Toilet Training: A Crash Course

We didn’t plan to start toilet training our preschooler this Sunday.

We’ve made attempts before, sort of lame attempts, just put him in underwear and make a potty available and waited for it to work out. Seven changes of clothes later, we gave up.

So, my latest plan was to get him trained before Fall, when he transitions from the “substantially separate” Special Ed preschool classroom to the Integrated preschool classroom, which is a mix of normally developing and special-needs kids. I ordered a book, the highest rated book on toilet training autistic children I could find on Amazon: Ready, Set, Potty by Brenda Batts (Jessica Kingsley Publishers, 2010).

Having Babyboy in size 7 Pampers Cruisers at this age has been embarrassing. They don’t sell that size in stores; you have to order them online. Trying to change his diaper on one of those plastic restroom changing tables was starting to get ridiculous. He’s a good-sized four-year-old, and he’s way bigger than the biggest child those tables are intended for, and this made the whole thing awkward and probably dangerous.

And then there was the rash.

It started when we were on our beach vacation, and the kids were running around in Little Swimmers diapers, you know, the ones that don’t hold anything and stay really damp. By the end of the trip, he had developed pretty bad diaper dermatitis with alot of chafing irritation.

Then, right when we came home, he developed this prolonged diarrhea-type situation that we never figured out. Too much watermelon? A touch of the GI bug? Gluten intolerance? Whatever it was, it lasted ten days or so. Then, we had a stretch of hot and humid weather…

The rash was getting worse, bright red patches with satellite lesions, progressing to almost little pustules, then, by this weekend, progressing to frank ulcerations….

I drew on my pediatrics training, applying layers of various skin barriers in copious amounts and trying to stay on top of the poop. Meantime, Nana was applying my grandma’s antifungal ointments and feeding him endless mac and cheese to try to solidify the output.

Day 1: Sunday morning, Hubby was at work, and I was home alone with the kids. I was up before them, puttering about in pajamas with my coffee, when I heard a cry, a wail, a scream:

“MOMMY! My fann-eeeeeeee! My fanny hurt! MY FANNY HURT! MOMMEEE!!!”

I ran upstairs and Babyboy was writhing and rolling around on the floor, trying to pull off his diaper. And… it smelled. He must have had a loose poop overnight, and been sitting in it for hours…

When I got the diaper off of him, there was blood oozing from the ulcerations. You couldn’t touch him. He was in serious pain. If I hadn’t seen this rash in evolution over four weeks, I would have brought him the the emergency room for viral cultures. It was horrific.

I tried to soothe him while I filled the tub. He was able to get in and, eventually, sit down. I let him soak and play while I tried to think of what to do.

There was no choice. We had to toilet-train him. But I hadn’t read the stupid book yet! I had no plan!

I went and got the book and speed- read, past all the planning stages (Pick a target day! Decorate the bathroom! Decorate your child’s underwear! Celebrate the night before! et cetera) to Chapter 8: Steps to Potty Training.

Brenda Batts describes that the first day of potty training is meant to establish the baseline. Basically, put your kid in underwear, offer the potty every 45 minutes or so, tolerate messes, and simply figure out when he pees and poops so you can make a schedule, more or less.

So, I went and got the big-boy undies, and made plans to stay in all day.

Babyboy was actually pretty psyched to wear undies. I put the potty in the play area and pestered him about it periodically. This, while also caring for Babygirl, who was curious about these activities, but not psyched to wear undies. He used the potty for pee several times, and wet his pants several times, but by 2 pm, he hadn’t pooped yet. This is the kid whose copious stools caused the problem in the first place. Where was the poop?

I didn’t see poop until later in the afternoon, after Hubby got home. Hubby took over Babygirl duty, and I focused on Babyboy.  I realized that he looked kind of tense as he was sitting. I remembered an article about toilet training that had suggested a distraction, like reading a book together on the potty, to help kids relax. So I got out a trucks book, and as we read it, and Babyboy pressed the buttons to make truck sounds, suddenly, there was an odor…

Yay! Celebration! Poopie on the potty!

Hubby and I rewarded the efforts with overly large servings of chocolate, which we later regretted as Babyboy was up really late, all hyper. But, it was a good start.

Later that night, I speed-read the whole Ready, Set, Potty book. Brenda Batts has great ideas, and I figured, it wasn’t too late to implement some of them. I made a Potty Kit for school: a bag with some “motivators”, things that would get him excited to sit on the potty. Hubby drew flash cards with drawings of shapes and different kinds of weather (Babyboy is currently really into these things). Then we decided on a reward, three m n m’s, which was better than a whole Kit Kat bar. I packed extra clothes and unerwear in his bag, and hoped for the best.

Day 2: I dropped him at school and explained the situation to his teachers. They were game. I had to go to work, but I got the report from Nana later: Babyboy had several accidents at school, and they had to put him in pull-ups, as they ran out of shorts. At Nana’s, he did better, but he still wet a few times.

Sigh. But, the Ready, Set, Potty book says not to give up, don’t go back to diapers, as this will set the child back. Just figure out better motivators and rewards, and make sure the potty procedure has order, predictability, and routine. That is actually kind of a mantra in the book: Order, predictability and routine.  Key elements to any plan for anything with autistic kids, I would agree. We decided to stick with the plan, and Hubby printed out pictures of weather and street signs to put in the motivator bag (street signs are also a major interest).

Day 3: Today. He was 100% potty-trained today. No accidents at school, at Nana’s, or at home. He sits there for ages and ages sometimes, but, he produces results. It’s all good.

He is so proud to wear his big-boy underpants, that he gets mad when we put a diaper on him at bedtime. (Maybe we shouldn’t- but we can’t deal with changing the bed every day, so for now, diaper at bedtime. I’ll re-consult the book about that later.) Best of all, his fanny is healing nicely.

We’ll see how Day 4 and beyond go. I admit, I am anxious about going places. We have invites to meet up with friends soon, and they want to meet locally, somewhere fun for kids. Panic! What if Babyboy has to go when we’re driving there? What if he has to go when we get there but we don’t know where the potty is? What if he has an accident?

Other friends have invited us to the beach. Panic! What do I do if he has to go and we’re on the beach? It’s a walk to the bathroom… And, will he go on a regular toilet? Should I put him in swim diapers that day? I don’t think he’ll go in them. What will we do?

I suspect that every parent who has gone through this has experienced similar anxieties, and we will make it through.

Babygirl is next…