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When parents start working with us, they often ask how to “jumpstart” the toileting process. In this video, Rebecca Ruid, clinical psychologist, explains why we have to decrease (not increase) the pressure and expectation on our children to increase their engagement.
Trancript
Hello, I am Rebecca Ruid, and I’m a clinical child psychologist with the Vermont Continence Project. We’re based at the Center on Disability and Community Inclusion at the University of Vermont. Our topic today is how to use division of responsibility to let down the pressure, a topic we discuss often at the Continence Project.
Alfie Kohn is an author and lecturer who commonly speaks about parenting, education, and human behavior. He once said, “If we want children to take responsibility for their own behavior, we must first give them responsibility.”
A parent’s daily life is full of responsibility. Think of all the responsibilities that you have. That may include preparing food for your child, bathing your child, and dressing your child. As children get older, parents give parts of these responsibilities to their children. The goal is for the child to take over tasks from you, such as being able to get their own snack, wash their own body in the tub, and select their own clothes.
For toileting, some of the responsibilities you may begin to transfer include noticing a need to go to the bathroom, getting clothes off and on, or wiping and handwashing. We get into conflict with our children when we give our children a task that they can’t or won’t complete. It’s very common that children who are struggling with continence will melt down or refuse to do things that their parent is sure they can do.
The trouble is that using the toilet has many different steps that we often don’t think about. Though we may consider toileting to be just a few simple steps, for someone just learning this new behavior, it can be overwhelming, scary, or stressful. Letting down the pressure means making choices that decrease unproductive or unnecessary stress and conflict with your child about toileting incontinence. Think about it as taking your foot off the gas to slow the car down so you feel better able to steer successfully.
The stress your child feels is usually not from any one task or skill, but from feeling overwhelmed by pressure or expectations, or feeling afraid that they won’t be successful. It’s common for a person to shut down or act out when they feel overwhelmed. Forcing, punishing, or yelling probably won’t make a child less overwhelmed—trust me, we’ve all tried. But if your child sees that you are supportive and trustworthy, you can work with them to build toileting independence.
Check out our Continence Participation Inchstones video and handout to determine which inchstones you are currently focused on, and consider if you could eliminate some of them for right now. Parents let down the pressure by lowering or taking away demands and also making clear choices about who is responsible for different tasks and decisions. This is called the division of responsibility.
The division of responsibility was created to help parents at mealtime, as shown here, and divides responsibilities between caregivers and children. Caregivers are responsible for what food is available to their children—they do the grocery shopping and cooking, after all—where children are permitted to eat (can they eat on the couch or in their bedrooms, or is food eaten just at the kitchen table), and when children can eat (are they allowed to graze all day, or are there somewhat set meal and snack times). Meanwhile, children are responsible for whether or not they’re going to eat a food, as well as how much they eat of that food.
The division of responsibility can also be used for toileting. When we use the division of responsibility, we clarify what you are responsible for, what your child is responsible for, what others are responsible for, and what you are going to let go of for now. Let’s look at an example of the division of responsibility in toileting.
Your child’s in diapers. She willingly takes her clothes on and off. She melts down when asked to clean her skin or wipe during changes. She’s scared of the echoey bathroom and the cold toilet seat. She wants to change in the hallway and does not want to sit on the toilet.
My child is responsible for stepping in and out of her pants and pull-up, getting a clean pull-up and a plastic bag for the wet pull-up from the bathroom, and holding open the bag while I drop the wet pull-up into the bag.
I, as the caregiver, am responsible for giving my child a two-minute warning before diaper changes, staying calm and non-accusatory while I help my child get clean, wiping her skin, holding a clean pull-up while she steps into it, and throwing away the wet pull-up.
In this case, our occupational therapist will practice wiping activities and also help us adapt our bathroom so it’s less echoey. For now, we will let go of changing in the bathroom and sitting on the toilet. Remember, this isn’t forever. This is for right now.
Now, let’s do this together. First, feel free to pause this video to go grab a piece of paper. It may also be helpful to look at the Continence Participation Inchstones handout to describe how you and your child meet toileting needs right now so that you can reference that.
Describe how you and your child meet the needs below. Mark any areas that are problems or don’t have a working division of responsibility:
- Getting clean, including wiped and hands washed when they pee and poop
- Taking clothes on and off
- Taking medication or other treatment related to pee and poop
- Deciding when and where to change, get clean, use the toilet, etc.
Again, feel free to pause the video as needed.
At the top of your paper in large letters, write: FOR THE TIME BEING. Create four spaces on the paper and label each with the following:
- My child is responsible for
- I am responsible for
- Someone else is responsible for
- And for now, we’re not worrying about
Now, write down what your child is currently doing willingly and well in the section “My child is responsible for.” These are going to be your child’s responsibilities.
Now think about any areas that your child is not doing willingly or having problems doing. This may be that your child is upset when doing the task and that is problematic. Could you let down the pressure by taking on these responsibilities yourself? That would go under “I am responsible for.” Delegating? Put these under “Someone else is responsible for.” Or letting go of? These would go under “For now, we’re not worrying about.” Remember, this is just for right now.
After you decide what your child, you, and other people will take on, and decide what you’re going to let go of for now, tell your child what changes they can expect. For example, you may say:
“I know that we’ve asked you to sit on the toilet after every meal. We realize that was causing you a lot of stress, so we’re going to take a break from that. How does that sound?”
You may be wondering: “What do I do if my child refuses to take any responsibility?”
First, consider if what you’re asking is reasonable. This means: are you asking your child to do something that they have demonstrated the ability to do consistently, or are you asking them to do something they have not shown they’re able to do on their own? A responsibility is reasonable if your [child] has shown that they can do the behavior each time it is required.
Next, consider if what you are asking is necessary. Oftentimes, we place demands on our children and ourselves that are somewhat arbitrary. Are you asking your child to do something that is important and necessary?
Then, consider if there are natural consequences that you can allow to encourage your child to complete the responsibility. Natural consequences can be rewarding—meaning that your child likes the consequence, so is more likely to do the behavior to have access to the reward. Or they can be punishing—meaning that your child does not like the consequence, so is less likely to do the behavior to avoid this consequence.
For example, being dry may feel good to your child, so they’ll urinate in the toilet to remain dry because this is rewarding. Alternatively, your child does not like being wet, so will not urinate in their pants to avoid this situation.
Refer to our handout or video titled Beyond the Sticker Chart for more information about rewards and consequences.
There are times that natural consequences do not occur, are not strong enough, or are not appropriate. If this is the case, consider if it would be helpful to add consequences. When addressing toileting, we encourage the use of reward rather than punishment. This means we want to offer our child something positive to motivate them to do the behavior we are asking.
Rewards can be tangible, activity-based, or verbal.
Thank you for taking the time to watch today. For questions, please email continents.project@uvm.edu.
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 healthcare provider.
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Taking Initial Bowel Data
