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A Parent/Carers Guide to the SEND Journey

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A Parent/Carers Guide to the SEND Journey

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Our services :: Lincolnshire Children’s Therapy Services

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Each child is unique and individual, and will develop skills at different rates. If your child is having difficulty developing certain skills they may benefit from specialist assessment, support and advice from our service.

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About the Autism Education Trust

The AET is a not-for-profit organisation, led by the National Autistic Society and  Ambitious about Autism, and supported by the Department for Education.
We work in Partnership.
Our training programme and education resources are created in partnership with our panel of Autistic Young Experts, parents/carers, and our network of Training Partners, education professionals, experts, and specialists.

All our materials bring to life the latest research in autism and the current, lived experiences of autistic children and young people in education.
The AET Board
The AET programme is governed by its Programme Board which determines its strategy, protects its values and supports, and holds the staff team to account for the delivery of its objectives.

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Since 2007 we have been helping you to develop good autism practice for autistic children and young people. Discover our vision, mission & journey.

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Different Together

Unique Together

Working Together.

Inclusion for Children & Young People in Lincolnshire

The Working Together Team is a National Autistic Society Advanced Status Accredited Service. We advocate best practice and provide specialist support to empower mainstream settings to ensure autistic children & young people thrive through collaborative working with families and professionals.

3 Key Areas of Difference

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Social Understanding and Communciation

Differences in understanding social behaviour and the feelings of others, which informs the development of friendships and relationships.

Flexibility, Information Processing and Understanding

Differences in perception, planning, understanding concepts, predicting, managing transitions, passions for interests, and ability to absorb auditory or spoken information.

Sensory Processing and Integration

Differences in perceiving sensory information. Hypo, hyper, touch, sight, hearing, small, castle, vestibular inner ear and proprioceptive.

The young person is at the heart of every decision. This is evident from the very start of the referral process through to supporting settings to embed person centred strategies that enable autistic young people to succeed in mainstream school settings.

NAS Accreditation Review Team

It was a real privilege to be on the course and have the support my family have received from the team. Thank you.

Parent on Teen Life Course

Thank you all again for the programme. I really enjoyed it and found it so helpful, I'd go as far as to say life changing!!

Parent on Teen Life Course

A really engaging and inspiring session. It was great to see and hear so much passion for inclusion

School leader

X from WTT especially explained Autism perfectly and of all the training I have done over the years, I feel I came away having learnt and understood so much and can't wait to share with my colleagues.

Pre-school SENCO

A huge thank you, our meeting this morning has been an enormous help at refocussing our thinking regards supporting X and how we should move forward. It has also been a valuable reminder at how we need to evidence the smaller steps

Learning Mentor

Training was brilliant and well received, I've already had a thank you from a member of staff and it's heartening to see them reflect and look at how strategies can benefit a whole class.

SENCo

This Autism session is already brilliant. Do all teachers on teacher training get this, they should, as should every teacher or person who comes into contact with young people. This is so informative, accessible and relevant.

Post-16 setting

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Skip to content ↓ Different Together Unique Together Working Together. The Working Together Team is a National Autistic Society Advanced Status Accredited Service. We advocate best practice and provide specialist support to empower mainstream settings to ensure autistic children & young people thrive through collaborative working with families and professionals.

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High Quality Interactions - ShRec approach

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High Quality Interactions - ShRec approach

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Teaching your child to use the toilet correctly can be a difficult task, whether they are on the autism spectrum or not. But if your child is autistic, the process of developing a toilet routine can take longer, and involve its own particular challenges. This guide provides some useful steps that will hopefully make your toilet training a success.

When to start

Choose a time when you have few engagements and are feeling relatively stress free. Some indicators of a good time to start are:

if your child has begun to become aware of needing to go to the toilet

if you notice changes in their behaviour patterns, such as appearing distracted or fidgeting when they are wet or have soiled

if they let you know when they need changing

if you have observed that your child is aware that they have started/finished weeing or pooing

if your child has shown an interest in using or used the toilet themselves without being prompted

if your child can avoid having a wee or poo accident for one or two hours at a time (ie has improved bladder/bowel control).

Developing a toileting routine

Remember that independent toileting is the ultimate aim and may take many months but there will be many small steps and successes along the way. As well as physical factors associated with toilet training, there are social factors to consider. It is rare for an autistic child to have the social motivation to want to be like mummy/daddy/friend and use the toilet. After using nappies for a number of years, your child might not see the point in starting to use the toilet. It's important to remember that all children are different and they will not all respond to the same teaching techniques.

Children on the autism spectrum often like routine. You can build upon this desire for predictability to develop a successful toilet training routine.

When changing your child's nappy, do this where the toilet is so they can start relating toileting activities to the bathroom.

Your child may behave differently than normal when their routine is changed so let everyone who cares for them know why there could be a change in behaviour. It is often easier not to use a potty as part of toilet training to avoid a possibly difficult change from potty to toilet.

Ensure everyone working with your child starts toilet training at the same time and follows your agreed approach. Send in any equipment to nursery/school which you use at home, for example a toilet seat they may use to make the seat smaller. Also remember to send spare clothes, plastic bags to put any wet clothes in and wet wipes. It is important that you have clear lines of communication during this time so having a home/school book to share concerns and successes is vital.

Observe your child over a few days to see when they do a wee or a poo. Identifying a regular pattern can help you take your child to the toilet with an increased likelihood of them doing a wee or poo. This then leads to positive reinforcement.

Continue to take your child at set times based on your observations. If they wet themselves at another time, take them to the toilet as quickly as possible and try to get them there so some of the wee goes into the toilet. Ignore the wetting and positively reinforce that the wee has gone into the toilet and continue the rest of the toileting routine.

Use a visual sequence beside the toilet to help your child understand what is expected of them, for example: trousers down, pants down, sit on the toilet, wee/poo in the toilet, wipe (you may need to show how many squares of paper to take), pants up, trousers up, flush toilet, wash hands. The sequence can either be in the form of photographs, pictures or the written word - whatever is most suitable and motivating for your child. You may need to create a way of removing or covering over each symbol as the step is completed to show that it is finished and to move on to the next step. There are some examples of visual supports on the Do2Learn website.

Make sure any pictures or instructions are very clear so there is no misunderstanding. For example, if you are teaching your son to stand and wee in the toilet, show an outline drawing of him standing and weeing in the toilet. If you are teaching sitting, show a picture of him sitting and weeing in the toilet.

Show your child a photo or drawing of the toilet and say 'your child's name, toilet', take them into the toilet, follow your visual sequence for undressing and sit your child on the toilet. Even if they do not open their bowel or bladder, continue to follow the visual sequence as if they had.

Use a laminated visual sequence above the sink at eye level for hand washing.

Teach toileting as a whole routine from communicating the need to go to the toilet, using the toilet, to drying hands, rather than just sitting on the toilet.

Keep the sequence of behaviours the same every time. Often when an activity is anticipated, the child is more receptive to it.

Concentrate on tackling one behaviour at a time; it's very difficult to change two behaviours at once.

Decide whether or not and how to praise your child for successfully following the toileting routine. Some children enjoy and respond to social praise ('well done', or a tickle), others respond better to an object. Some children find praise difficult and keeping a calm, structured routine with a preferred activity after toileting may work better.

Dressing and undressing

Dress your child in comfortable clothes they can easily manage themselves such as elasticated waistbands on trousers and skirts or dresses that are not too long.

Motivate your child to wear underwear by buying pants with their favourite cartoon or television programme characters on them.

Use 'backward chaining' to teach new skills. This involves breaking a skill down into smaller steps, teaching the last stage of the sequence first. So if you were teaching your child to pull up his trousers, you would pull them up to his hips and then he would pull them up to his waist. Next time, you would pull them up to just under his hips and he would pull them over his hips and waist. This is a particularly good way of teaching new skills as it raises your child's self-esteem as they have taken the final step of the task themselves to complete the sequence.

Hand washing

Follow the same steps each time: sleeves up, tap on, wet hands, squirt soap, rub hands together, rinse hands, turn off tap, shake hands, dry hands.

Stand behind your child and physically prompt them if necessary, slowly withdrawing.

Avoid using verbal prompts as your child can become dependent on these without you realising. Instead let your child refer to a visual sequence as a reminder.

You may wish to teach your child to use the cold tap only. Beware that if you teach them to use the hot tap independently at home, when they go into other settings and wash their hands, the water may be too hot and could burn them.

Boys - sit or stand?

When deciding whether to teach a boy to sit or stand to urinate, ask yourself the following questions:

Can they distinguish between when they want to wee and poo?

Do they have the co-ordination, focus and control needed to aim?

If they learn by imitation, is there someone they can watch?

If the answer to any of the above is 'yes', then they are probably able to be taught to stand to urinate. To start teaching them to aim, it can be useful to put a piece of cereal (preferably one they don't eat as this could lead to confusion) down the toilet so they have something to aim for and concentrate on. You can also purchase a variety of fun toilet target stickers online.

Bowel control

Bowel control is usually learnt after bladder control. Some children can find bowel movements very frightening and not understand what is happening. It can help to get a book with pictures to explain the digestion process.

Some children find the feel of a full nappy comforting, and may enjoy the sensory feeling of the weight of the nappy. Find alternative ways to replace these feelings so you can continue toilet training. Give your child a means of requesting the activity eg being wrapped in a warm, heavy blanket and fit it into their routine.

Sit your child on the toilet, keep the nappy on but with a hole cut in the bottom, slowly cut away the nappy each time until they are able to go without the nappy at all. To start with, they will still have the feeling of a security around their waist which in turn will enable them to feel relaxed enough to poo on the toilet.

Habit training

Some children are toilet trained through habit. Habit training is effective for children who may: lack awareness, not understand the significance or meaning related to physical sensations, be limited by decreased or absent physical sensations or have unsuccessfully tried toilet training before.

Habit training involves training the body to go at set times. Take your child to the toilet at set times throughout the day, every day.

As before, observe your child to discover the best times to take them to the toilet.

Make sure your child feels relaxed enough to open their bladder/bowels while they sit on the toilet. Having the tap running in the background can help enable your child to wee for example.

Sometimes having a toy to handle - not one which causes excitement - can be useful to both keep your child on the toilet and relax them. Keep certain toys/books for just when they are sitting on the toilet.

If your child lacks awareness or sensation, they may have to be taught a strategy before getting off the toilet, to avoid accidentally weeing on the floor. Encourage them to slowly count to ten out loud when they have finished weeing before allowing them to get up, or give them a sand timer to look at.

To help your child to independently manage their own toileting routine when they are older, you can buy watches which you can set to vibrate at certain times throughout the day. You can then teach your child when the watch vibrates, they are to go to the toilet.

Environment

Ensure the bathroom is a calm, relaxing environment to encourage independence and success with the complete toileting routine.

Remove all distractions which are not associated with toileting to help your child understand what is expected of them while in the toilet.

Make the bathroom as comfortable as possible, adding foot supports, side rails and a smaller toilet seat if necessary.

Encourage independence by ensuring that everything in the bathroom is at the right level for your child eg soap and towels.

Think about your child's sensory needs and make changes to reduce their anxiety. Does the soap smell too strong for them? Does the noise of the extractor fan bother them? Does the water temperature need to be adjusted? Is the lighting too bright?

Make sure your child can sit comfortably on the toilet with hips and knees flexed at a 90 degree angle and have feet flat on a secure object.

Night-time

Once your child is mostly dry during the day you will be able to start night-time toilet training.

Have a set bedtime routine which does not change with weekends or holidays.

Limit the amount your child eats and drinks before bed, having no fluid an hour before bedtime, but ensuring your child has enough fluid throughout the day.

Take your child to the toilet before they go to bed. They then may need to be taken once during the night. You could fit this in with your routine by taking them before you go to bed.

If they are unable to keep dry during the night, you may need to try different times in the night to take them.

Use products to protect bedding.

Schools and early years settings

Admission to school should not be refused simply because a child has difficulties with continence. A school that does this may be at risk of disability discrimination (alternative legislation operates in Northern Ireland).

Further tips

Giving a drink 10 to 15 minutes before toileting can help increase the chances of your child successfully doing a wee on the toilet but avoid giving too much as this creates an unnatural routine.

Decide if you are going to teach your child to shut the door as part of the whole toileting routine or only in certain situations.

Avoid using childlike terms for toileting as your child may find it difficult to change language later in life.

If your child has a fear of flushing the toilet, you may wish to remove this from the visual sequence and leave it until the end of the routine - after your child has dried their hands. They then may need to stand in the doorway while you flush the toilet and gradually stand closer each time until they are able to flush for themselves. Playing calming music to drown out the noise of the flush or explaining with pictures what makes the noise when the toilet is flushed may also help.

When your child is in a car, ensure they have a protector to sit on to stop the car seat from being soiled by accidents. Avoid drinks before long car journeys.

Be aware that some children will hold onto their wee/poo until they have their nappy put on, for example if they know they always have a nappy on before going in the car they may wait until it is put back to release their bowel/bladder.

A range of absorbent pants and swimwear for older children is available.

Once your child is toilet trained at home, you will want to teach them to use toilets when out. When visiting new places, show your child where the toilets are and use the same routine as you do at home. Use the same picture and toy or book they may have for toileting at home.

Some children smear their poo. Read our guide on smearing for strategies to try (link to new guide in behaviour section).

Further information

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Toileting - a guide for parents and carers

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This guide provides some useful steps to help make toilet training an autistic child a success.

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Social scripts are a communication strategy to help support children's understanding of events, social situations and more. They help describe what to do and promote independence.

They are always positive and avoid placing blame on an individual.

Social scripts can provide a positive and clear way of describing going to the toilet, reducing frustrations and supporting your child's understanding.

You can download, print and personalise for your child by using your own photos and language that you use with your child.

There are 6 pages to print, on single sides. The flash cards can be cut out and stuck to card or laminated.

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Advice, resources and recomended products to support your child with toileting routines, including social stories, flash cards and videos.

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Speech and Language UK: Changing young lives

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We give families the confidence and skills to help their children. If you're concerned about your child's speech and language development, we can help.

We know that it can be hard to know where to start if you are worried about your child's development. If you think your child is having challenges with talking and understanding words, we are here to help you.

Our free resources and services can help with understanding what to look out for, how to get support and even some simple ways you can help your child at home.

Our progress checker will provide short questions you can answer to see how your baby or child is getting on with their talking and understanding of words.

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Help for families - Speech and Language UK: Changing young lives

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We give families the confidence and skills to help their children. Access our free resources and learn more about ways to encourage children's speech and language development.

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Your child's GP or school can make an NHS referral for your child to have a developmental assessment (Note: Some areas have rules on referral including needing both School and GP agreement to refer. Please talk to your local GP and/or school to confirm the local rules).

Depending on their age and your local borough the referral may be to the local Developmental Paediatric team or to the Child and Adolescent Mental Health Service (CAMHS). Your child should be referred to the appropriate service within the borough you live in. If your GP is making the referral, it is often useful for your child's school to also send in information to support the referral.

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ADHD Diagnosis Pathways (Children) - ADHD UK

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Your child's GP or school can make an NHS referral for your child to have a developmental assessment (Note: Some areas have rules on referral including needing both School and GP agreement to refer. Please talk to your local GP and/or school to confirm the local rules).

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The British Dyslexia Association is the voice for the 10% of the population that are dyslexic

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How can I explain about Dyslexia to my child?
You can view and share our booklet 'Understanding Dyslexia', which was written by a parent and child, specifically for parents and children. The booklet is available in two versions, one for primary age and one for secondary aged children.Click here

Helpful information is also available via the CBBC Newsround website here
How can I support my child's reading, spelling or writing?
You can also view the parent area on the websites of some of the Trust Member organisations.

What about other Specific Learning Difficulties?

Other useful links for support of those with Specific Learning Difficulties are:

Other Resources

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How can I explain about Dyslexia to my child? You can view and share our booklet 'Understanding Dyslexia', which was written by a parent and child, specifically for parents and children.

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Cognition and learning – Professional resources

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SEND information for parents and carers - Family Action

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Special education needs and disabilities (SEND) information for parents can often be hard to find or difficult to access. To help parents and carers we have bought together some useful national information on key topics below. The information below is grouped into categories that the SENDIAS service in your local area would be able to help […]

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Referring your child to Physiotherapy and/or Occupational Therapy 

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Referring your child to Physiotherapy and/or Occupational Therapy 

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If you are referring into Children's Physiotherapy, Occupational Therapy or Speech and Language Therapy, please complete the form below.

Please note, by completing this form, you will be contacted by text, phone and email regarding the child. If you do not wish to be contacted, please inform the service by calling 01522 309025 or emailing LHNT.lincschildrenstherapyservice@nhs.net.

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If you are referring into Children's Physiotherapy, Occupational Therapy or Speech and Language Therapy, please complete the form below. Please note, by completing this form, you will be contacted by text, phone and email regarding the child. If you do not wish to be contacted, please inform the service by calling 01522 309025 or emailing LHNT.lincschildrenstherapyservice@nhs.net.

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If you are referring into Children's Physiotherapy, Occupational Therapy or Speech and Language Therapy, please complete the form below.

Please note, by completing this form, you will be contacted by text, phone and email regarding the child. If you do not wish to be contacted, please inform the service by calling 01522 309025 or emailing LHNT.lincschildrenstherapyservice@nhs.net.

Return to header

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If you are referring into Children's Physiotherapy, Occupational Therapy or Speech and Language Therapy, please complete the form below. Please note, by completing this form, you will be contacted by text, phone and email regarding the child. If you do not wish to be contacted, please inform the service by calling 01522 309025 or emailing LHNT.lincschildrenstherapyservice@nhs.net.

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Supporting the development of Gross Motor Skills

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Supporting the development of Gross Motor Skills

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Supporting the development of Fine Motor Skills

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Supporting the development of Fine Motor Skills

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The workshops and groups we deliver are easy to access virtually.

It can be quite scary attending a group or a workshop when you don't know anyone else in the group. If you are worried about coming to a group or workshop there are lots of things we can do to support you.

Here is some feedback from other young people:

It is really good! Everyone is friendly and you learn some really helpful things which you can keep practicing.

I would say that I was worried before I started a group but once you get in to it it's completely fine and you forget about being nervous. From my experience once the session had started I felt more confident in myself

Although the groups and workshops are to support your emotional wellbeing, they are not like attending a lesson in school. They have been proven to have a positive effect on your emotional wellbeing and are there to help you with life's problems before they get too much to handle.

Top three benefits of groups and workshops:

You're not alone and they help you to realise that we all have similar experiences, but cope with them differently

Making new friends and building positive relationships

Groups and workshops include lots of interactive activities, games, quizzes, alongside learning some new skills to manage your emotional wellbeing.

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The workshops and groups we deliver are easy to access virtually. It can be quite scary attending a group or a workshop when you don't know anyone else in the group. If you are worried about coming to a group or workshop there are lots of things we can do to support you.

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If you believe your child has SEN, then please do raise this with your child's class teacher, who can help and advise you of any next steps. Please also see the Parent/Carers Guide to the SEND journey for more support.

If you wish to speak to Miss Vaughan our SENCO, please email SENCO@spiresfederation.co.uk.

Please note that Miss Vaughan has a day and a half dedicated to SEN.

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Supporting people across all ages to improve sleep, and provides sleep training to professionals in the health, social and corporate sectors.

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Fortunately, specific behavioral changes and adjustments to the sleep environment will help most children with insomnia. We've compiled the top tips that are proven to help kids sleep. The recommendations outlined here are best suited for toddlers through early adolescence. Both babies and teens will have specific considerations of their own.

These lists may seem long, but you don't need to implement them all at once. It's better to focus on trying a few small changes, giving them time to work, and then adjusting your approach based on how your child responds.

Keep in mind that every child's sleep needs will vary based on their age, genetics, and cultural differences. Therefore, not all approaches will work equally well for all children, and there can be an element of trial and error. However, your patience will be rewarded in time as your little one learns to fall asleep quickly on their own and keep sleeping soundly through the night.

Sleep hygiene - a collection of habits and behaviors that promote good sleep - is vital for children. Many sleep struggles are caused or made worse by poor sleep hygiene. When practicing sleep hygiene, remember that consistency is key. Sleep strategies take time and repetition to be effective.

Create a Routine: Humans are creatures of habit. A lets your child's body and mind know that it's time to settle down and prepare for sleep. The actual routine can be specific to your child, but it should last around 20 minutes and consist of three to four quiet, soothing activities such as putting on PJs, brushing teeth, a warm bath, and reading. Bedtime routines provide children with a sense of familiarity and comfort, which acts in direct opposition to the uncertainty of insomnia.

Set a Bedtime: A sleep schedule works with your child's natural biological clock to promote dozing off with regularity. Bedtimes are most useful when they're consistent, so try to keep the same bedtime on weekends as on school nights. Altering bedtimes during the weekend will make it more difficult for kids to maintain their normal weekday schedules.

Implement a Screen Curfew: The ubiquity of screens makes this rule hard to implement, but it's well worth it. Mobile devices, TVs, and tablets emit a type of blue light that suppresses melatonin, a hormone that promotes sleep. Children may be to the effects of light from screens. Screen time also stimulates the brain, making it harder to wind down for sleep. Electronic devices should be kept out of the bedroom and ideally not used within one hour of bedtime. Consider using the created by the American Academy of Pediatrics.

Get Exercise: Physical activity is proven to help people of all ages . Most children need at least of exercise per day. Just make sure to avoid vigorous activity within two hours of bedtime. Otherwise, your child may feel wound-up and find it harder to fall asleep.

Avoid Scary or Violent Content: Feeling scared or worried is a common reason kids can't sleep. So it's no wonder that scary or violent movies, TV, video games, and even books in the evening are in children. If your kiddo likes the gory or spooky stuff, save it for the daytime.

Nix Caffeine: This is a no brainer. Caffeine is a stimulant that can both make it harder to fall asleep and reduce the quality of sleep. In addition to the usual suspects like soda, coffee, and energy drinks, watch out for more discreet sources like tea, decaf coffee (which still has trace amounts of caffeine) and chocolate. Even small amounts of caffeine can have a in a little body. Don't let your child consume caffeine , or preferably, avoid it all together.

Don't Sleep With a Pet: While it's tempting for tots to snuggle Fido in bed, a pet's movements and noises during the night can awaken them from a peaceful slumber. Try having your furry family member sleep outside of your child's bedroom for a few nights to see if that helps. To make the transition easier, include saying goodnight to pets in the bedtime routine.

Optimizing your child's bedroom is an integral part of inducing quick and seamless shuteye. People with insomnia are more likely to be distracted by an uncomfortable bedroom National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source , which makes sleep even harder. These tips can help you create the perfect sleep setup for your little one:

Room Temperature: The body and brain both in preparation for sleep, and this can be disrupted by a stuffy bedroom. To avoid this, try to keep the thermostat around 65 degrees.

Noise: Research suggests that even mild sound disturbances can , even if the sleeper never awakens. Consider noise-blocking curtains to cut down on street noise. You can also use a fan or white noise machine to drown out unpredictable or distracting sounds.

Light Level: Start dimming indoor lights as bedtime approaches, and keep your child's bedroom as dark as possible. This and . If your child is afraid of the dark, a small nightlight is okay.

Soothing smells: Calming scents like can have mild sedative effects. You might try using essential oils, a room diffuser, or dried potpourri sachet to provide a soothing, sleep-inducing smell.

Unfortunately, childhood anxiety is steadily rising Centers for Disease Control and Prevention (CDC) As the nation's health protection agency, CDC saves lives and protects people from health threats. known to disrupt sleep Anxiety and Depression Association of America (ADAA) ADAA's mission focuses on improving quality of life for those with anxiety, depression, OCD, PTSD, and co-occurring disorders through education, practice, and research. View Source . Stress is View Source in all ages, so anything that can reduce worrying before bed is helpful. Help your child learn to manage their concerns with these tactics:

Write In a Journal: Encourage your child to get their anxious thoughts out of their head and onto paper. It can also help for them to write about the good things that happened in the day. Focusing on the positive will help children feel more secure.

Mindfulness Exercises: Mindfulness exercises like meditation are proven to . There are many kid-friendly meditations that parents and children can do together. These often consist of simple breathing techniques, body awareness, or guided imagery. Look to books, tapes, and even smartphone apps for ideas.

Create a Worry Time: It's okay to discuss worries, just not at bedtime. Set aside a specific time during the day for your children to discuss their concerns and how to cope with them. This can free children of the need to dwell on worries before bed.

It's normal for even the best little sleepers to awaken from slumber and ask for a parent. When your child cries out for you, it's okay to tend to them. However, you should do so with intention. This is not the time to give in to demands, as doing so can increase stimulation and make it harder to fall asleep. Fulfilling your child's every request can also reinforce an unhelpful pattern of relying on parental assistance for sleep.

Instead, keep the checks short and simple. The point is to provide your child with reassurance that they're safe and cared for, while still fostering their ability to self-soothe and sleep on their own. Some parents may even wait a few seconds before answering a call so that their child has the opportunity to fall back asleep on their own.

If you have any doubt over whether your child's nighttime checks are appropriate, consult your child's doctor for guidance.

If your child continues to have trouble sleeping despite your best efforts, it may be time to check in with their pediatrician. Although uncommon, there can be more serious causes of childhood insomnia, such as childhood sleep apnea or restless leg syndrome.

Any of these reasons are cause to involve a doctor:

Significant daytime sleepiness

Frequent or severe snoring or other abnormal breathing during sleep

Suspected psychological or developmental condition

Considering medications or supplements to aid in sleep

For a couple of weeks before the doctor appointment, it can help to keep a sleep diary. This is a nightly recording of your child's bed time, nap times, sleep length, and activities. A sleep diary helps to identify patterns and possible problems to address.

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References

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Sleep Strategies for Children | Sleep Foundation

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Wondering about sleep aids for kids? These proven sleep tips will help children learn to fall asleep quickly and stay asleep.

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Ideas to cope with and manage sleep in young children, including if your child refuses to go to bed.

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A fantastic organisation who are there to support parents who have children with SEND.

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Virtual Autism Hub :: Lincolnshire Partnership NHS Trust

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The Virtual Autism Hub is an innovative source of all age autism support to empower autistic people and their parents/carers. We work closely with community groups and organisations to strengthen support for autistic adults, children and young people and parent/carers, increasing the range, breadth and reach of these groups.

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Many people, of all ages, find toilets unpleasant and sometimes worrying. It is particularly common in children and can impact on their bowel and bladder control and function.

It is important to recognise toilet anxiety or toilet phobia in children and the effect it can have on them, so that they can be supported to overcome their fear. This can avoid further problems developing and focuses on the underlying cause.

What is anxiety?

Anxiety is the emotional response to an unfamiliar or alarming situation, and is linked with physical changes in the body. It is a normal response which can help us learn and adapt - you may have heard it described as 'flight or fight'.

It can sometimes be fun and exciting, such as in stories like 'Going on a Bear Hunt' or whilst watching films, like Star Wars. New situations can often make children anxious, but this feeling usually reduces quickly and they start to feel better.

What is toilet anxiety?

Toilet anxiety, toilet phobia or paruresis may be triggered by an unpleasant experience, such as a noisy or smelly toilet. Children might remember this each time they go - leading to an association of anxiety with going to the toilet. They may also start to hold in wee or poo to avoid using the toilet.

This can lead to constipation as the poo is not let go and this can result in a large uncomfortable poo, causing even more increased anxiety. Memories of an unpleasant or painful poo, following constipation can last for a long time, even if the poo has returned to normal so the anxiety may continue.

Anxiety following an unpleasant experience can be hard to forget and overcome. It can also continue to affect children's confidence and behaviour.

Fear of toilets is often about the unknown, and may be linked to imagined monsters and scary things, snakes in the toilet, and dangerous germs (Toilet cleaners 'kill all known germs' after all!).

Physical effects of anxiety

These may include:

Nausea and stomach ache

Rapid shallow pulse

Rapid shallow breathing (even triggering an asthma attack if children have this).

Headaches

Wee and poo accidents

Faints

Emotional effects of anxiety

These might include:

Panic attacks

Tantrums and meltdowns

Withdrawal

Freezing

Sleep problems and nightmares

Irritability

Clinging

Distress and exhaustion

Denial and resistance to engage with the problem

Possible causes of toilet anxiety

New, unfamiliar toilets

Constipation and/or a painful poo

Soreness and skin inflammation round the anus or round the urine outlet

Different clothes e.g. pants which may be different and feel strange

The sensation of wee and poo coming out and losing part of yourself

Splash back from the toilet

Will it stop?

Feeling that they could fall into the loo

Background factors

Individual personality

Family changes and stress e.g. new baby, moving house

Potty training (this is the first time a child needs to actually engage with their wee or poo)

Starting school and/or nursery
Being denied access to the toilet at school

Being called names or bullied

Inability to cope with new situations

Trauma

Health issues

Developmental conditions e.g. autism (ASD)

Children with concentration difficulties (ADHD,ADD)

Sensory factors

Many children may be upset by too much sensory stimulation including:

Visual - bright lights, reflections, glare

Hearing - echoes, sounds of toilet filling and/or flushing, hand driers

Touch - the feeling of the toilet seat, toilet paper, clothes being down round the legs

Smell - highly perfumed bathroom products and cleaners, the smell of poo

Balance - feeling of unsteadiness especially on a strange or different toilet

Proprioception - understanding where your body is in space and in relation to the toilet

Interoception - understanding and feeling the sensations from inside the body, including sensations from bowel and bladder activity

Responding to sensory factors

Analyse the toilet environment

Reduce the amount and impact of unpleasant sensations

Make the bathroom familiar and friendly, with games music and pictures

Provide distractions and more stimulation for those who need it

Our sensory factsheet has lot more information on supporting children with sensory needs.

How to stop toilet anxiety in children

Accept and recognise the child's anxiety and analyse the factors contributing to this.

Check bowel and bladder function. Many children are constipated too and that will need treatment before progress can be made. See our advice for children with constipation for more information.

Build confidence with other activities and skills e.g. washing hands, putting on socks, being helpful

Break up the task into small, easy steps that can be gradually built on

Use predictable routines

Distraction

Try to make toileting fun

Talk to the child about anxiety

Some things to try

Music and songs

Videos which explain how toilets work

Tactile activities e.g. fiddle toys, putty, play dough

Joke book - laughter is a great way to relax children

Visuals e.g. kaleidoscopes, spinning danglers

Gentle massage, tummy, feet or hands

Sounds e.g. waves, music, bird song

Slow, deep breathing

Thinking about a favourite place or activity

Using rewards

Reward effort as much as success

Keep rewards small and fun

A lucky dip box

Activities and targets for older children

Peace and quiet may be preferred by some children.

Things to avoid

Giving unrealistic targets

Asking too many questions- use "I wonder what..."?

Getting cross - but you can be cross with the wee and poo coming out in the wrong place! Talk about how annoying it is that the wee/poo is misbehaving again, and how you and the child will have to teach it how to behave.

Other things to consider and try

It's always important to consider and assess anxiety

Try to see the situation from the child's perspective

Toilet anxiety may be linked only to toileting activities

Anxiety improves with experience and familiarity

Parents and carers need support too, it is stressful dealing with an upset child

Consider and discuss school toilets

Make sure children get used to other toilets (these can be scored out of 10).

Remember: Anxiety usually improves with experience, support and growing up.

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Toilet anxiety and toilet phobia in children - ERIC

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Why the bathroom is frightening place for some children and how we can help them overcome their fears.

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Toilet Anxiety in Children: A Parent’s Guide

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Toilet anxiety in children can be stressful for both kids and parents. Discover what it is, how to recognise it, and effective tips to manage it in this comprehensive guide.