Routines & Goals: Toileting “Inchstones”

We might think of “toilet training” as one activity, but it’s actually made of lots of separate steps and skills! This video can help you figure out where to focus your attention and support your child with the skills they are working on right now.

Resources

Steps to Toileting Participation (pdf)

A full transcript of the video appears below.

Hi, my name is Chayah Lichtig. I’m the director and occupational therapy consultant with the Vermont Continence Project. In this video, we’re going to talk about the many skills that make up the toileting routine, and how to choose the most important ones to work on with your child. You may have noticed that the title of this video includes the term “Inchstones”

People use the term inchstones to describe all of the small steps that make up the big goals. We understand that your attention is probably on milestones, things like your child staying dry and clean through a family outing or using an unfamiliar bathroom, or doing their hygiene and clothing by themselves in the bathroom. Some parents come to see us and they aren’t clear on their milestones, only that they want their child to increase their toilet use and continence skills.

So take a minute and think of a few of your milestones for your child. If you need to pause this video and write them down. I’ll be here when you get back. So if your goal is the milestones, why do you need to think about inchstones? Seemingly simple activities that we take for granted are actually made up of many, many steps.

Struggling with even one can make continence almost impossible. The next time that you go to use the toilet. Keep track of some of them. I’ll give you a head start with an example about peeing. First, you have to notice the feeling of your bladder stretching and know that it’s enough that you need to empty it. You also need to know what that feeling means. Stop what you’re doing right now. It doesn’t matter if you’re watching your favorite show, and you can’t take it with you. Plan your walk to the bathroom. Don’t get distracted on the way there. You know that urge to pee and how you were able to notice it? Don’t focus on it too much or your bladder might start to contract and the people come out too soon.

Are you in the bathroom yet? Does it have an echo or smell funny? Is a seat going to feel cold and uncomfortable when you sit down, and you’ll sit anyway? Wow. Great work. That was a lot. And you didn’t even sit down yet. Now go back to your milestone for your child and break it down. What are the steps?

What are the skills? What is your child able to do right now and what are they not yet able to do? Then focus on the next step and what kinds of support your child needs to take that step. Here’s an example. If your milestone goal for your child is for them to poop on the toilet, but right now they won’t sit on a toilet with their pants down, then that’s a goal to meet first. And that goal has a lot of inchstones. For example, teaching your child to cope with the worries or stress and feeling of the open toilet. Teaching your child to sit for a minute or more and teaching them how to breathe, to push poop out for your child to be successful with these inchstones. They’ll also need some supports, for example, a toilet seat reducer and a tall footstool, a visual timer and a reward for their sitting.

We talk about all of those things in other videos, which we hope you’ll check out. Some parents feel overwhelmed with all of these inchstones and don’t know where to focus their attention. If you’re having trouble thinking of some of the inchstones that make up your milestone, you can check out the handout in the files for this video, Steps to Toileting Participation. It doesn’t have all of the inch stones that you might need, but it definitely lists many of them.

Here are some guidelines for how to put an inchstone mindset in place. Too many demands at once can cause stress for you and your child and sometimes set you back. So choose three or fewer inch stones to work on at any time and support them well. Reward the stones that you’re focusing on and let everything else go that you haven’t worked on with your child yet.

Remember to put the right supports in place. Your child’s success is your goal. Remember to focus on the big picture, not just continence. You’ll want your child to be independent with things like transitioning to the bathroom, wiping and clothing, too. Also, focusing on things other than continence can give your child other places to feel successful.

Parents often want their child to show all the skills related to toileting at once. They may say, My child knows how to put on their clothes, wash their hands, poop in the toilet and more. I just want them to do it. I often compare it to something like cooking a huge meal for an event or programing a computer. You may know how to make all the dishes that make up the meal, but have you ever coordinated it so that they come out at the right time looking nice on the plate, served for 100 people?

Or you may know where all the keys on your computer keyboard are, but what order do you press them in to create a new video game or app? You might find yourself pretty stressed and anxious at the sum of all of those expectations. By taking this process step by step over time, your inchstones will build to be the milestones you’re hoping to see.

We wish you the best on your journey. 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.