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How to Help Kids Stop Bedwetting - Child Mind Institute

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Bedwetting accidents can be a sign of enuresis. Find out more about the issues underlying this common condition and effective ways to treat them.

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How to Help Kids Deal With Embarrassment

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How to Help Kids Deal With Embarrassment

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For most adults minor embarrassments are just a part of life - annoying, but inevitable and hardly a big deal. But for many kids, embarrassing experiences can be very upsetting and, in some cases, may lead to serious issues like anxiety and avoidance.

We can't protect our children from embarrassment, but we can help them build the resilience and confidence they need to deal with it in a healthy way.

Kids look to parents for cues on how to manage difficult emotions like embarrassment. "As parents we set the behavioral tone for our kids," says Rachel Busman, PsyD, a clinical psychologist, "So when we're helping children learn healthy emotional habits, the first step is to consider how we handle similar situations in our own lives."

Taking a look at how you deal with embarrassing experiences at home will help you set an example of healthy behavior for your child.

Don't obsess: If you tend to dwell on mistakes you've made ("I can't believe I did that!" "I could have died of embarrassment!"), it's more likely your child will do the same.

Stay calm: If you lose your cool when an embarrassing situation happens to you, or react by becoming angry or upset, you're sending a message to your child that it's a big deal.

No teasing: Kids accidentally do and say some very funny things, but it's important not to mock mistakes or poke fun at embarrassing incidents. If small embarrassments are treated with ridicule, kids may start associating even minor missteps with feelings of shame and humiliation. Teasing - even if it seems gentle - can be very upsetting to kids, especially if they're already feeling sensitive.

There's no yardstick for embarrassment. Something that sounds small to you - giving the wrong answer in class for example - may feel huge to your child.

If your child is embarrassed it's important not to dismiss their feelings, even if the situation that caused them sounds like no big deal.

"We naturally want to downplay embarrassing experiences by saying things like 'it's not as bad as you think,'" says Dr. Busman. "But when kids are experiencing these big, really upsetting emotions that can feel like a brush-off."

If your child comes home upset, what they don't need is for you to get upset, too, or angry on their behalf. ("That sounds awful!" "Those kids should be ashamed of themselves for laughing!") And don't assume that they want or need you to do something about it. When a self-concious child worries that a parent will overreact or make an embarrassing situation worse, they're likely to be reluctant to share their feelings.

"When a child is hurting, as parents we want to do all we can," says Dr. Busman, "but if your kid is feeling embarrassed, heaping more attention on the situation can make it worse, not better."

If your child shares an embarrassing situation with you, take care to validate their feelings, but don't dwell on them or over comfort. Instead, praise positive coping skills. If they made a mistake during a piano recital, praise them for staying focused and finishing the piece. Reframing negative experiences will help your child identify healthy reactions and practice them, building what we call metacognitive skills. You could say: "I'm so sorry that happened today. I know it was upsetting but I am so proud of how you handled it. It takes a really brave person to keep playing when things are hard."

If your child fell in gym class and other kids laughed, it may seem to them as though everyone saw, everyone laughed and no one will ever forget it - ever.

Of course you know that's not true but kids, especially younger ones, often struggle to see beyond their own feelings, which can make embarrassing situations feel like front-page news. "Kids can be egocentric," explains Dr. Busman, "so when something embarrassing happens to your child it can feel like everyone is thinking about it as much as they are, when in reality most kids will have moved on by the next day."

Learning to put their feelings and experiences in context will help your child gain perspective and build resilience.

Unpack: Help your child take a metacognitive approach to their feelings by asking open-ended questions. For example: Your child isn't the only one who's ever fallen down in gym class, so you could begin by asking how they felt when other kids did the same thing. Learning to put their own experiences in context can help your child start to see embarrassing situations from a better angle.

Share: Sharing examples from your own life will help normalize embarrassment. "I dropped my handbag at the grocery store the other day. It practically exploded all over the floor. Everyone laughed, but then several people helped pick things up."

But don't compare: Offering perspective is good but be careful to avoid comparing your experiences with your child's. ("You think that's bad, when your brother was your age...") Your child may end up feeling like their experiences are unimportant - or not serious enough to warrant how upset they're feeling - which can make them feel worse for not being tougher.

Let your child take the lead: Sometimes questions are helpful, but there may be times when your child just doesn't want to talk about it. "Letting kids take the lead is important," says Dr. Busman. "If your child says, 'I don't want to talk about it' or seems too upset, don't push." Embarrassment is a big feeling and sometimes kids just need space to cool down.

Helping your child gain perspective without minimizing their feelings will make it easier for them to move past negative experiences - and give them an important tool for building self-awareness in the future.

Embarrassing situations happen to everyone from time to time, but if your child regularly comes home from school upset, or has a major change in behavior or mood, there may be something more serious going on.

Bullying: Unfortunately, kids aren't always kind. Most children will be made fun of at some point during their lives. Sporadic episodes of embarrassment are unpleasant - but not unusual. However, if your child regularly reports being teased or humiliated by their peers - especially kids who are bigger, older or more "popular" - there's a chance they're being bullied, and it's time to step in.

Behavioral changes: Feeling a little down or anxious after an embarrassing incident is normal, but lingering behavioral changes - not sleeping, low appetite, excessive worrying - are not.

Overreacting or obsessing: If your child's reaction to something embarrassing seems out of proportion to the situation or they seem unable to move past it, they may need support.

Avoidance: Most kids who've had an embarrassing experience feel reluctant about returning to the class or social group where the problem occurred for a little while, but persistent avoidance is cause for concern. Some signs to watch for include frequently being too sick to go to school or asking to go to the nurse during a particular class, making excuses to avoid seeing friends, cutting class, skipping extracurricular activities or refusing to attend school entirely.

For some kids, fear of being embarrassed itself can become a serious issue. If a child seems to live in perpetual fear of embarrassment - even when there's no obvious reason to worry - they may be experiencing social anxiety.

Social anxiety usually occurs in children who've reached adolescence, but it can develop earlier. A child with social anxiety panics at the thought of participating in day-to-day activities because they worry chronically about what other people will think of them, obsess on how they appears to others, or fear making a mistake.

These fears can be very debilitating. For kids who see potential for humiliation at every turn, even basic interactions can feel like a minefield, and social, school and personal interactions often suffer. Withdrawal is common, but kids with social anxiety are also prone to lashing out when the threat of embarrassment overwhelms them.

The good news is that kids who develop social anxiety respond well to cognitive behavioral therapy, and with help can return to their normal activities.

It's natural to want to protect your child from experiences that are hurtful or upsetting, but in the end, the best way for your child to build coping skills is through experience - with a side of support.

"Being embarrassed is part of life," says Dr. Busman. "It's tempting to try to shield our kids from difficult things, but in reality learning how to deal with those experiences in a healthy way is a skill that will serve your child well as they grow up."

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How to Help Kids Deal With Embarrassment - Child Mind Institute

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Adults can't protect kids from embarrassment but they can help them build resilience and confidence to deal with it.

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Browse our collection of books about Toilet Training here:

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Browse our collection of books about Toilet Training here:

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There are plenty of other more typical watch styles to choose from and you can also use a timer or app on your phone to help you remember to remind your child.

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This whole series is incredible

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Potty Time is a playful and positive approach to potty training. Emmy-nominated host Rachel Coleman teaches and inspires children to use the potty - and helps them sing, sign, and dance to celebrate their amazing bodies and potty time success. Potty Time is a perfect partner in potty training, working with any potty training method you choose. We believe children learn best by having fun, positive experiences through music, movement and fun! Try Potty Time today and we guarantee you'll love it!

Potty Time Preview

Grin and giggle with charming animations

Play and dance along with other children

Sing and sign with host Rachel Coleman

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Potty Time is a playful and positive approach to potty training. Emmy-nominated host Rachel Coleman teaches and inspires children to use the potty - and helps them sing, sign, and dance to celebrate their amazing bodies and potty time success. Potty Time is a perfect partner in potty training, working with any potty training method you choose.

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Play Sesame Street games with Elmo, Cookie Monster, Abby Cadabby, Grover, and more!

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Your guide to potty training basics, including when to start and what to do.

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About Ask Dr. Sears

AskDrSears.com is intended to help parents become better informed consumers of health care. The information presented in this site gives general advice on parenting and health care. Always consult your doctor for your individual needs.

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AskDrSears.com is intended to help parents become better informed consumers of health care. The information presented in this site gives general advice on parenting and health care. Always consult your doctor for your individual needs.

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Sadly, there is no magical app that will do the hard work of potty training for you - it's always going to take time, patience, and practice. But thankfully there are some apps that'll encourage your kids to listen to their bodies, entertain them while they sit on the potty, remind them to go, or take the work out of a rewards-tracking system for you. Here, some helpful toilet-training apps - and a few old-school, hard-copy books to help smooth the potty process.

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by Leslie Patricelli

Toddlers: They tell the truth.

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"Daniel Tiger's Stop & Go Potty" Is Actually a Really Smart Potty Training App

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Sadly, there is no magical app that will do the hard work of potty training for you - it's always going to take time, patience, and practice. But thankfully there are some apps that'll encourage your kids to listen to their bodies, entertain them while they sit on the potty, remind them to go, or take the work out of a rewards-tracking system for you.

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TOP 20 POTTY TRAINING REWARDS (THAT ACTUALLY WORK)

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TOP 20 POTTY TRAINING REWARDS (THAT ACTUALLY WORK)

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Potty training children is difficult. It's enough to take the calmest mom and dad and force them to get clever, sometimes cruelly so. We find ourselves using swear words - potty training bringing out our potty mouths. Or, perhaps, we regale our children with scary stories: there's an alligator in the toilet named Charlie who's getting thirsty. And Charlie's angry when he's thirsty.

Still, while we find ourselves frustrated by the flush, a positive reward system is much more effective.

A reward system is different than a bribe - this is an important distinction. A reward follows behavior while a bribe precedes it. Rewards are very useful in toilet training, but only if they're given with expedience. If you wait too long, your child may fail to make the connection and any positive reinforcement you would have gained will be lost.

So, what kind of potty training rewards are worth your time? Take a swipe (or a wipe) at the following tricks:

1. Simple Praise

Children respond to things that are easy; thus, keep your praise as simple as possible. There's no need to make a deposit into their college fund every time they poop in the potty - clapping, dancing, or squealing with delight will all suffice.

2. The Happiness Jar

Your child will respond to tangible items (such as a new toy). But they'll also respond to their favorite activities. Use this to your advantage. Write down some of the things your child loves to do - a trip to the zoo or finger painting in the garage - and place them in a jar. Then when your child uses the potty, allow them to pick from the jar and reward them with whatever activity they've chosen.

3. Books

Using books in the bathroom is helpful for many reasons. For one thing, reading on the toilet helps your child stay entertained - Hansel and Gretel are more fun than staring at the wall. Books also help them get comfortable with the idea of using the bathroom. Keep a stash of potty books nearby and reserve them for potty time only.

4. Potty Doll

Potty dolls are designed to drink and then wet themselves. Buying one for your toddler helps them learn about the concept of urination. Encourage your child to teach their doll how to use the potty; they'll teach themselves in the process.

5. Offer Special Time

Kids love attention (until they're teenagers). Providing extra tender loving care is a good way to help your child acclimate to the potty. Each time they have a successful day, reward them with special mommy or daddy time.

6. Lollipop Tree

"The Lollipop Tree" is a song by Burl Ives, but it's also something you can use to help the - er - flow of things. Simply put: kids will be a sucker for it. Why? Because most children love treats. Create a lollipop tree and reward them each time they use the potty.

7. Use Visual Representation

If your child is visual, break out the marbles! Keep a container nearby and allow your child to add marbles each time they use the bathroom (let them add more for going number 2). Decide on the reward they'll get when the container is filled. Making it something big - like a new bike - will help them along.

8. Celebrate in the Evenings

Each day your child stays dry, use the evening to celebrate their success. You might take them to the park or out for ice cream. Make sure they understand why they're being rewarded.

9. Have a Block Party

Use blocks to lock in the concept of potty time. Like the marble idea above, this provides visual representation. Legos are best as they stick together. Allow your child to add a Lego with each successful potty trip and then reward them with a prize when the tower gets high. Some kids will focus on the prize; others will love the idea of watching the tower grow from their successes.

10. Potty Log

A potty log is also a great way to reward your child. No, it's not really a "Dear Diary, Mary pooped in the potty today!" sort of thing. Rather, it's a story that catalogs your little one's journey from diaper to potty trained big kid. It's a story where, naturally, they're the hero.
Are you feeling overwhelmed about potty training? My NEW book can help make life easier for you. Click this link to get it now on Amazon: 3-Day Potty Training Boot Camp
11. Use Food Coloring

Food coloring turns toilet water into the color of your child's choosing. They might not want to go in a clear bowl, but a bowl that's blue? Bring on number one and two!

12. Print out Potty Tickets

These tickets act as punch cards for your child. Each time they go, the card is marked. When it's filled, they get a surprise. If they refuse, they get another kind of ticket: a one-way pass to grandma's.

13. Purchase the Poop N' Pull

It might sound like something that you have to do when you don't eat quite enough fiber, but the Poop N' Pull is a potty training reward system where your child pulls a string for a toy each time they go to the bathroom. Some kids might only pretend they need to go, so make sure they're not pulling your leg as well.

14. Have Consequences and Incentives

The idea behind this is simple: grab a jar and, for every dry diaper, give them something to put in the jar (a ping pong ball, for instance). Once the jar is full, they earn a gift. But, for every soiled or wet diaper, make them take a ball out. They'll probably struggle with this concept, but they may as well learn now: if you crap in your diaper, life craps on you.

15. Buy a Potty Prize

If your child is particularly motivated by prizes, congratulations: they're easier to manipulate! This is especially true in regards to toilet training: take your kid on a shopping spree and purchase potty related items (such as big boy or big girl underwear) and a few prizes. Then wrap these prizes in enticing and "must have right now" paper. Place them somewhere visible and remind your child that they'll earn the prize when their potty training goals are achieved. Just like some horses need a carrot dangled in order to walk, some kids need a trinket before they'll tinkle.

16. Make a Potty Training Sticker Chart

Children love stickers (for some reason). Posting a sticker chart outside your bathroom and rewarding them whenever they go is a great way to make sure they "stick" to the program. You can even celebrate how long they've gone: Days without an Accident: 2...scratch that, 0.

17. Break out the Chocolate

If there's one thing that we as human beings respond to, it's chocolate. And children are no different. Each time they go, reward them with a small treat: M&Ms or a Hershey Kiss. Because, let's face it, certain types of chocolate make a good segue to poop. Remind your kids, for instance, that if they drop a Milk Dud inside a petting zoo, it's best to assume it's gone forever.

18. Personalize the Potty

Let your child decorate their throne. Stickers or colors or even drawings taped to the bathroom walls make the porcelain a bit more welcoming. After all, toilets aren't all that inviting. And that's probably why so many men seem to miss the bowl completely.

19. Bring a Friend

If your child has an attachment to a toy, a doll, or a blanket, summons it to help you. This added friend gives some kids the security they need. So, bring their teddy bear to the toilet in the early years. In the later ones, try to swap it out for a magazine.

20. Search for Treasure

Placing a treasure chest on top of the toilet is a perfect way to get your child interested in using it. When they do, allow them to blindly pick a prize. If they don't like that particular prize, well, they may always come back for more after a nice glass of prune juice.

Maybe, someday, parents will band together in a movement to make potty training easier (the Bowel Movement). But, in the meantime, we do what we can. Many children respond to the potty training rewards above, making your life a little less crappy.

Do you want to potty train your child fast without stress? Get my NEW book now (click the image below to check it out on Amazon):

Related Posts:
Best Potty Training Tools & Supplies Free Printable Potty Training Charts (Tried-and-True) How to Potty Train in 3 Days without Losing Your Sanity 20 Highly Effective Potty Training Tips (Revealed by Experts!)

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Top 20 Potty Training Rewards (That Actually Work)

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Potty training children is difficult. It's enough to take the calmest mom and dad and force them to get clever, sometimes cruelly so. We find ourselves using swear words - potty training bringing out our potty mouths. Or, perhaps, we regale our children with scary stories: there's an alligator in the toilet named Charlie who's getting thirsty.

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Oh Crap! Potty Training: Everything Modern Parents Need to Know to Do it Once and Do it Right

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Oh Crap! Potty Training: Everything Modern Parents Need to Know to Do it Once and Do it Right

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Our 23-month-old son is well on his way to joining the ranks of the potty trained (knock on wood). That's in no small part to this book.

Glowacki's biggest strength as a potty training consultant is that she's an acute observer. She doesn't have one-size-fits-all steps for you to follow. Instead, she relays the patterns of how children learn to use the potty, and how their parents guide them.

My only gripe is that the book is written for mothers. It's not really her fault though. She admitted as m...more

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Our 23-month-old son is well on his way to joining the ranks of the potty trained (knock on wood). That's in no small part to this book. Glowacki's biggest strength as a potty training consultant is that she's an acute observer. She doesn't have one-size-fits-all steps for you to follow.

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I was sent this book by the author and I have to say as ever the approach is gentle and has provided me with confidence to begin toilet training my two year old son. The advice is common sense and gentle. I've passed it on to my friend with an 18 month old. It has lots of different ideas all in one book!

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I was sent this book by the author and I have to say as ever the approach is gentle and has provided me with confidence to begin toilet training my two year old son. The advice is common sense and gentle. I've passed it on to my friend with an 18 month old.

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In order for a toddler to be successfully potty trained, she needs to be able to sense the urge to go, be able to understand what the feeling means, and then be able to verbalize that she needs your help to make it to the toilet and actually go. Waiting until your child is truly ready will make the experience much faster and more pleasant for everyone involved.

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In order for a toddler to be successfully potty trained, she needs to be able to sense the urge to go, be able to understand what the feeling means, and then be able to verbalize that she needs your help to make it to the toilet and actually go.

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Potty Training Children with Special Needs

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Potty Training Children with Special Needs

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The issue of when and how to begin toilet training can be particularly challenging for parents of children with special needs. The sense of accomplishment when they do succeed in this important aspect of self-care can make an enormous difference in their level of self-esteem.

Perhaps more than other parents, those who have children with physical, intellectual, or developmental disabilities can appreciate the toilet-training process as a way to follow and celebrate a child's overall growth. Rather than focusing negatively on setbacks, which are inevitable in any case, they can use the setbacks as opportunities to discover how their child learns best and to demonstrate to them that they are able to progress.

Toilet training works best when parents of children with special needs have access to the guidance, instruction, and encouragement of their pediatrician, other trained professionals (including school personnel), support groups, or a combination of all . The first step you must take is to determine whether your child is ready to begin.

Signs of potty training readiness are the same for your child as for all children:

Is your child aware of the difference between being wet and being dry?

Can they stay dry for at least two hours at a time?

Can they sense when he needs to urinate or have a bowel movement?

Are they capable of reaching the toilet or potty in time (perhaps with your help)?

Can they undress and dress themselves or are they ready to learn?

Are they motivated at some level to take this next step?

If your child is in a resistant phase, is not ready to take on a new challenge, or does not yet feel the urge to behave "like other kids" in this way, you might take some extra time to prepare them mentally before starting the potty training process.

If you feel that your child is ready, ask your pediatrician for their opinion. They can examine your child to offer a physical assessment and perhaps special insight into the particular needs of your child. They can also provide further information that you may need before starting, and let you know what types of special equipment may be advisable.

It is also important to prepare yourself emotionally before you and your child begin the process. Children with special needs often begin toilet training later than other children, frequently completing the process at age five years old or even later. Of course, children with some conditions may always need help with their clothing (button, zippers, tights) and some might need help getting to the bathroom. Some will develop innovative ways of achieving independence.

Learning to use the toilet can be physically painful to some, and challenging for others to understand. Accidents will happen, of course, and you will need to draw on an extra dose of patience and humor when they occur. Ask for help from your spouse, relatives or friends before you begin.

Physical challenges

A number of physical disabilities and illnesses can hinder a child's ability to become fully toilet-trained or easily adjust to bathroom use. If your child faces such a challenge, you will need to think about how their unique situation affects each stage of toilet training and how you can compensate. Whether your child is unable to sense the need to urinate, has difficulty getting onto or staying on a standard potty or toilet or must adjust or readjust to toilet use after having used an ostomy device, they will need extra support from you and their other caregivers as they learn to master this new skill.

Visual disabilities

Children with visual disabilities and those with sight deficiencies experience a disadvantage at several stages of toilet training. First, they might be unable to observe family members and peers using the toilet, so they cannot mimic their behavior. So many details of toilet or potty use-where the potty is in the bathroom, how the body is oriented to it as one sits down, how the urine and poop get into the potty, how one tears off and uses toilet paper-are simple to understand if a child can observe the process but difficult if they cannot. Without sight to help them, your child will need to rely more on language to understand how the process works. Because of this, you will probably want to wait a little longer to begin potty training-until they are three or four years old (or even later, since language delays can accompany blindness)-so that they can fully comprehend what you are telling her.

When you are ready to introduce your child with a visual impairment to the concept of toilet use, start bringing them with you when you use the bathroom. Allow them to explore the bathroom and locate the toilet. (Be sure it's well ventilated and smells pleasant so they will want to return.) Place their hands on your shoulders so they can feel you sitting on the toilet, explain what you are doing and why, and guide her hands to the toilet paper dispenser. Also show them the flush handle and the sink for hand washing.

Once you have placed a potty in the bathroom, lead them to it, let them accustom herself to its presence, and keep it in the same place throughout the toilet-training process. Talk to them about toilet use at other times, too-pointing out that most of the people they knows use the toilet and that toilet use is a sign of being a big kid who can take care of themselves.

Once your child begins practicing potty use themselves, keep the bathroom and the passage to it clear of obstacles. A musical potty that is activated when urine hits the bowl might make the learning process more fun. Teach them to feel the inner edge of the seat before tossing in the toilet paper and, if the child is a boy urinating standing up at a toilet, to position his body so he doesn't urinate on the toilet itself. (You may want to have your son first sit to urinate; once he masters that skill, then you can teach him to stand in front of the toilet.)

Finally, as your child grows more comfortable with bathroom use, make a point of taking them to the bathroom at each public place you visit. By helping them familiarize themselves with the wide variety of bathroom layouts and toilet styles, you will help build their self-confidence when away from home and prevent accidents. And don't forget to reward their progress with praise, hugs or a small reward.

Hearing disabilities

Children who are deaf or have difficulty hearing may or may not find toilet training challenging, depending on their ability to communicate. A child who is already fluent in sign language can rely on a combination of visual observation and explanations from you to understand what's expected of them-much like any other child. Children who do not yet have the ability to understand your signals and simple signs may not be ready for toilet training until they are somewhat older.

The key to training in these cases is to keep the process simple. When introducing the concept, emphasize the visual: Allow your child to observe you (and, even better, other children) using the bathroom, and show them picture books about it. Choose one gesture or sign for the essential terms (pee, poop, potty, wet, dry, and need to go). Use these gestures each time you use the bathroom, and use them with them as well-signing "wet" (with a sad face) when you change her diaper or wet underwear, "dry" (with a happy expression) once they've been changed, and "need to go" after lunch when it's time to sit on the potty.

As long as you are consistent and stick with the half-dozen signals you need, your child will get the hang of potty use without longer explanations. When they do, be sure to reward them with plenty of hugs, stars on a potty chart or another small reward.

Continence problems

Some conditions have no effect on a child's ability to understand the process of toilet training but make it difficult for a child to comply. Your child may grow increasingly frustrated in their efforts to stay dry and may even give up trying.

The best solution to this dilemma is to put your child on a regular potty schedule. By placing them on the potty frequently (reminding them every hour or so to visit the bathroom), you remove the burden of having to acknowledge so many times each day that they must interrupt an activity to tend to their physical needs. Going to the bathroom at the top of every hour can become a habit similar to brushing teeth twice a day or getting dressed in the morning-freeing her up to focus on other activities between visits.

Cerebral palsy

Children with cerebral palsy not only tend to be slow in developing bladder control, but may not have enough bladder awareness to begin toilet training at age two or three. If your child has cerebral palsy, they will need help to develop an awareness they needs to go (which may be signaled to you when you see them clutching their genitals or fidgeting anxiously) before they can begin toilet training. They will have to be able to delay urination until they are in position on the potty. They will need to remove their clothing and then hold themselves on the potty (with supports) long enough to achieve success. Again, these challenges mean that it is usually best to wait to toilet-train until they are older.

It is possible that limited physical activity, undeveloped muscle tone, or medications may cause constipation for your child with cerebral palsy. So, pay special attention to their diet as you start toilet-training. Make sure they are drinking plenty of fluids and eating foods high in fiber such as fruits and vegetables. As they begin to practice removing her clothes before getting onto the potty, make it easier by providing clothes with Velcro fasteners or loose elastic waistbands. (They may find it easier to remove her clothes while lying down.)

Spina bifida and spinal cord injury

Spina bifida, spinal cord injury, or spinal tumors create toilet-training problems for young children similar to those of cerebral palsy. But since most children with this condition never develop an awareness of when they need to go, few can ever fully use a toilet. You can, however, teach your child to remove urine through a catheter on a regular basis, and to visit the bathroom for bowel movements on a regular schedule. (A high-fiber diet with plenty of liquids and meals served on a regular schedule will make this process easier. Sometimes a stool softener or even a suppository or enema is needed.) Since your child will find it difficult to remove her clothing, be sure to provide them with Velcro fastened clothes and allow them to lie down to undress if necessary.

A child with spinal cord dysfunctions will likely not feel the need to move their bowels and have a greater risk of being constipated. Help prevent constipation by giving them enough fluids and a diet high in fiber. They may need to be on a bowel regimen designed so that they have a bowel movement at home and then does not have a bowel movement at school. Your pediatrician and therapist should be able to help develop a successful program for your child. They will need regular catheterizations, and either an aide or school nurse will have to help until your child can perform their own catheterizations.

Parents of children with physical disabilities such as cerebral palsy or spina bifida may become so distracted by the need for special equipment or physical support that they neglect the cognitive and emotional support that all children need to succeed at toilet training.

While installing that special potty in the bathroom, talk with your child about using the potty and why it's important. Let them observe you and others using the bathroom, and praise and reward them when they succeed even a little bit. Resist the temptation to "let things go" when there is difficulty and remain firm about the schedule or routine you have created-unless the experience becomes negative and your child becomes very resistant. Remember, their progress is especially significant if it increases their self-confidence and prepares them for more challenges. Give them all the information, attention and support they need to succeed.

Behavioral and mental disorders

Your experience toilet-training a toddler who has been identified as having developmental or behavioral difficulties will depend a great deal on your particular child's temperament, behavior patterns and coexisting conditions. Your knowledge of your child's strengths, weaknesses, tendencies and interests will help the process.

Toilet training can be particularly trying for parents of children who have developmental disorders or behavioral difficulties. This includes those with autism, fetal alcohol syndrome (FAS), oppositional defiant disorder (ODD), and, in cases when it is diagnosed this early, attention deficit /hyperactivity disorder (ADHD). Many children with these conditions may not be strongly motivated, or sufficiently equipped, to respond to the social reinforcements that work so well with other children ("What a big boy!"). For some, small tangible rewards such as a sticker or small toy can be effective.

Many find it extremely difficult to adjust to any change in routine. Some are particularly sensitive to touch and other sensory input and become upset by the frequent pulling off and on of clothing, the physical closeness with an adult and the unfamiliar surroundings of the bathroom.

For some children, simply learning the abstract concept of potty use can be complicated. For example, some children with behavioral disorders do not naturally imitate their parents' or peers' behavior. Others learn only through simple imitation or other concrete, nonverbal demonstrations. Such complications in the training process mean that early efforts can create a high level of frustration in your child and may lead to displays of temper, stubbornness, and refusal to cooperate.

Despite challenges, most children with special needs-whether they have physical challenges or behavioral issues-can be toilet trained, though in some cases the process may take up to a year or even longer. They may require help from an occupational or physical therapist or a rehabilitation engineer.

Your first step is to determine whether your child is ready to start training. Usually the time to think about beginning is when you notice that they can stay dry for an hour or more at a time, has regular bowel movements, is aware that he is about to pee or poop and dislikes being wet or soiled. It is also important to have your child examined by their pediatrician, since they may be at a higher risk for constipation or loose stools, which may interfere with training.

Once you have decided to begin, observe your child and consider carefully the specific traits, patterns of behavior, and obstacles that may impact their learning process. If they seems to dislike entering the bathroom, determine the cause of their discomfort. Is it the smell of disinfectant? The cold floor? The flushing toilet? Change or fix it if possible (change cleansers, put socks on their feet, move their potty away from the noisy toilet).

If they do not overtly signal the need to go, do they pause just before voiding or otherwise behave in a way that will provide you with a cue? At what times, or how long after eating or drinking, does he usually pee or poop? What foods, toys or other objects are they most passionate about? These can be used as tangible potty-training rewards, which may prove more effective than praise.

Identify how your child learns best. Some respond to firm but gentle physical demonstrations (being placed on the potty at regular times). Others do best with a formal routine containing a series of simple and predictable steps (verbally explained and reexplained, illustrated with pictures, or listed on a chart). Still others do best with offhand comments and conversations that inform without inviting resistance.

Intellectual Disabilities and Developmental Disorders

Most children with a developmental delay, an intellectual disability, or an autism spectrum disorder can be toilet-trained. The time it takes to achieve success ranges from a few months to a year or more. The process becomes easier as your child achieves at least a minimal level of verbal ability, is able to manage their clothes (perhaps with some help from you), and shows awareness of the need to go.

Toilet training for children with developmental delay, intellectual disability or autism spectrum disorder can be quite similar to training for other children, but sometimes it is not. Like with other children, as you introduce your child to the concept of potty use, it often helps to keep explanations simple. Start by checking the state of their diaper or pants every hour or so and offering a one-word, nonjudgmental comment when they are wet ("Wet!"). After you change them, smile and say "Dry!" If their verbal skills are limited, you might substitute a special gesture or sign for the words wet, dry, potty, need to go, and so on.

Begin bringing them to the bathroom with you when you need to use it. Smile and say "Dry!" after you've finished and pulled your pants up. If at all possible, have your child observe other children using the bathroom, too. They may make the connection between themselves and another child more easily than between themselves and you. After you've finished and are dressed, show them how happy you are and tell them "Dry!" If they have a favorite doll or stuffed animal, use it to play "potty," demonstrating again how the potty is used.

When they are ready to begin using the potty, begin setting them on it at regular times-quite frequently at first (as frequently as you checked them for wetness earlier) and then gradually settling down to the times when they usually go. Try to keep them on the potty for five or ten minutes at a time-keeping them company, reading to them, playing children's music and otherwise ensuring that they stays in place long enough to succeed. Once they do urinate into the potty, give him a big smile and say "Pee!" (or whatever word you have chosen for this event). Help them wipe off and then praise them with a happy "Dry!" and give them a reward. Eventually, with enough repetition, they will understand the connection.

If your child has an intellectual disability or developmental delay, it is best to toilet train one step at a time. Don't expect your child to learn to signal or announce their need to go, pull down their pants, use the potty, wipe their bottom and wash their hands all at once, the way their peers might. Toilet training will work best if you focus on the actual act of peeing and pooping first and address the other skills later. It is more important to keep them motivated than to achieve instant success.

Adapted from American Academy of Pediatrics Guide to Toilet Training, 2nd Edition (Copyright © 2016 American Academy of Pediatrics)

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Toilet training works best when parents of children with special needs have access to the guidance, instruction, and encouragement of their pediatrician, other trained professionals, or support groups.

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