As a first-time parent I read up about potty training and
learnt about signs of readiness that kids show and so when my daughter started
refusing nappies, we figured she was ready. What we did not realise is actually
sensory issues were at the heart of her refusing nappies. She was dry and night
pretty quickly, but day times ended up being a mess. Reintroducing nappies
resulted in screaming the house down, no nappies meant frequent accidents, we
tried the traditional stuff that we were not a great fan but were getting pretty
desperate such as reward charts.
A reward chart was not as great idea, there wasn’t anything
she cared enough about, stickers, she didn’t care for, eventually we decided on
a trip to Cadbury world, but when she filled the chart, she expected to go right
then. She totally didn’t get the idea that we had to wait until Saturday, so
then refused to even let us use the chart again. One thing that did motivate
her was screen time so for some time on the iPad she mostly used the toilet. It
stopped the accidents, but it was problematic out and about and it did not help
with poop in fact poo became a big issue. She wouldn’t go for days.
With a lot of research, I learnt about interoception,
sensory issues and we started to understand about PDA.
We changed the language around using the bathroom, we’d got
to the stage, of cajoling, begging, pleading, bribing but all this was doing
was increasing the demand on her. We tried completely not talking about it, but
still innate demand was there, and a lack of sensory regulation meant that she
was craving the feedback that holding was giving her.
We saw a sensory occupational therapist, and this really
helped, we started increasing activities around the house that gave sensory
feedback. She particularly loved us pretending she was a hotdog and wrapping
her tight in a blanket and patting on toppings, and playing “mine, mine mine”
where again she was wrapped up and me and my husband would wrestle her from
each other’s arms, spin her, toss her between us. I’d mentally take a check of
where we were at in the day if we’d not moved much, I’d initiate something, or
we’d head to a soft play centre.
We learnt that if she had anything demanding like a dental
appointment to make sure sensory activity came before and after. We also found
that if she hadn’t been for a poo in a day or so, we’d stay home so she’d have
a “safe” toilet.
Over time she’s become better at self-regulation and we’ve
adjusted our house to make this possible so there’s a trampoline and a door
swing, gym balls in the lounge and other stuff around.
She thankfully doesn’t chronically hold anymore, but her
struggle with it isn’t over, we’ve tried to remove the screen-time rewards, but
it’s just too much. So, despite re-regulating screen she’ll still opt to self-reward
bathroom trips with some iPad and she still wants/need support with personal
care but in general the panic of kidney infections and impaction are in the
past for us.
Where’s my point in all this waffle?
Avoid rewards if you can! Bo’s work goes into the why
rewards are not ideal from a psychological perspective. If you really want to
do rewards make sure it’s something you are willing to do forever and be aware
that demand avoidant kids don’t tend to respond well to rewards anyway.
If your child is
struggling and you know sensory needs are at play, help your child tackle
those. If they are in school, that may mean asking for your child to have
movement breaks or use a wobble cushion, the book” Kid’s guide to staying
awesome and being in control” has some great mini body breaks that can be done
at a desk. Again, with schools it may be that the child needs access to a
quieter toilet or the toilets when there are not as many kids in there at the
same time. Let’s face it school toilets aren’t the nicest! Schools are obliged
to make reasonable adjustments for your child even if there is no diagnosis.
Make your bathrooms at home more sensory friendly, often
they are cold and echo-y and just well weird compared to the rest of the house.
Dressing gowns hanging can reduce echoes, a smaller toilet seat can help a
child feel secure, etc! Using headphones or ear defenders in public loos,
particularly if they have hand driers can make a massive difference. This is
the one setting my daughter uses ear defenders for. Finding good smells for
your bathroom, or out and about we use roll on essential oils or body spray on
a wrist or cuff so there’s something pleasant to smell.
If demand avoidance is at play remember demands aren’t just
external! Even if you don’t place a demand around toileting (and lets face it
we can be pretty bad at this as parents after all it’s hard not to react when
your child is squiggling and it’s your soft furnishings at risk) the child is
struggling with their body telling them what to do! We can support this by
making sure the child has control over as much of their life as possible often
called low arousal or low demand lifestyle. If the child feels in control
generally then needing to pee isn’t so bad, if they already feel like life is
out of control then it’s a real kicker!
And lastly when your child is struggling, take a deep
breath, remind yourself they are trying their best and they don’t mean to make
life more difficult! I know I honestly made things worse with my reactions at
points (because it’s hard, I get that!) but the better I get at checking my own
reactions the less of a deal grabbing a towel and squirty bottle of carpet
cleaner feels, honestly!
Best of luck to families still struggling with this!
