Children and Potty Training
Learning how to use the toilet and becoming proficient at it is one of the many milestones that young children go through. Having learned this valuable skill learned a long time ago, it can be easy for adults to not think about how many steps and complex factors go into toileting, since it is one of those daily tasks that are often completed with ease.
The American Occupational Therapy Association offers many tips for parents and caregivers who are potty training their children. These tips include things like observing and identifying signs that the child is ready to begin toilet training, setting up a routine that is supportive of potty training, providing a comfortable bathroom environment, and using positive reinforcement to encourage children’s bathroom use.
Children with sensory challenges and self-help deficits may need a greater level of support from their caregivers in this big transition. And in those cases, occupational therapy (OT) can offer valuable contributions to ensure the little ones have the adequate skills needed to be successful and as independent as possible in toileting. Occupational therapists are equipped to have a holistic approach to each child, considering the demands of activities of daily living, environmental factors, and a child’s unique skills and interests in order to facilitate their toilet training process. The contributions that OT can make in this area also include addressing sensory processing and development – and one of the ways of doing that is by assessing and supporting a child’s interoception.
What is interoception?
At some point in their lives, people will often learn about the five basic senses that human beings have: touch, sight, hearing, smell, and taste. These senses work to capture information from the outside world and process that information inside of each person. For instance, with the sense of touch people are able to notice the temperature of an object. The pathway of these five basic senses begins at external organs that can be easily identified: in the case of the sense of touch, that information is captured by receptors in their skin to help people make decisions about how to interact with that object. Similarly, there are also receptors for sight in the eyes, for hearing in the ear, for smell in the nose, and for taste in the mouth.
However, science has found that there are three additional senses in addition that are less known and less talked about: proprioception, vestibular and interoception. These senses give people information about the inside of their bodies, and how their bodies move and are positioned in space. Unlike the pathways of the five basic senses described above, the receptors for these three additional senses are spread throughout the internal area of a person’s body.
Interoception is the sense that is responsible for communicating to people what is going on inside their bodies, including awareness about their temperature, how tired they feel, their feelings of hunger and satiety, their increased heart rate, and their need to use the bathroom.
These signs are experienced in different ways by each individual person – hunger, satiety, thirst, the need to go to the bathroom, are all things that people may feel in different ways in their bodies. For instance, someone may feel tightness in their stomach when they need to urinate. For other people, they may feel pain. Throughout their lives, people learn what those physical feelings are, to connect them with emotions, and to know how to act upon them. For people who experience sensory processing challenges, learning how to make those connections may take more time and a more concerted effort, and it may require additional help from professionals like occupational therapists.
Interoception and Toileting
People who experience interoception and sensory processing challenges may have a hard time connecting the physical cues in their bodies to what they mean, and what they need to do after that. They may feel something in their stomach area, but not be able to identify whether that means they are hungry, thirsty, or in need to go to the bathroom. In addition to not being able to identify those cues, a person may have subtle cues that do not communicate what is going on soon enough. In contrast, they may have physical cues that are overpowering and end up causing a stressful reaction, or inability to act upon them soon enough.
For a child who has sensory processing challenges, not being able to understand their body cues and what to do next can be one of the factors that impact their toilet training process. Through a comprehensive process that includes careful evaluation and skilled intervention, occupational therapy can support a child in understanding their interoception system, and in working towards independence and proficiency in using the bathroom.