty training process your child needs to get used to the toilet and the bathroom! Ideally they should be walking, but they don't HAVE to be to start this process. Here is what we did:

#1 - Stop changing a diaper lying down.  Get rid of the changing table somewhere between age 2.5 and 3 years old. (If your child is older than this then just stop laying them down ASAP.) Switch to pull-up diapers that can be opened at the side. We used Huggies Pull-ups.  There are also cloth pull-up diapers available too.  Honestly, when you lay your child down to change their diaper you are treating them like a baby. You really don't want to do this after 2.5 years old when they aren't a baby anymore (I don't care what their developmental age is!).  Bring them to the bathroom to change their diaper.  Put them on the toilet, remove their clothing, and remove their pull-up from the sides.  Then put on a new pull-up and put the clothing back on. I did this step for about four months BEFORE I did step two.

#2 Learning WHAT to DO on the potty.
Quite honestly, I am not a fan of the "take them to the potty every 10-20 minutes or so and have them sit there for five to ten minutes" method to teach going on the potty.  I think it's mean. And a lot of kids can't sit still long enough to stay on the potty for five minutes. This is just MY opinion, so take it for what it's worth. If it worked for you, great, but I think it takes longer for the child to figure out what to do ON the potty, because you are "hoping" and praying they actually pee or poop on the potty in that time frame.

I am a BIG fan of the learning by making mistakes method! And so I LOVED this method.
www.3daypottytraining.com
It is worth the money. It will teach your child WHAT to do on the potty. They MUST be in underwear.  You will not be able to successfully potty train your child during the day in pull-ups.  They KNOW the difference. You probably won't get it done in three days (we didn't!), but you might get lucky.

Another item I used was the Potty Patty (or Potty Scotty) doll.  It is a doll that actually pees. I showed this to Olivia for several months before I did the 3day method.

Once a child knows WHAT to do on the potty, then you can get them on a schedule. I know the book says NOT to do this and you won't do this during the three day method, but after the three day method, if your child doesn't tell you they need to go (and most don't), you have to get them on a schedule! I started with taking her every hour. If she didn't go after about two minutes, then she didn't have to. MOST of our kids need to be on a schedule first, before they can start to recognize their own body signals (although again you might get lucky).  This can take awhile - months to years for some children.  IF you can get them on a schedule of every two to three hours, you are golden.  Even your child's pre-school/day care can take them every hour or two. I recommend NOT going back to pull-ups, but dealing with the mistakes.  They will get less frequent. You MIGHT need to do a repeat potty training weekend.

I won't lie, the potty training weekends are INTENSE.  You have to clear your schedule and focus 100% on your child. You will be cleaning up a LOT of mistakes, but the method DOES work. It is a method with lots of positive reinforcement.  Naturally, anytime your child puts pee or poop in the potty, you'll make a BIG deal out of it.

Learning WHAT to do on the potty didn't take long for Olivia to learn, BUT we had setbacks due to being on chemotherapy.  She would be doing GREAT, going on a schedule every two to three hours, in underwear, have a chemo treatment and then all of a sudden be going every 20 minutes.  At one point, I HAD to put her back in pull-ups because she was literally peeing every 20 minutes.  It was insane. This probably won't happen to you, but if it does for some reason, do another three day potty training weekend.  Over a two year period, I did three(!) potty training weekends.  I'm sure it would not have been like this had she not been on chemotherapy!! The last time I did a three-day potty training weekend, I had Olivia help me with cleaning up the messes.  This REALLY seemed to help. She didn't like it too much.  I DO NOT recommend doing this if it is your first potty training weekend.

For our kids with special needs, I recommend NOT using a special potty seat that is not part of the toilet.  I think the transition to the toilet can be challenging and with a step stool, like I have linked to below, there really is no need for it.

#3 Learning how to pull underwear and pants up and down 
This took us at LEAST six months for her to acquire this skill.  It is a fine motor task and it was REALLY hard for her. Lots of hand over hand.

#4 Wiping - First you do it for them, then hand over hand.  Then they do it.  It won't be perfect for awhile.  I still wipe her for poop.  This one will probably take a little longer to learn. I will use the above steps for that too.

#5 Pulling the right amount of toilet paper off  - another fine motor task.

#6 Flushing  - at home I do this as it is an awkward position. At school, she does it. When we are out and about I usually do it.

#7 Recognizing when they need to go and going independently -  I started by gradually phasing myself out of the bathroom.  I will tell her, "you haven't peed in two hours, it's time to go" and I would send her in there. I recommend creating a story on the iPad with Story Creator or making a book.  Use pictures of your child going on the potty, walking to the potty, etc. After almost three years of this training, Olivia will tell me when she needs to go, but not always.  It's just going to take time...but we are about 95% there.   We just went on an airplane for five hours (one way!), and a seven-day cruise and she told me when she needed to go the entire vacation.  :) I was overjoyed!!

#8 Always take them before you leave the house and before you leave anywhere to get into the car. 

Some helpful products:
See Me Go Potty - iPad app (this can be customized to look like your child): I really liked this, because it tastefully showed WHAT you are supposed to DO on the potty. It REALLY gives a visual of it which is a MUST have for our kids

The Potty Stool - This is a MUST (or something REALLY similar) IF you want your child to be able to get on and off the toilet all by themselves. I KNOW it's expensive, but it is SO worth it!! Another alternative is the Looster Booster (it's not as good, but it will work).

You'll want a toilet seat insert. I love this product.

Potty books and DVDs:
Tinkle Tinkle Little Tot

Signing Time Potty Time - Olivia loved all of these products.  We watched the video a LOT and I had her watching it several MONTHS before we started step #2.
Elmo Potty Time DVD and book

I also had a small step stool for me to sit on in the bathroom.  I would have her lean over my legs to wipe her for messes when she was in pull-ups.

Piddle Pads for the car seat - a definite MUST for in the car accidents.

For going to the bathroom in public places, I LOVE this product. I never use the bottom half, but I know people who do, but I LOVE the top portion.  I can place the potty ring on any public toilet and she will go without fear.  She doesn't have to be able to hold herself up and I don't have to hold her. This made going to the bathroom in public MUCH easier. Always keep a change of clothes or two in the car with your portable potty seat...just in case.

I hope these tips and products will make your potty training journey (and it IS a journey) MUCH easier and less stressful.  A big part of it, I think, is our attitude toward it.  Make it fun! Do not show any stress even if it's the 100th accident. I think if you go into it, knowing that IS a journey and will take some time, the process goes much better for you and your child.

Good luck!

P.S. The nighttime potty process is whole other story.  For now, I am not going to worry about it.  I might tackle that when she is 6.5 to 7 years old, but not now. She is currently 5.5 years old.

P.S2. I never used stickers or any other bribery method.  She did get LOTS of praise though, but since she doesn't care about stickers, I didn't do that.

Update 3/24/2015

Since I originally wrote this, Olivia had regressed BIG time in her potty training habits. She started going in her underwear about FOUR or MORE times a day after the cruise.  I just could NOT keep up with the laundry, so much to my dismay, I HAD to put her back in pull-ups! UGH! I hated to do it, but she had a double knee surgery coming up and was going to be in a cast with both legs for a month.  I could not risk an accident in that state! No way! We went back into pull-ups in Mid-October. Then the surgery was mid-November and the casts came off in mid-December.  Then I had to figure out my plan of attack.  After three YEARS of potty training, I was getting tired.  I KNEW that Olivia knew ALL the steps for going to the bathroom completely independently.

I did yet ANOTHER 3-day potty training weekend in January. I had HER clean up her mistakes. She knew where the pee-pee goes. After the three days, we switched to these underwear when she went to school. They are exactly like underwear but with a removable insert.  This way if she had an accident then it wouldn't soak through her pants/skirt. After using those for about two weeks, we went to straight underwear.  We would always have her go before we left the house and we're leaving somewhere.  I would tell her we're leaving to go to XYZ, you need to go potty and she would go. Sometimes she would fuss about it, but she would eventually go.  I never wavered on this.

She might have an accident once or twice a week. To be honest, I was getting discouraged.  Finally one day at horseback riding in early February, she had a MAJOR accident in the front seat of my car.  I was pissed! We have this routine at horse.  We've had it for TWO years.  After she rides her horse, she sits in the front seat and we drive up to where the bathroom is. Yes we could walk it, but not when she HAS to go which is usually! She had signed potty that fateful day and I was hurrying to get her to the potty. I put her in the front seat like usual and by the time I walked around to the drivers seat she had PEED! I was mad. Did I scold her no? But I was pissed. Literally! And I had NOTHING to change her into. I took off her pants and undies and she rode bare bottom on the piddle pad in her car seat the 30 minute ride home. When we got home, I told her to put her underwear and pants in the washing machine while we were in the garage.  I used a tone of voice that indicated I was upset. She walked in the house and put them both in the washing machine.  Then I got her dressed and we went out to clean the car seat that she had peed on with disinfecting sheets.  She didn't like doing it. Since that day, six weeks ago, she has not had one accident.  She is now taking herself to the bathroom at school and at home (is it consistent? No. Am I still reminding her? Yes). Sometimes I'll say, Olivia you haven't gone to the potty in two hours, it's time to go.  It's like the switch changed. I may occasionally ask her "where does the pee-pee go?" and she will say potty. I think if your child KNOWS where the "stuff" goes, we have to hold them accountable for any accidents they may have. They don't like cleaning it up.

Other than wiping her rear end, she is potty trained.  I hope I haven't jinxed myself by writing that. LOL!!

Our story with apraxia

Our journey with apraxia really began when Olivia was about 18 months old.  We saw an SLP for a consultation and said that Olivia was showing signs of apraxia. Why? She was not babbling and could not imitate mouth movements at all. She also could imitate other gross motor movements, but not oral movements such as puckering, blowing, etc. I truly think I have tried EVERY therapy out there is which I will describe below.  

First off what IS apraxia? According to the National Institute on Deafness and Other Communication Disorders is a speech disorder in which a person has trouble saying what he or she wants to say correctly and consistently. It is not due to weakness or paralysis of the speech muscles (the muscles of the face, tongue, and lips). The severity of apraxia of speech can range from mild to severe. People with apraxia of speech may have a number of different speech characteristics, or symptoms. One of the most notable symptoms is difficulty putting sounds and syllables together in the correct order to form words. Longer or more complex words are usually harder to say than shorter or simpler words. People with apraxia of speech also tend to make inconsistent mistakes when speaking. For example, they may say a difficult word correctly but then have trouble repeating it, or they may be able to say a particular sound one day and have trouble with the same sound the next day. People with apraxia of speech often appear to be groping for the right sound or word, and may try saying a word several times before they say it correctly. Another common characteristic of apraxia of speech is the incorrect use of “prosody” — that is, the varying rhythms, stresses, and inflections of speech that are used to help express meaning.

Here is what I didn't know. According to Libby Kumin, speech expert in Down syndrome, about 30-40% of kids with Down syndrome also have apraxia.  It is MUCH more than a speech delay.  It is a speech DISORDER.  If your child has apraxia, you can NOT compare their speech with typical kids with Down.  And sadly, our kids with apraxia develop speech MUCH slower than other kids with Down with the first words arriving at age five. It doesn't mean they won't ever talk (although some kids don't, but it is rare!), but just to expect it to be slow going.  Apraxia is also VERY frustrating. One day they will say a word PERFECTLY and you think they have it down, the next day it is GONE! And the parent is thinking where did it go? It is part motor planning and memory! For example, Olivia can say "bye" and "kuh", but she can not say "bike".  

So now that you know what it is (and you're thinking the future is bleak!), I am here to tell you its not.  There is a LOT you can do. I am a research queen, so let me save you some time.  First thing IF you suspect your child has apraxia, get a diagnosis by an SLP who knows what apraxia looks like.  Believe it or not, a LOT of them don't! The treatment plan is different for our kids.  If you suspect it, what should you be looking for, other than the signs above, of course? For starters, if your child is not babbling (mama, papa, dada, etc.) by the age of two and cannot imitate your pucker or blowing, then you should suspect it and get a diagnosis.  Do NOT let a SLP tell you that your child is just delayed in their speech because of Down syndrome! 

Next, you MUST get this book.  Speaking of Apraxia

And also this book Early Communication Skills for Children with Down syndrome.  On page 125 - 126, she lists the characteristics of apraxia with our kids.

You must have these CD's in your car.  They are music specifically designed to encourage your kids to talk.  It is basically speech therapy in the car!!! 

https://www.therapro.com/Browse-Category/Songs/

If your child is age three or older, I highly recommend hippotherapy.  There is something about being on a horse that strengthens the core that is really beneficial for our kids. More details are in the book above. 

For blog reading, I recommend the following:

http://pursuitofresearch.org/2010/12/01/therapeutic-use-of-fish-oil-for-apraxia-autism-and-other-communication-impairments/

http://www.ourperfectlyimperfectlife.com/search?q=apraxia

Learning sign language, while controversial in our community, has been a HUGE blessing.  We started teaching it to Olivia when she was nine months old. She did her first sign at 18 months...it took awhile! BUT I am so glad I did! Without it we would have had huge behavior problems because she couldn't communicate and we don't have that.  In addition, it is a wonderful way to help them learn imitation. It was a bridge into the speech program that we used with Olivia. 

Learning how to read has also helped Olivia to talk. I recommend starting with their favorite things on a flash card.  Working with the Downs Ed See and Learn (match, select and name program) has also helped. Olivia is now starting to read ALOUD basic sentences.  I won't go into details on a reading program here as there are others who have done an excellent job with that. 

I give Olivia a LOT of supplements too (except where indicated see Andi's blog dsdaytoday.blogspot.com).

Fish oils as recommended by Pursuit of Research

Green Tea, 

Gingko Bilboba 

Blueberry Extract

Choline

Acetyl-L-Carnitine 

As for therapy, you must have an SLP that is an expert in apraxia. A lot of people do PROMPT therapy.  We tried it for about two or three months and did not have any success with it.  Unless you have wonderful insurance (which we don't), it's an out of pocket expense and at $150 an hour that can quickly add up.  I also found that it is not IMMEDIATELY duplicatible.  I know some people have had good success with it and I am happy for them, but it can take awhile..as in months.  Honestly, I am not THAT patient!  We had the most success with https://fdhkids.com/ Lynn Carahaly, is an expert in apraxia and has been a keynote speaker at many conferences. We spent a week in Arizona with her.  Within TWO DAYS, Olivia was starting to babble.  She uses prompts that are VERY similar to sign language. So if your child knows the alphabet in sign language, which Olivia did, they will pick up how to make sounds very quickly.  At the end of the week, Olivia was saying about five words.  Are you kidding me? We went there and the only word Olivia had was Hi! Five words in a week!! I will take it!!! I was ecstatic to say the least.  She teaches you how to do a program at home, so that is what we have been doing.  I'm not as consistent as I would like, but we try to get the program in at least three or four times a week.  It takes about 10 - 15 minutes. 

We have also done Talk Tools and Beckman Oral Motor therapy.  Neither one of those produced actual speech for Olivia.  I do think they helped to strengthen her lip muscles, but we actually never worked on speech sounds during these therapies (shocking I know!).  The only time Olivia worked on actual speech sounds was during the therapy sessions in Arizona. I still, however, do Talk Tools to strengthen her lip muscles and to get that tongue back in her mouth!

I have not done the Kaufman program (although I did order set one of the cards) primarily because it is too far for me to get to. I have heard some people have had good success with it. http://www.northernspeech.com/

We also work with some apps on the iPad.

Articulation Station

Tiga Talk

Speech Box

Speech-ez apps

As for Olivia's story; we had a preliminary diagnosis of apraxia at 18 months due to no babbling, a fairly quiet child, and unable to imitate lip movements.  As the years progressed Olivia moved from mild apraxia to severe apraxia simply because she did not progress with speech at all.  It wasn't until we learned the speech-ez program that Olivia had changes at the age of four! She is now almost five and is reading simple "I see a ____" sentence books. She can say about twenty to thirty words with many more approximations.  AND, here is the kicker, this girl is a leukemia patient.  She has been on chemotherapy all of last year.  We have both worked hard.  I hope my story will help someone else whose child has apraxia.