Beyond the Sticker Chart: Using Rewards to Teach Toileting

Using rewards can be a great way to increase your child’s participation in toileting and continence. Many parents aren’t sure what to reward, or how. This video explains how to choose a good reward, how to give it, and what skills to reward. For more information on what to reward, check out our video about “Inchstones”.

A full transcript of the video appears below.

Hi, my name is Chayah Lichtig. I am the occupational therapy consultant and project director for the Vermont Continence Project. Today’s topic is “beyond the sticker chart: using rewards to teach toileting”. And that is exactly what we are going to talk about. Appropriate and creative ways to use rewards. While you are teaching toileting to your child.

So a comment that we get often is that people have been told that they’re not supposed to reward people for sitting on the toilet or other toileting related skills. And while there’s a certain logic to that, when you are thinking about a certain toddler or somebody else who might be motivated by toileting and learning new things about how their body is working, Unfortunately, not every toilet learner is motivated by toileting incontinence. This is especially true for our older toilet learners who may have months or even years years of frustrating, difficult experiences related to toileting and maybe have even internalized some shame or blame from the people around them about their continence challenges.

So having a reward when we are teaching toileting can create new excitement or a new commitment. And for someone who is maybe not feeling super excited about learning, toileting, having a reward can also clue a child into the most important skill in that moment, because that’s the skill that we are going to be offering. The reward for. It also has the benefit of helping us adults to remember what skill to focus on, because it’s the thing we’re rewarding and we can often remember to let a lot of other things go and let the pressure down around other aspects of the toileting experience, because they’re not the thing that we’re focused on in that moment.

Next, we’re going to talk about how to use rewards throughout the toilet journey. So as you’ll remember, phase one is the getting started or the getting restarted phase. This is the phase before we are asking our child to use the toilet. This is our ounce of prevention stage. We may be offering a reward to our child for entering the bathroom. We may be offering our child a reward for changing in the bathroom. We may be offering them a reward for engaging in hygiene. For example, taking part in dressing, undressing or wiping. We may offer a reward for taking their medication and something you’ve learned about perhaps from another one of our videos. You may also be offering a reward for your child during practice sets, which are sitting on that closed toilet or a pants up toilet just to get used to the feeling of sitting there.

So phase two is what we call getting to the toilet or back to the toilet. And there are several things that you can reward in this phase that aren’t just whether or not your child successfully gets their PE or poop into the toilet. For example, you can reward for the duration of sitting in the case of urination when you’re just expecting that your child is going to pee. 1 to 3 minutes is plenty. And when you expect that a BM might be coming out, 3 to 5 is the maximum amount of time that your child should have to sit.

So you may also want to offer what’s called a differential reward. That means you offer one reward for your child sitting and a larger or additional reward for a successful pee or poop. Remember that if your child sits on the toilet and they do happen to pee into the toilet, we’re not going to tell them that they didn’t earn the reward if they didn’t sit for a full 3 minutes because they sat as long as they needed to to urinate successfully.

It’s also important to remember that in phase two, we are not trying to stay dry.You want to keep your Pull-Ups. This is really important because when your child is just starting to have new control and awareness of their body, if we are asking them to stay dry, we are often reinforcing withholding patterns that your child has just started to change in phase three toward independence. We will reward for each successful void or a BM in the toilet.

We will reward for self initiation. Even if your child misses. And when your child is well established in getting themselves to the toilet, that is when you could start to consider using a token system, which means using something that isn’t rewarding in and of itself. That works towards a bigger prize. For example, ten stickers equals a trip to McDonald’s. Or when you fill out this entire picture of a favorite toy, we will go to the store and buy that toy. But remember, especially at first, we want to be giving a reward every single time because we want to really, really encourage child to be as consistent and as excited as possible.

So you may be wondering what makes a good reward. The five principles for a good reward are that it is easy to give, that you can give it immediately, that it is inexpensive or even free, that it’s high preference for your child and that it is not offered at other times. So to illustrate this, I’ll give the example of one of my favorite rewards: chocolate.

So if someone were going to reward me with chocolate for doing something that they really want me to do for example, my job, they might do something like give me a chocolate each time I write an email. But unfortunately, if they needed to drive to a store every time they needed to get me a piece of chocolate, that wouldn’t be easy for them. And it would be really unlikely that I was going to get that chocolate every single time. So it needs to be easy to give.

It also needs to be something that they can give to me immediately. If I write my email and I get my chocolate 2 hours later, I might not make the connection that the chocolate is for making for writing the email.

It also should be a relatively inexpensive chocolate. So if you are buying fancy Belgian dark chocolate for me, I will surely appreciate it. But it might be hard for the person who’s giving me those rewards to sustain that over a long period of time because I write a lot of email.

It also has to be something that’s high preference. So if you picked out something I didn’t particularly like, like another kind of candy, I might not actually be motivated to complete that task. But give me a chocolate and pretty good chance that I am going to want to do the thing that you ask.

It also can’t be offered at other times. Yes, it’s great that I can get a chocolate for writing an email, but if there’s also chocolate sitting right next to me on my desk at all times or in my kitchen cabinet, and I really don’t want to write that email, it might be more likely just to go get the chocolate that I can get more easily. So to increase the excitement of getting that reward, I have to not get it at other times that we want to use rewards to increase a feeling of excitement and well-being around the skills that we want them to learn.

So we really want to do what we can to help a child meet their goals rather than making it really, really difficult for them. So we want to analyze the routine. As we’ve discussed in other videos. What are the interest stones that your child is working on right now and what are the next steps to learn? Those are the ones to reward for, not the way off in the distance ones, right? You may also want to give them a choice. What skill would you like to work on next?

It could be something like pulling up your pants. It could be working on wiping, it could be washing your hands, whichever step they choose. That gives them some agency and some power in the process. You also will want to represent the goal and the reward. You see on this slide, there’s a very simple image that has a picture of a toilet with a poo in it, and next to it is a picture of that candy that you’re going to give to that child.

Some other tips to help your child reach their goal are to offer different forms of prompting. Remember that the goal is toileting and continence, not compliance. So we don’t want to have to get into a battle with our child to do the thing that helps them to get the reward. We also want to make sure that this schedule is predictable, right? Again, the goal is toileting and continence, not to be able to guess what’s coming next in their day. So something like a simple visual schedule that shows where in the routine of your day toileting usually falls can help a lot of kids to feel a sense of understanding and a sense of agency when it comes to toileting and finally make time concepts visible.

So as we’ve talked about in other videos, while some children may understand the concept of saying we’re going to sit for a minute, that is pretty abstract and we will be way better off and help a lot more kids if we show them the time using any kind of sound timer, kitchen timer, or perhaps a visual timer app, anything that relies on more of a pizza pie instead of counting down numbers.

Thank you so much for taking the time to watch this video. The information contained in this video is for informational purposes only. It is not a substitute for professional health or medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care professional.