Beginning Bowel Training
In the morning, when your child wakes, bring her to the toilet to urinate. Then, dress her in a shirt and underwear but no pants. This is so you can see any accidents that might occur at the earliest possible time. This will give you the best chance to catch the accident in time for at least some of the bowel movement to go into the toilet. If your child is older, or you need to leave the house, don’t worry about it. Just dress her as you normally do.
Schedule BM Sittings About 15 Minutes After Meals or Large Snacks
Feed your child her breakfast and then follow her around. Interact with her frequently for the next 15 minutes. The first sitting should be about 15 minutes after your child finishes breakfast. It can be sooner if you see her hiding, straining, or holding in a BM. The reason for scheduling the sittings 15 minutes after meals and large snacks is that this is when it should be easiest for your child to have a BM. This is just how our bodies work. As we eat and swallow food, the muscles in our digestive system become more active. The older waste gets pushed down to the bowel to make room for the new food as it starts its way through our digestive system.
A typical schedule for putting your child on the toilet for a BM might look like this:
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Prompt and Reinforce Initiation
As you did with urine training, prompt your child to request the toilet by handing you the picture of the toilet. Or if your child says words, she can say “toilet” or “want toilet”. She can use whatever words you use for the toilet. You want to get her into the habit of letting you know when she has to go. This will be especially important when you are out of the house together.
Reward Clean Pants
When your child gets to the bathroom and pulls down her pants, check to see if there are streaks or pieces of stool (BM) in the underpants. If the pants are clean, praise her for having “clean pants.” If there are streaks or pieces of stool in the underpants, just clean her up and change her underpants. (Have a few pairs of underpants in the bathroom.) Streaking in the underwear may be a sign that she is trying to hold in a BM and may also be a sign of chronic constipation. If you see this, be sure to let your doctor know about it.
Do Not Keep Your Child on the Toilet Longer than 5 Minutes
As with urine training, the sittings should be roughly 3 -5 minutes long. It may be helpful to use a timer. That way, your child will learn that when the timer goes off it is okay to get up from the toilet. Do not keep your child on the toilet for longer than 5 minutes or the toilet may begin to be seen as an unpleasant place to be and we don’t want that!
A Few More Words about Reinforcement
Remember to reinforce your child for sitting on the toilet with lots of social attention as well as books, music, etc. Make sitting on the toilet a pleasant experience for your child. But save your most powerful reinforcers (like a little snack sized bag of skittles or a small dish of ice cream) until she has a BM on the toilet. If your child passes gas while sitting on the toilet, praise her and give her a small reinforcer (like one or two skittles, for example). But save the really big reinforcers ONLY for BMs. You can keep the powerful reinforcer in sight, if it can be sealed into a clean, plastic bag. Or you can keep a picture of the reinforcer, close by. If your child reaches for it, gently but firmly tell her that the really special treat is only for BM’S on the toilet. Of course, you should use whatever words you use in your family.
Repeat this Process After All Meals and Large Snacks
If your child does not have a BM on the toilet during the after-breakfast sitting, take her off of the toilet. Wash her hands and leave the bathroom. Remain neutral during this time. Continue playing, teaching, or whatever you were doing before the sitting. Then after her next meal or snack repeat the process. Remember, each time that you repeat this process, begin by prompting your child to request the toilet.
What To Do If Your Child Has An Accident During Toilet-Training
During this beginning phase of bowel training, you need to be with your child all day and to check her pants frequently. If you see her starting to strain and you think she may be trying to have a BM, take her right away to the toilet. Do so calmly and quietly. If she has already started to have the BM, simply drop anything that is in her pants into the toilet. Then see if she can finish the BM while sitting on the toilet. If that works, reinforce your child for having a partial BM in the toilet. Do this just as you would have, had she had a complete BM in the toilet – with enthusiasm!
If your child has a complete BM in her pants, and you don’t see it until it is finished, take her to the bathroom. Do this calmly and quietly. Clean her up and then go back to whatever you were doing. Don’t reinforce her but don’t scold or punish her either. That will not help! Hopefully, this will not happen often. Paying close attention to her during training should help a lot. This will be most important 10 to 30 minutes after she eats a meal or large snack.
Reinforce Success with a Highly Preferred Reinforcer
When your child first has success having a bowel movement on the toilet during a scheduled sitting, deliver your power-packed reinforcer! Immediately and enthusiastically hand her the really powerful reinforcer (for example, a whole snack-sized bag of skittles), paired with lots of praise, tickles, etc. If you think that your child will understand that she has earned the Skittles without actually opening the bag, show her the Skittles while praising her and place them on the counter. Then you can wipe her bottom and wash your hands and her hands. Then give her the Skittles. Or you can put a few skittles in her mouth, one-at-a time, while she’s still sitting on the toilet before you wipe her. This will be especially important if she doesn’t like to be wiped. She should get the reinforcer as soon as possible after a BM so that she makes the connection between having a BM on the toilet and the reinforcer. You can teach her to wash her hands later in the toilet training.
After a BM on the Toilet – Do Something Really Fun!
Once the toilet routine is finished, take her immediately to one of her favorite activities. This could be a favorite music video, or going outside to play on the swings. It has to be done immediately, or she may not get the connection that the fun activity is a reward for having a BM in the toilet. If there are other family members at home, make a big deal of it by telling them that your child made a BM in the toilet. Then she can get even more praise from them. You can all give her a big round of applause!
It’s OK to Skip Some of the Daily Sittings After Your Child has had a BM
Continue with this process. Put your child on the toilet about 15 minutes after each meal and snack until she has a good-sized BM. After that, you should use your judgement about the remaining sittings for the day. Remember to praise your child at each sitting for having clean pants. It might be a good idea to try and do a sitting 15 minutes after dinner if that is the largest meal. But if she has already had a good-sized BM, she may not have another one. As we said, once your child has a good-sized BM, more sittings that day are not likely to produce more BM’s. You don’t want to encourage your child to push or strain when there is no BM to push out. So it’s fine not to do more sittings after the big BM. But do continue to keep a close eye on her, just in case!
Always Reinforce Initiation
What if your child lets you know that she wants to use the toilet, or just goes into the bathroom by herself? If she tries to sit on the toilet and then makes even a tiny BM in the toilet, throw a party! Whatever your child loves most, be sure that she gets it…right away!!
Fade Your Prompts By Eliminating One Scheduled Sitting At A Time
Continue with this initial phase of toilet training until your child is having BM’s in the toilet nearly every day. She should have no more than 1 accident every two weeks. At this point, even if she is not initiating, drop one of the sittings. If there is one particular sitting that tends to be most successful, keep this one the longest. One idea is to stop doing the sittings after snacks first. Do this until you are prompting your child to request the toilet for BM sittings only two or three times a day. The sittings to drop are those that don’t usually produce a BM. Keep on rewarding BM’s on the toilet and respond to accidents in the same way as before. Make sure your child is still having BM’s in the toilet on most days. When your child goes two weeks without an accident, you can drop one more sitting.
When to Begin Gradually Reducing the Reinforcement
Continue like this until your child achieves independence. A month or two of successful bowel training, means that your child is having BM’s on the toilet on most days. And she should have no more than two accidents in a month. Then you can give your child smaller rewards. Do this gradually. Always praise her enthusiastically for having BM’s on the toilet. And as with urine training, even after your child is no longer getting rewards for BM’s in the toilet, it’s a good idea to give your child a nice surprise reward now and then for success on the toilet.
When to Seek Professional Help
As we discussed earlier, if your child tends to be constipated, you should speak to your child’s doctor before you begin bowel training. Also, if you have followed these guidelines for a couple of months and your child is making little or no progress, talk to your child’s doctor. If you have a Board Certified Behavior Analyst (BCBA) working with you and your child, ask them to review your plan before you start. And your child’s BCBA should also check on your child’s progress. He or she should do this until your child is fully toilet trained. Sometimes, a specialist will need to help. But usually, an experienced BCBA should be able to help you trouble shoot most problems with toilet training.