For many children with special needs, urinary incontinence can be an issue both day and night. Some children simply cannot be toilet trained due to medical problems while others may just take a little longer to learn the skill.

For Angie Carothers, a special education teacher in John's Island, S.C., helping children develop toilet skills is all in a day's work. "These are life skills," she says. "It's a big hurdle for a child to cross, and it helps the parent for them to be toilet trained."

Toilet Training
So how can you help your child learn this all-important life skill?

First, check with your pediatrician to be sure your child is capable, ready and that there's no other underlying medical problem. According to Dr. Stanley Hellerstein, professor of pediatrics at Children's Mercy Hospital in Kansas City, Mo., children who dribble urine or are wet all of the time may have a neurological problem or a problem with the structure of their urinary tract. "In that instance, a urologic evaluation is indicated," he explains. "This should also be obtained if urinary urgency, urinary frequency, pain on urination or an abnormal routine (malodorous or abnormal color) is present."

If your child checks out okay, and the doctor gives you the thumbs up on toilet training, there are a few techniques you can employ to help you both along the path to dryness.

Routine. Routine. Routine.
Carothers, who teaches children ages 6 to 11 at Angel Oak Elementary School, finds an important part of training her kids to use the bathroom is getting them into a routine. "My classroom is very structured, and the children need to have that structure," she says. "I start by structuring their day so they know when they'll be going to the bathroom."

Carothers' students, who suffer from Down syndrome, spina bifida and cystic fibrosis, go to the bathroom as a group three times a day – when they arrive, after lunch and before they go home. When children are at home, she recommends that parents keep the same, or similar, routine.

That's what works for 42-year-old Tina and her 10-year-old son, Tyler, one of Carothers' students. "He's got a routine," says Tina, who lives in Charleston, S.C. "He pretty much goes to the bathroom the same time every day." And, she says, Tyler, who has Down syndrome and is autistic, hasn't had a urinary accident since he was 5, though he does still occasionally have bowel accidents.

Carothers also makes sure her students know when they will have the opportunity to use the toilet. She tells them every morning when they'll be going to the bathroom and encourages them to let her know (through a picture symbol, as most of her students do not speak) whenever they need to go and that it's okay to just get up and go themselves. "I just get so excited when one of them signs to go the bathroom and goes," she says.

Accidents Happen
When "accidents" happen, don't make a big deal of it. "If they do have an accident, I don't want to make a spectacle or embarrass the child," says Carothers. Instead, she matter-of-factly tells them to go get cleaned up and change their clothes.

Most schools and daycares are prepared to handle this situation and, in fact, deal with it on a daily basis. So wet pants shouldn't keep your child from doing any activity. Most will simply ask parents to send a change of clothes for just such a situation.

Carothers finds that the kids don't like having to go through the hassle of getting up, going to their locker, changing their clothes and cleaning themselves. "They get to where they don't like it, so they don't want to wet themselves," she says. Again, she encourages the same routine at home. "Be patient. Most children will be toilet trained, but they have to experience some level of discomfort with it.”

When Tyler used to have urinary accidents, Tina did just that. "I would take him straight into the bathroom and we would clean up and wash up, so he realized what he was doing," she says. "He doesn’t like to stay in dirty pants. He knows there was an accident, and he knows he needs to get cleaned."

The use of disposable absorbent underpants can be helpful when training a special needs child to use the toilet. They eliminate the need for frequent clothing changes when accidents happen, yet are a tool for teaching kids what happens when they don’t make it to the bathroom on time. Because they can be disposed of rather than cleaned like underwear, kids don’t feel as much shame when they wet or soil them, ultimately salvaging self-esteem.

Praising Success

With a little work, "accidents" will likely become less and less frequent, and soon your child will begin trying to use the toilet. When your child does make an attempt to use the bathroom, your response is very important.

"I think they want to please you," says Carothers. "I praise any effort that a child makes to go to the bathroom."

Tina agrees. "Reward them when they do start using the toilet," she says. "I make a big deal about it when [Tyler] goes."

And that first time your child goes to the bathroom on his own will be a special moment. As a teacher, Carothers knows. She says it's like someone's given her a million dollars.

Toilet Training Tips from Dr. Stanley Hellerstein, Children's Mercy Hospital, Kansas City, Mo.:


Have the child try to use the toilet every one and a half to two hours while awake.
Encourage them to relax as much as possible while urinating.
Have a boy sit to urinate if balance is an issue.
If sitting, have a stool if their feet don't reach the ground.
Encourage them to drink proper fluids such as water, nectars, milk or juices without citrus fruits.

* Actual names of people in this article may have been changed to protect their privacy.