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Downloadable resources to help with Toilet training

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Downloadable resources to help with Toilet training

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This includes toilet bingo and visual schedules as will as top tips.

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Our childcare expert, Laura Amies, shares her parenting advice on the common potty-training challenges and child toilet problems families face when it comes to toilet training.

Click below to download our free potty-training resources:

See Laura's top 7 tips on overcoming healthy hygiene habits stumbling blocks:

Personal Care Bags

There are of course stumbling blocks that many families face on the road towards personal care - and that's OK! No parent is expected to be 'perfect' and every family will find different ways to make their hygiene education and routines work for them.

From questions like when to start potty training, to potty training at night.

Key factors to consider include your child's natural temperament, their abilities, where they spend the majority of their time and how possible it is to implement structure whilst navigating childcare across different homes or settings.

When facing a barrier or stumbling block with building your child's toilet training and hygiene habits, here are the 7 key tips to overcome:

7 tools, tips and tricks to overcome common toilet training stumbling blocks:
Language
is something which I consider to be a tool that can be leant upon at all times. The way we deliver instructions can be the difference between a child pushing back and getting to work. With this in mind, the most effective tip I can offer is one which promotes the use of positive statements over optional language.

For example, "It's toilet time, thank you!" is often more effective than "Will you please go to the toilet?"

Transitional Objects such as favoured teddies, blankets, or toys can help to create stability and security, add a squirt of perfume or aftershave and a child can take true comfort in these objects whilst in other settings. When children feel safe and secure, they are more likely to develop new skills. TOP TIP: Practice personal care skills like how to wipe during play time with your little ones favourite doll or teddy!

Rituals can provide mini routines during trigger times such as bedtime, dinner time and even toilet time. Offering the exact same chain of events for a few minutes is much more attainable than doing so for an entire day, especially where childcare is offered in multiple places. If your little one pushes back during trigger times, consider singing songs to help motivate them. I often lean on hand washing, toileting and bedtime songs to pave the way for good habits!

Routine maps offer children a visual aid to help them navigate a routine in any setting. They highlight each aspect of a routine via a simple image and children can then see what is coming next. In turn they learn how to develop those all-important personal hygiene skills! I find routine maps particularly helpful for children who are potty training because you can add in pictures of the toilet, hand washing and even images that encourage a little one to get themselves cleaned up properly!

Personal Care Bingo is exactly what it says on the tin! You can easily create this with a piece of paper, a ruler and some pens by mapping out a very basic grid to fill with things like hand washing, teeth brushing, toilet trips and bathing. Children under the age of 5 will require support to fill out the bingo sheet, whereas children 6 years and over (depending on their individual development) may be able to check things off independently. I have found this to be a really fun and useful way to help children embrace their personal care!

Tick charts are similar to bingo in the fact that they highlight certain tasks and each time a child achieves them they can tick them off. The great thing about these methods is the fact that children are given a goal and can feel motivated to see them through. Internal motivation is essential for creating the independence needed to tackle self-care. You can also use this as a toilet training reward chart to keep them motivated.

Personal Care bags can bridge the gap between home and other environments. By using the same products between various settings, a child can take comfort in familiar smells and sensations. I highly recommend this method when it comes to encouraging personal hygiene because it allows a child to take ownership over their own toileting habits. Feeling in control of their own personal care can be really empowering for a youngster!

Ultimately every family is different and because of this every routine will be also. I urge parents to try and ignore the pressures that can be placed on them due to societal expectations or comparisons which are so easily made between two different children.

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Toilet Training Resources and Tips | Andrex®

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Child care expert Laura Amies shares her tips and essential resources to help parents who are facing challenges when toilet training their children.

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Podcast: children who only poo in a nappy

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Podcast: children who only poo in a nappy

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This is a 16 minute listen.

Resources signposted in this episode

Here is the transcript of Alina and Bethan's discussion.

Today we're talking about children that will only poo in their nappy. It's a really common issue that parents contact our Helpline about. Alina is going to be offering some really good advice and tips about how to work through this issue.

Here's an email we received from a parent.

My daughter started toilet training at two and a half, and not long after had a tummy bug. Since then she won't use the toilet or the potty for a poo. She turned for a few months ago and will start school this September. She poos every day, but will only do it wearing a nappy when we're at home. It's got so bad that last week she wore knickers to nursery and didn't do a wee for seven hours and waited until she got home. She'll tell us when she's been and her nappy needs changing, we've tried so hard to persuade her that it will be easier for her to go on the toilet, but she point blank refuses. I get so worried when she holds her wee for that long that it's going to cause long term damage. What can we do?

Well, Alina, over to you.

I've got lots of different tricks up my sleeve for this one. We get asked this a lot but the first thing to do is to try and reassure you that it is really common.

It's just a phase for a lot of children. It's something that they go through, particularly after potty training has begun when they just do this refusal. But they will come through it with your help.

Why does it happen?

It depends on the child.

With this girl it's quite likely that the tummy bug she had gave her trouble doing poos - the diarrhoea that frightened her or that it hurt her. And that's what triggered it.

For some children, they don't like the flush in the toilet, they go straight to the toilet, and we're pulling away from home they're okay at home just about. But when they're away from home they find that too daunting.

For some children it's around liking the comfort and security of a nappy.

They have spent those early months of their lives wearing a nappy and potty training is quite a big thing for them to get used to. Some children just find it really hard to not have that nappy there.

So what can parents do to break this habit?

It can be caused by a physical problem that starts a really strong fear. It's a bit like having a fear of a spider - like a phobia. We get parents that say, well, they don't have a problem weeing and pooing, but they just will not do it in the place that we want to.

What's borne out by the calls that we get, is that for a lot of children, it's because they've had a painful poo. Perhaps they were a little bit constipated. And then that memory, that fear of pushing the poo out, means that they just don't want to go anywhere near the place where they're expected to do it. So they would rather have that nappy on.

You find that children will often disappear behind the sofa or in their bedrooms and hide and to stand up to do that poo because they've worked out that actually that is the most comfortable place for them to do that.

Clinging on to the nappy is that sort of comfort and security.

It can be incredibly upsetting for everybody. And it and it can be quite easy to get into a real battle over it.

Get that constipation checked out.

We would recommend looking at the ERIC website where we've got a whole section on children's bowel problems, and then booking an appointment with your doctor GP.

They can check your child for constipation and prescribe some laxatives if that's what's needed. I would also really strongly recommend that you get the child checked for a urinary tract infection.

Holding on of a wee for that long, it's very unlikely to cause long term damage. I mean, if you were doing that over months and years, then yes, your bladder muscles are going to get over stretched, but doing this for short period is very unlikely to cause long term damage. But what it can do holding on to it like that is it can cause a UTI.

What you need to do is sort those physical things out to give yourself the best chance of of helping them on the behavioural side.

What are they drinking during the day?

This is important because it doesn't take much for even quite young children to work out that the more they drink, the more they're going to need to go and do wee so they also avoid drinking as well.

So drinking plenty is really important and it's just a really nice thing that you can reward a child for.

This issue makes kids feel pretty miserable. It can cause a lot of stress and angst but using drinking as a nice achievable goal for them, which we know is going to help soften that poo and is also going to help with their bladder signalling and avoid infections and constipation.

How do you tackle the behavioural side of this issue?

All the things that I'm going to say are covered in a document we've got on the website called "children who will only poo in a nappy and other toilet avoiders".

The first thing I would say is, if your child insists on wearing a nappy to poo or wee, don't say "no" as it's not going to help the problem. They're just going to simply just avoid doing it even more and then that withholding is going to cause more and more problems.

What you need to do is let them have that nappy on and then work on gradually changing their behaviour.

Tiny steps approach

So it's all about using a tiny steps approach. And being absolutely consistent in sticking to the programme that you decide to do.

So what we would say is, talk to your child and explain what's happening and what you're planning to do to try to avoid being in nappies the whole time.

Perhaps you can make it a part of the negotiation and agree with your child a new sort of regime that you're going to have, which is that its fine for them to do their wee or the poo in the nappy, but the nappies are going to be kept in the bathroom toilet area, and they just need to let you know when they want to go.

Keeping them in the bathroom area, reinforces where weeing and pooing should happen.

Some children are happy to start sitting on the potty or the toilet, perhaps in the bathroom, perhaps not, wearing a nappy and over time, you can just loosen it at the side or even cut a hole in. Other children might choose to go to their bedroom and do it there.

Begin there and then come to an agreement with your child that they're going to move closer towards the bathroom with the potty. You might find you've got to be really patient because it might take days to get them to the place you want to be. But follow this approach because it really does work.

Routine and rewards

Children love routine, they also like rewards as well. The key point is that they need to feel that they're achieving something. So make all of these goals achievable for them.

Alongside doing this its worth having just toilet time, they can be fully clothed, you're not expecting them to do anything on the potty or toilet. But just for even, you know, less than a minute, they're going to sit on that toilet once a day or the potty once a day just to get used to being there.

Fear of the bathroom

In terms of the other achievable goals, it's things like them helping you to clean up after they've done the wee or poo, tipping the poo from the nappy into the toilet can be a really good trick because again, it starts breaking down that fear.

For lots of children, it's the flush. So you may like to get them used to pushing the flush so they get used to it. Also things like splashing and noise, showing them how to put a layer of paper in the toilet. Lots of children don't like the thought that the poo might splash.

You're trying to reduce the fear and increase their interaction with the toilet because unfortunately it is something they're going to have to do and you're just trying to make it manageable for them.

Try to make it a nice friendly place whether that's putting posters up and having a little basket of toys next to the potty or the toilet they that they wouldn't normally see. That can be really helpful because it works as a distraction.

I remember talking to one family and they got the child involved in making cutouts of feet with brightly coloured paper. And they would come to an agreement with their child that the feet were going to move.

So after she'd done her poo in the nappy in the bedroom, then they just came to the bedroom door. And then it was onto the landing. And then it was a toilet door. And so then she got right next to the toilet.

It is about knowing your child and thinking what how would they like to approach here? What are their kind of things that they like doing?

What about outside the home, at nursery and school?

It is absolutely vital that everybody's singing from the same hymn sheet on this because otherwise a child will just get confused.

That so there's a couple of things we'd, we'd suggest doing. And so this in the case of this family, you know, this this little girl is about to start school.

So we would say before she starts for the parents to ask for a meeting with the class teacher, and any assistants that are going to be working with their child, the special educational needs coordinator of the school and a school nurse ideally as well.

Agree a plan with nursery or school

We have a really good template healthcare plan form on the website in the help at school section, to download. We try to make it easy as easy for schools and families as possible. This helps you to run through what that girl's routine is, what the issue is and how it's being managed at home.

So it can be agreed with the school what they're going to do and how they are going to try and keep it as consistent as possible.

It's all about open lines of communication with the staff. Really trying to make sure the staff aren't making a big deal of it. Children, even if they don't share it, will be feeling anxious and sad that this is happening to them and this sort of denial and things are just their way of dealing with it and sort of blocking out of the problem. They need to be treated with plenty of kindness. You've got to be really sensitive to their feelings.

There's lots of resources in the Help at School section of our website. It's also just good idea to point the school in the direction of the bowel problems section just so they understand how much struggling with constipation and withholding for example can affect a child.

I think there is a tendency for family members and perhaps nursery and school staff to think well, your child really should be out of nappies by now, that they're just being a bit lazy, they can't be bothered. It's not that at all it really needs to be recognised as what can be quite a quite an overwhelming problem.

A common problem shared by many families

This affects so many parents and families and but maybe people aren't wanting to talk about it so families end up feeling a bit like you're the only one battling with this problem.

There's no magic wand like a lot of things to do children's wee and poo problems. There is no overnight fix.

It's very rare that you will get a child that will happily ditch that nappy, particularly when this has become a bit entrenched. But sticking to these approaches, which is all based on what the work that we've done with families and is what they tell us has worked.

We have got a HealthUnlocked community page where parents and carers can get the peer to peer support, so you can actually talk to other families going through it.

But it's a tiny steps approach needed to move forward and there's lots of lots of patience, lots of praise, and you'll get there in the end.

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Episode 2 - Children that will only poo in a nappy - ERIC

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Understanding why children will only poo or wee in their nappy and tips for moving them beyond this tricky stage

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The official and only genuine Radar Key. Buy your disabled toilet key from Disability Rights UK. The National Key Scheme (NKS) offers disabled people independent access to locked public toilets around the country. Toilets fitted with National Key Scheme (NKS) locks can now be found in shopping centres, pubs, cafés, department stores, bus and train stations and many other locations in most parts of the country.

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Why are public toilets a challenge for young people with autism?

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This post has been written by Davina Richardson, Children's Specialist Nurse at Bladder & Bowel UK. Toilet training a child with autism is often difficult. Autism is a spectrum condition that affects social communication, social interaction and imagination. There are often sensory issues as well.

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Post-It Notes

It's annoying when you’re using an auto-flush toilet and it flushes but for a child sitting on the toilet when this happens, it can be especially frightening. One top tip we have come across is carrying a small stack of Post-it Notes in your bag to use to cover the sensor that triggers the auto-flush.

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Thinking that your child needs help with anxiety can be scary for us as parents. We may feel we need others or specialist services to help support our child. Whilst this can be the case for a minority of children, there are loads of things parents and caregivers can do to help them with anxiety without lengthy waits. From educating yourself and your child about anxiety to guided CBT workbooks there is a lot you can do to support your child.

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Secondary bedwetting (also known as sudden onset bedwetting) is when a child starts to wet again after at least six months of being dry.

There other potential medical causes of this which need to be checked out by a medical practitioner but they can include:

Periods of change and stress in a child’s life can also explain why they may suddenly start to wet again after even a long stretch of dryness.

DID YOU KNOW:
Vasopressin, the hormone that controls how much wee we produce at night can be affected by anxiety. When children feel worried, they produce less vasopressin, so bedwetting is more likely.

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You've arrived at this page because you may have a child or young person with continence difficulties. The clinician you are working with thought it might be a good idea for you to learn a bit more about anxiety to see if that helps. On this padlet we've tried to pull together information about anxiety and how learning and tackling anxiety might help with your child's continence difficulties.

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Contains helpful advice, education and resources for parents, young people and children about anxiety and how to overcome it.

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Fight Flight Freeze - A Guide to Anxiety for Kids

Anxiety is one of the most common mental health concerns for children and adults, affecting upwards of 20% of children and adolescents over the lifespan. Anxious youth are often quiet and well behaved, and thus frequently go unnoticed by their parents, teachers, and coaches. Alternatively others can be disruptive and act out, being labeled as having attention deficit disorder or being a "bad" kid. Both scenarios result in youth failing to receive the help they desperately need. Sadly, untreated anxiety can lead to depression, missed opportunities in career and relationships, increased substance use, and a decreased quality of life.

Parents often say that from a very young age, they knew there was something different about their child, but did not immediately recognize it as an anxiety problem. Some waited for their child to "grow out of it", never expecting their child to become even more debilitated over time. Other parents viewed the anxious behaviours as normal as, they, too behaved in a similar way. As a result, parents of anxious children and teens are often confused about what to do, as well as frustrated, and overwhelmed.

The good news is that this website is designed to help parents and their anxious children. You will find practical strategies and tools to help you manage your child's anxiety, whether your child is just beginning to show symptoms, or has been diagnosed with an anxiety disorder. The first step is to find out more about anxiety - how it presents, how it works, and how to recognize if it is problematic.

Parents play an essential role in helping their child or teen manage anxiety. When coping skills and brave behaviour is rewarded and practiced in the home, children and teens can learn to face their fears, take reasonable risks, and ultimately gain confidence.

For even more information and tools, visit MAP for Children. My Anxiety Plan (MAP) is a free, self-paced, online anxiety management program designed to help with anxiety. MAP includes 6 easy to navigate units with 45 lessons.

Does My Child Have An Anxiety Disorder?

As discussed throughout this website, anxiety is useful in certain situations, some of the time. But how do you, the parent or caregiver, know when the signs of anxiety you are seeing in your child might be significant enough to qualify for an anxiety disorder? An appointment with your family physician or a trained mental health professional is a good first step. However, in preparation for that visit, or to decide whether a visit is needed, it can help to understand what professionals look for in diagnosing an anxiety disorder.

To begin with, there are eleven different "types" of anxiety disorders, and each anxiety disorder has a list of commonly occurring symptoms clustered into four areas:

Next, anxiety specialists have identified that when a child experiences anxiety more often (e.g. most days, and for months at a time), and more intensely than other children of the same age, it is more likely that the child has an anxiety disorder. Finally, those children who experience a specific list of anxious symptoms, more frequently and intensely than peers, are more likely to also experience significant disruption in their lives. This disruption can interrupt or even stop him or her from participating in a variety of typical childhood experiences such as:

Attending school

Joining social, athletic, or recreational clubs

Meeting age expected demands such as sleeping through the night, doing homework, and making friends.

It is common for children and teens to experience anxiety symptoms of more than one anxiety disorder. This means as you read the definitions, it would be fairly common to say, "Yes! This sounds like my child, but so does this other description!" Fortunately, the helpful approaches outlined throughout the website can be used for various anxiety problems, many of the same tools can be used for all the disorders.

It may be hard for children to recognize anxiety, which is why Caretoons, our animated series, are powerful tools. Not only do they entertain with fun characters, but they help kids understand the anxieties they feel and how to cope with them. Let Drexal the Alien and Chris Crust the time-travelling pizza slice help you start a conversation with your child about anxiety. Our Caretoons show children that it's okay to talk about mental health with someone they trust, and they're not alone. Follow Drexal and Chris Crust on our YouTube channel.

Help children prepare for school-based vaccinations and other stressors using the CARD™ system ( Comfort, Ask, Relax, Distract). Many parents agree that the quality of their child's school vaccination experience can influence their feelings about vaccinations in the future. CARD™ is a science-based, proven framework that helps children cope with stressful events, like school-based vaccinations. A free CARD™ Toolkit for parents, educators, and health professionals is available for download here.

How To Teach Your Child Calm Breathing

Download this resource to learn how to use calm breathing as a portable tool that your child can use when feeling anxious, especially in situations when you are not there to help him or her through it.

Helping Your Child Overcome Perfectionism

Use this helpful guide to help your child overcome perfectionism.

Common Topics for Children

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Anxiety is one of the most common mental health concerns for children and adults, affecting upwards of 20% of children and adolescents over the lifespan. Anxious youth are often quiet and well behaved, and thus frequently go unnoticed by their parents, teachers, and coaches.

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Check out our anxiety Padlet for self help and resources

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Check out our anxiety Padlet for self help and resources

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Takes you to the anxiety padlet developed by our Child Wellbeing Practitioner Team at the Child Development Centre

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Urinary System| How your Urinary System Works | Urinary System - Parts & Function | Video for Kids

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Studies show a clear significant difference between anxiety disorders and:

Bed wetting - Salehi et al. (2016)
Incontinence - Hussong et al. (2022)

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You can see more about toilet phobias here...

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You can see more about toilet phobias here...

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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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Anxiety can also be described as feeling:

Worried

Nervous

Scared

Anxious

Panicked

Different people can feel anxious/worried about different things including:

Going to new places/ Meeting new people

Being in busy places

Going to school

Making mistakes/ doing things wrong

Becoming poorly or someone else becoming poorly.

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You can find information about the following in this Padlet:
Knowledge is power
·         Toilet phobias

Secondary Bedwetting and Anxiety

Anxiety about using toilets in secondary schools

·         What is anxiety?

·         Anxiety and continence

·         How can these anxieties be managed?

·         Helpful tips/ resources

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Many of these continence difficulties can create feelings of embarrassment and fear in children, often resulting in feelings of increased anxiety which can then worsen the symptoms of continence difficulties.

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Raising Children - supporting mental health in 3-8 year olds

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Raising Children - supporting mental health in 3-8 year olds

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Children's mental health: what it is and why it matters

Mental health is the way children think and feel about themselves and the world around them. It affects how children cope with life's challenges and stresses.

What good mental health in children looks like

Children with good mental health feel loved, safe and secure in their environments. They also feel happy and positive about themselves most of the time.

They're kind to themselves during tough times or when things don't go the way they expect. This means they feel OK about trying new or challenging things.

They enjoy life, learn well and get along well with family and friends.

And they can manage sad, worrying or angry feelings and bounce back from tough times.

Good mental health is an important part of healthy child development. It helps children build positive social, emotional, behaviour, thinking and communication skills. It also lays the foundation for better mental health and wellbeing later in life.

Relationships and good mental health for children

A positive relationship with you directly and positively affects your child's mental health.

Here are ideas to promote your child's mental health and wellbeing through a loving and supportive relationship:

Tell your child that you love them, no matter what. You can also show love through your body language and nonverbal communication - for example, making eye contact, giving a hug or smiling at your child.

Use a positive, constructive and consistent approach to guide your child's behaviour. This means giving your child praise and attention when they behave well, rather than negative consequences when they behave in challenging ways.

Make time each day to talk and listen to your child. If your child wants to talk, try to stop what you're doing and give them your full attention.

Enjoy time with your child doing activities they like. This could be reading together, kicking a ball, drawing, playing board games and so on.

Have regular family meals. Eating together can strengthen your relationship with your child, give your child a sense of stability and connectedness, and have a positive effect on their development. It might also encourage your child to eat well too.

Work on positive ways to solve problems and manage conflict between you and your partner, with your child and among other family members.

Encourage your child to connect with others in the community - for example, waving and chatting to neighbours, attending local festivals or helping out at a community garden. This gives your child a stronger sense of their place in the world and helps them learn how to relate to different people.

Emotions and good mental health for children

Children experience all sorts of emotions as part of growing up - fear, disappointment, sadness, anxiety, anger, joy, hope and so on. When children cope with big emotions or calm themselves down in difficult or emotional situations, they're likely to feel good about themselves.

Here are ways you can help your child learn to manage emotions:

Talk about emotions with your child, and encourage them to recognise and label their emotions. You can also let your child know that it's natural to have all sorts of feelings. For example, 'It looks like you're really frustrated that your toy won't work. I can understand that'.

Role-model a positive outlook for your child - for example, 'Running all the way around the oval looks hard, but I think I can do it if I take it slow and steady', or 'I'm disappointed that my cake didn't cook properly, but that's OK - I'll try it again another time'.

Support your child when something is bothering them. For example, if your child is having trouble with friends at school, you could give your child plenty of hugs and reassure them that you're there for them. And you could work with the teacher on a plan to handle the situation.

Help your child learn to manage small worries so they don't become big problems. You can do this by gently encouraging your child to do things they're anxious about instead of avoiding scary situations. For example, 'Have you thought about trying out for the school choir this year? You really enjoy singing'.

Behaviour, goals, skills and good mental health for children

Here are ways to promote your child's mental health and wellbeing through a focus on behaviour:

Have family rules about behaviour and involve your child in developing rules and consequences. Adjust the rules and consequences as your child grows. For example, you and your child might make and adjust rules about digital technology use or online behaviour. Rules and boundaries help children of all ages feel safe and secure.

Help your child to set realistic goals for their age and abilities and work towards achieving them - for example, riding a bike without training wheels or trying to solve a difficult maths problem for school. And praise your child's efforts to achieve the goal, rather than the goal itself.

Help your child learn how to solve problems so that they develop the skills to do this for themselves when they're older. For example, you can help your child work out what the problem is, brainstorm possible solutions, and choose a solution to put into action.

Encourage your child to try new things, take age-appropriate risks, and learn from their mistakes. This could be things like entering a competition, speaking in front of the class, climbing new equipment at the playground and so on.

Good physical health and mental health for children

Good physical health is important for mental health. That's because being fit and well helps your child have more energy, feel confident, manage stress and sleep well.

Here are ways to help your child stay physically fit and well:

Offer healthy food and encourage healthy eating habits in your family.

Encourage your child to try plenty of different physical activities and sports. Trying different activities is good for fitness and energy levels. It can also help children feel good about themselves as they develop new skills.

Make sure your child gets the sleep they need. Quality sleep will help your child to manage stress and a busy life.

If you're concerned that your child is showing signs of poor mental health, it's best to seek professional help as soon as possible. Your GP can guide you to the most appropriate services for your family.

Looking after yourself: why it's important to children's mental health

Looking after yourself helps you stay physically, mentally and emotionally well. This is good for you, and it's also very important for your child. When you're well, you're better able to give your child the warmth, care and attention they need to grow and thrive. You also set a good example of self-care for your child.

Looking after yourself includes:

If you're feeling overwhelmed or stressed or you're struggling with your mental health, parenting or relationship, getting professional support is a very good idea. You could start by talking to your GP.

Here are more ways to get support:

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Good mental health for children: 3-8 years

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Mental health is the way children think and feel about themselves and the world around them. It affects how children cope with life's challenges and stresses. Children with good mental health feel loved, safe and secure in their environments. They also feel happy and positive about themselves most of the time.

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Raising Children - supporting mental health in 9-18 year olds

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Raising Children - supporting mental health in 9-18 year olds

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What is pre-teen and teenage mental health?

Mental health is a way of describing social and emotional wellbeing.

Your child needs good mental health to develop in a healthy way, build strong relationships, adapt to change and deal with life's challenges.

Pre-teens and teenagers who have good mental health often:

feel happier and more positive about themselves and enjoy life

bounce back from upsets and disappointments

have healthier relationships with family and friends

do physical activity and eat a healthy diet

get involved in activities

have a sense of achievement

can relax and get a good night's sleep

feel like they belong to their communities.

Adolescence can be a risky period for mental health problems because teenagers are going through many changes and challenges in a short period of time. This all happens while teenage brains are still maturing.

Promoting good teenage mental health

Your love and support and a strong relationship with you can have a direct and positive influence on your child's mental health. It can even reduce the chances of your child experiencing mental health problems.

Here are some ideas to promote your child's mental health and wellbeing:

Show love, affection and care for your child.

Show that you're interested in what's happening in your child's life. Praise your child's efforts as well as their good points and achievements. Value your child's ideas and opinions.

Enjoy spending time together one on one with your child, and also as a family.

Encourage your child to talk about feelings with you. It's important for your child to feel they don't have to go through things on their own and that you can work together to find solutions to problems.

Deal with problems as they arise, rather than letting them build up.

Talk to trusted family members, friends, other parents or teachers if you have any concerns. If you feel you need more help, speak to your GP or another health professional.

Physical health is a big part of mental health. To help your child stay emotionally and physically healthy, encourage your child to do the following:

Keep active. Physical fitness will help your child stay healthy, have more energy, feel confident, manage stress and sleep well.

Develop and maintain healthy eating habits.

Get enough regular sleep. Quality sleep will help your child to manage a busy life, stress and responsibilities.

Avoid alcohol and other drugs.

Alcohol and other drugs are a major risk factor for teenage mental health problems. You should encourage your child to avoid drugs, and don't give your child opportunities to drink alcohol until they're 18 years old. If you know your child is using alcohol or other drugs and you're worried, talk with your child. Also consider speaking to a health professional or counsellor.

Signs teenagers might need help with mental health

It's normal for children and teenagers to sometimes have low moods, poor motivation and trouble sleeping. These things aren't always the signs of a mental health problem. But if you notice any of the following signs and the signs go on for more than a few weeks, it's important to talk with your child. The next step is to get professional help.

For children younger than 12 years, mental health warning signs might include:

sadness a lot of the time

a drop in school performance

ongoing worries or fears

aches and pains that don't go away quickly

loss of appetite or being picky with food

problems fitting in at school or getting along with other children

aggressive or consistently disobedient behaviour, or repeated temper tantrums

sleep problems, including nightmares.

For children 12 years and older, watch out for your child:

seeming down, feeling things are hopeless, being tearful or lacking motivation

having trouble coping with everyday activities

showing sudden changes in behaviour, often for no obvious reason

having trouble eating or sleeping

doing less well at school, or suddenly refusing to go to school, TAFE or work

avoiding friends or social contact

saying they have physical pain - for example, headache, stomach ache or backache

being aggressive or antisocial - for example, missing school, getting into trouble with the police, fighting or stealing

being very anxious about weight or physical appearance, losing weight or failing to gain weight as they grow.

If your child tells you they keep thinking about self-harm or suicide, seek urgent professional help. Call Lifeline on 131 114, 24 hours a day, 7 days a week. You can also call 000 or go straight to a hospital emergency department.

Talking with teenagers about mental health

If you're concerned about your child's mental health, start by talking with your child. Talking with your child about how they're feeling shows your child they're not alone and that you care. Also, your child might need your help to get professional support.

Here are some ideas to encourage your child to talk with you about how they're feeling:

Say that even adults have problems they can't sort out on their own. Point out that it's easier to get help when you have someone else's support.

Tell your child that it's not unusual for young people to feel worried, stressed or sad. Also tell your child that opening up about personal thoughts and feelings can be scary.

Tell your child that talking about a problem can often help put things into perspective and make feelings clearer. Someone with more or different experience - like an adult - might be able to suggest options your child hasn't thought of.

Suggest some other people your child could talk with if they don't want to talk with you - for example, aunts or uncles, close family friends, a trusted sports coach or religious leader, an elder or your GP.

Let your child know that talking with GPs or other health professionals is confidential. These professionals can't tell anyone else, unless they're worried about your child's safety or someone else's safety.

Emphasise that your child isn't alone. You'll be there whenever your child is ready to talk.

If you raise your concerns with your child, they might refuse any help or say there's nothing wrong. Many young people won't seek help themselves. So you might need to say that you're worried about them and you'll be trying to get professional advice. It's a good idea to encourage your child to come with you. If your child won't come, you might need to go on your own.

If you're not sure what to do, a GP or school counsellor is a good place to start.

Your child could try a confidential counselling service for young people like Kids Helpline for teens - 1800 551 800. There are also online counselling services like Reach Out, Beyond Blue and eheadspace.

Getting help for teenage mental health problems

Mental health problems are unlikely to get better on their own. And poor mental health or unmanaged mental health problems can affect your child's wellbeing, physical health, schoolwork, relationships and development - social, physical, educational and vocational.

This means it's important to get professional help as soon as possible. Mental health problems do respond well to treatment.

There are many professional support options, including:

If you don't know where to go, your GP will be able to guide you to the most appropriate services for your family.

Poor mental health is no-one's fault, and no-one is to blame.

Looking after yourself, especially your physical and emotional wellbeing, is good for you. It can help you stay calm and consistent when things get tough, which is good for your child too. You can find support options for yourself on our mental health links and resources page. You could also call a parenting helpline in your state or territory.

Teenage mental health conditions

If your child's mental health problems are interfering significantly with their life, a qualified professional might diagnose a mental health condition.

You can read more about how to recognise adolescent mental health conditions and seek help in the following articles:

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Mental health in pre-teens and teenagers

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Mental health is a way of describing social and emotional wellbeing. Your child needs good mental health to develop in a healthy way, build strong relationships, adapt to change and deal with life's challenges.

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Young minds - support for young people and families

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Young minds - support for young people and families

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YoungMinds | Mental Health Charity For Children And Young People

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YoungMinds are a mental health charity for children, young people and their parents, making sure all young people can get the mental health support they need.

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Get more support

If you're struggling with your mental health, or you're worried about one of your friends, there are lots of organisations and charities that offer help specifically for young people.

Support from charities for young people

The Mix has a free, confidential telephone helpline and online service that aims to find you the best help, whatever the problem.

Shout 85258 provides free, confidential, 24/7 text message support in the UK for anyone struggling to cope. They can help with issues including suicidal thoughts, depression, anxiety, panic attacks, abuse, self-harm, relationship problems and bullying. Text "Shout" to 85258 to speak to an empathetic, trained volunteer who will listen and work with you to solve problems.

Young Minds offers support and advice including practical tips and advice from young people, as well as information on where to get support.

If you're under 19, you can also call Childline on 0800 1111 to talk. The number will not appear on your phone bill.

Support from the NHS

You can find more information about NHS children and young people's mental health services (CYPMHS) on the NHS website. You can also look at your local Clinical Commissioning Group website.

Alternatively, most services also have their own website with information about access, referrals (including whether you can "self-refer") and contact details - try searching in your area for "CYPMHS" or "CAMHS" (children and adolescent mental health services, an older term used for some CYPMHS).

You can also talk to an adult you trust - for example a parent, carer, teacher, social worker or GP - and they can look into this for you.

Support for different groups

There are lots of organisations and networks who provide advice and support for specific groups. It can help to connect with other young people and supporters who understand where you are coming from:

Support for learnig disabilities and autism

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Self-care tips videos for young people - Every Mind Matters

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Mental health self-care has never been more important - watch our videos for loads of advice and techniques to help you cope with stress and anxiety, and boost your mental wellbeing

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Fight Flight Freeze – A Guide to Anxiety for Kids

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Information and advice for toileting and anxiety

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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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Information Book for Children who Soil and their Families

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Constipation, Withholding and Your Child

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Constipation, Withholding and Your Child

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A Family Guide to Soiling and Wetting

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A story for children who soil

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When people feel nervous, threatened or afraid, this can trigger the fight or flight response (see more information about this below). This can cause the muscles to tighten to protect any injury the threat may cause. This can also tighten the muscles in the abdomen, leading to an increased urge to go to the toilet and even accidents when the person cannot get to the bathroom in time.

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Many children can sometimes find toilets unpleasant and worrying. These feelings of anxiety can impact 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.

You can find some helpful information in this Padlet about what toilet anxiety can look like, the link between anxiety and continence and tips and resources in managing this anxiety.

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A toilet phobia 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.

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Anxiety can be linked to many continence difficulties

Accidental leakage of urine or faeces

Being unable to reach the toilet in time

Releasing small amounts of urine throughout the day

Getting out of bed often during the night to pass urine or faeces

Bedwetting

The urge to urinate or defecate that may be difficult to stop or control, which can lead to leakage incidents

Changes in appetite

A heightened worry of having a urinary issue or anxiety bowel movement incident in public (incontinence anxiety)

A sensitivity to urinary incontinence or anxiety bowel movements and where they occur

Limited lifestyle due to the risk of an involuntary urinary or bowel movement incident[viii]

Constipation

Diarrhoea

Stomach cramps

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A toilet phobia 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. 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.