incontinence toilet talk.

You read last month's article in EP on potty training and were totally motivated to start the process. Then you realized you had no equipment, were not sure how to transfer or position your child, and didn't know what to do about inaccessible clothes. Well, here we are to help you out! We spoke with many parents scoped out different trade shows, and researched options and strategies to make potty training and toileting a little bit easier.

We hope packaging you find some helpful tips in the following article. Transfers Transferring from wheelchair seat to toilet takes time, so plan ahead! If you wait until it is urgent, you cannot take the time needed to perform the safest, most independent transfer possible. Use a schedule to decrease the urgency of the transfer so you feel successful and continue toward independence The ultimate goal is for the child to be as independent as possible.
At home, there is lots of space as well as privacy and you know it is clean. You will need a whole different strategy in a tight, cramped stall. Parents can use several types of transfers at home depending on the size and age of the child.
Here are some descriptions of transfers to help you pick out which one will work best for you and your child. * During a dependent transfer or total lift, the adult does all the work to transfer the child from the wheelchair to the toilet. We found this works best when the child is undressed before transferring.
The child is totally dependent on the parent to move him or her from one place to the other and back This transfer may require more than one person depending on the size of the child. It is always important to remember proper body mechanics so no one is injured. * use your legs, not your back or arms * spread your legs to shoulder width * do not twist * keep child as close to your body as possible * A stand-pivot transfer requires the child to stand from sitting and take small steps or pivot his or her body toward the commode for sitting This transfer can require different levels of assistance by the parent to make it successful To perform this transfer, the child must first be positioned at the edge of the wheelchair with feet placed firmly on the floor.
The parent will position his or her own body directly in front of the child with knees bent and touching the child's knees for support when standing. The parent will position his or her arms around the child's waist and hold the back of the pants. The child can be positioned as if he or she is giving the parent a big hug or can hold onto the arms of the chair to offer as much assistance as possible.
The parent will count to three and rock back and forth packaging with the child. On three, the parent and child will stand while the parent lifts up and pulls the child forward. It is important for the parent to remember to use his or her legs while standing Together, parent and child will take several small steps or pivot toward the toilet.
While standing in front of the commode, remove clothes. If the child can reach back to a supporting surface, have him or her do so to help lower into a sitting position. * The squat-pivot is similar to the stand- pivot transfer.
This transfer does not require the child to completely stand to transfer Follow the same steps as the stand-pivot transfer using squatting to move the child from one place to another. Since this transfer may seem more awkward, the parent may want to remove clothes upon initial squatting. * Transfer boards are flat boards. The child is placed with one edge of the board on the wheelchair and the other on the toilet seat.
Using a transfer board requires practice. Initially the parent may have to position the transfer board for the child. This transfer is ideal for the child with good upper-extremity and trunk control but poor leg strength/control.
Positioning dycem (a non-skid material) onto the seat of the commode prevents the board from slipping. The child can scoot himself or herself onto the commode using his or industry her arms to push toward the commode. This child may want to remove his or her clothing before transferring by leaning side to side in the chair.
Another option when using a transfer board is to cover it with a pillowcase. This will help the child slide towards the toilet when clothing has been removed. Positioning Positioning your child is very important during toileting.
The child needs to be in a relaxed environment to perform the required functions. Depending on your child's postural control, there are many positions that can be used to facilitate normal toileting. If your child has high tone, toileting will be more successful when his or her tone is reduced prior to initiating toileting.
Here are some positions that can help.
The child should have his or her feet supported using the ground, step stool, or leg rests from a positioning device to allow his or her energy to be devoted to urinatin or moving the bowels instead of postural control. Maximal hip flexion and forward leaning may also be helpful. Asking your child to exhale slowly helps relax the muscles needed to void.
Other people are more successful leaning backward a few degrees. Commodes can be purchased that have adjustable legs; seat belts; safety bars; angled legs for stability; and padded, upholstered, adjustable backrests and headrests packaging to supply the appropriate support to accommodate the child's needs. There are units that can be purchased that will roll over a standard toilet and which accommodate your child's positioning needs.
A child with low tone can be placed in a positioning device that will provide him or her with the support he or she needs to be successful in toileting. A caregiver's hands and body can provide the postural control to a child with low tone need. There are specific recommendations for positioning children with other disabilities.
An occupational or physical therapist can help you determine which is the best option for your child. We have included some photos and descriptions of models to get you started. Adding a table in front of your child to provide support when he or she needs it also assists with forward leaning.
There are several other positioning options available. A boy can be given support to the shoulders or pelvis as seen in the picture below or by leaning on grab bars while standing to urinate. The child is given support while seated facing the back of the toilet.
The front approach, or frontal mount, is a great position for a child who cannot stand industry to transfer or who needs to be transferred quickly. This also directs the flow of urine away from the caregiver, especially when working with boys. The child can be positioned in the traditional toileting posture facing out.
The child can be given support from behind with the caregiver straddling the toilet or from the front with support provided by the caregiver where the child needs it most. The key to successful positioning is that the experience should be as normal as possible and the same sex caregiver (if available) can be a role model to normalize the experience. It is important to individualize the training and help the child become as independent as possible.
Bathroom adaptations Most home bathrooms are not accessible and require modification for a child who uses a wheelchair or walker. Grab bars should be installed for safety and support. The toilet seat height can be adjusted by adding a raised toilet seat, or a device installed under the toilet to add height to the toilet for easier transfers.
A child-size toilet can be purchased for a lower cost until the child is large enough to fit onto a regular- sized toilet. Below, are various supportive toileting devices. The bedside commode can be positioned next to the child's bed for independence in nighttime toileting.
This will reduce the traveling back and forth to the bathroom, reducing the risk of falls. Adapted clothing Clothing can be adapted to accommodate the needs of exceptional children. Velcro brand fasteners can be substituted for buttons, zippers, and snaps to allow easier and quicker removal and fastening of clothing during toileting.
Wrist or finger loops can be added on pants or shorts to allow easier donning after toileting or while getting dressed for children with difficulty with fine motor control. One mother we spoke to, Teresa Kendrick, offered this advice: "[My daughter] Amanda sustained a traumatic brain injury when she was 2. Amanda was nonverbal, non-ambulatory, ate through a G-tube and breathed through a trach.
It took us a few years, but now she signs `potty' when she needs to go, gets herself to the bathroom, pulls up on the potty, and even gets her pants off by herself. The key to this was a Velcro fastened diaper that she could pull off with her good hand. This diaper also had a pad in case of accidents.
" Snap crotches can be added to pants for quick and easy removal during toileting or diaper changes. Absorbent lining can be added to the area of pants between the legs to absorb additional wetness between diaper changes. An easy solution is to buy clothing one size too big with elastic waistbands such as sweat pants or jogging pants.
Many nylon sweat pants have zippers or snaps that extend from the ankle to the waist for easy removal during toileting or diaper changes. It is important to remember that there are options for adaptive clothing available commercially through catalogs and through many others online. Adapting clothing can allow your child to be more independent and help you make toileting more successful.
Toilet adaptations A toilet seat minimizer is essential for small children who may slip into the water. These soft models make the child feel secure. A folding potty seat is wide enough to cover all toilet seats and conveniently folds in quarters to fit easily into a diaper bag or glove compartment.
Potty chairs For kids with cortical blindness and other visual impairments we found musical potties might work. Special sensors in the potty are triggered when moisture is present, playing, cheerful tunes. The feedback is conditional, positive, immediate, and consistent.
Another variation are potties that make "flushing" noises. There is an inflatable potty called "Inflate a Potty" that fits inside a pocketsize carrying pouch. Inflate the potty quickly by blowing it up like a beach ball, using a removable extension tube.
Insert a disposable garbage bag and cover the potty completely. After use, remove and seal the bag and dispose of it. We also found a "potty context." This little cardboard bathroom scenery prop can be used as a privacy screen, when the real bathroom is not available, or when you want to discuss bathroom words and need a visual context.
Supportive devices Not all equipment is "created equal." We found differences in weight, portability, ease of storage, and ease of cleaning. Models that offer varying amounts of support can grow as your child improves his or her motor skills, especially trunk control.
There are a few models that can be easily removed so others can use the facilities. Some potty-chairs can be used as bath chairs and floor sitters as well. For boys, a splashguard can be useful. (Please note: care must be exercised when child is getting on or off the potty to avoid injury.
) Adjustable footrests are also a must.
Kids have to feel secure and stable in order to relax their "elimination" muscles. Most folks find 45 degrees of hip flexion is the best for getting quick elimination. Here are two multi-use bath systems we found that offer tilt and recline as well as a height adjustable frame.
The seat can be removed and used as a toilet seat or bath seat. The footrest is also angle adjustable, which really helps in getting good hip flexion with feet flat on the foot-board. The wheels on the base can be locked securely.
Both systems fold flat for storage and transport. There are also toilet seats that secure to the toilet. A favorite feature is a pummel, a block or wedge between the legs that stop the knees from hitting together and the child from slipping forward.
This helps kids who are always scooting their bottoms forward and slipping out of the seat. We found another system that runs on tracks mounted on the ceiling. The tracks can run from the bedroom to the bathroom and more.
The harness can be used for lifting and even assisted walking. Bedside commodes There are some bedside commodes that are self-cleaning. Snap off the top part, fit it on top of the toilet, and flush.
The water from the toilet swirls and cleans the contents of the commode tray. Bidets We found a bidet that fits over your regular toilet and has an automatic sensor to turn on and off. This is great for kids who cannot wipe. A bidet cleanses naturally with a soft, soothing, aerated stream of warm water.
It is conveniently activated by an easy-to-use remote control that extends the bidet wand at the touch of a button and retracts completely when finished. Additionally, an innovative automatic air deodorizer quickly eliminates all toilet odors. There is even an optional, comfortable, warm-seat feature.
You can install this bidet on an existing toilet by simply replacing the standard seat. Other equipment There are helpful items on the market that will help children perform self-care after toileting. These toilet aides allow the child who cannot quite hold on to the toilet paper or reach around to their bottom to wipe efficiently.
The first toilet aid has a curved, extended handle and recessions that grip the toilet paper. Kitchen tongs used solely for bathrooms also serve the same purpose for helping the child to wipe himself. Summary Potty training can be a long complicated road.
You may find yourself taking the first exit, learning the best lying down diaper change. We hope your travels take you further after reading this article and you try the standing diaper changes. And for those in for the long haul, do not give up until you reach the last exit, and come to the land of the royal flush, a fully potty-trained child! We wish you success and lots of dry diapers.
Please contact us if you have specific questions or have other helpful ideas we can pass on. Ginny Paleg, PT, Amy McHugh, OT, and Camille Jackson, OT, are pediatric therapists at the Hospital for Sick Children in Washington, DC. They can be reached