Inchstones Make Milestones

Next resource:

Using Data for Continence Success

Next resource:

Using Data for Continence Success

Hi, my name is Chayah Lichtig. I am the occupational therapy consultant and director of the Vermont Continence Project.

In this video, “Inchstones Make Milestones,” we’re going to talk about setting goals and planning your child’s toilet learning journey.

First things first though—if you are struggling with your child who’s refusing to use the toilet, or having meltdowns or tantrums when you try to work on toileting, we suggest that you pause here. If you are experiencing lots of stress around toileting with your child, they’re not likely to be successful with new or different expectations yet. We suggest that you go back to our videos on letting down the pressure and preventing power struggles.

You might have noticed that the title of this video includes the word “inchstones.” Inchstones is a term coined by disability parent activist Sarah Kernion, and it refers to all of the small steps that can make up those big goals—you know, the milestones.

We understand that your attention might be on those milestones—those things like your child staying dry and clean through a family outing, or using an unfamiliar bathroom outside of the house, or doing their hygiene and clothing by themselves in the bathroom.

Sometimes parents might know where they want to go, but they don’t know how to get there. And that’s where inchstones come in. They show us the path.

It turns out that all of those milestones are actually made of many, many steps. And struggling with even one of them can make continence feel almost impossible—and toilet use feel almost impossible.

Think about, in your own life, all of the things that it might take for you to go to the bathroom when you have to pee. First, you have to notice that sensation, and you have to know what it means. You have to let go of the activity that you’re doing in that moment. You have to head to the bathroom, even if you want to be doing something else more—and even if there are other things that might be distracting you or weighing on your mind. And when you get to that bathroom, you might notice that it smells funny, or it has an echo, or perhaps it’s cold—and you do it anyway. That takes a tremendous amount of skill on your part as an adult.

And when we think that our child can simply go into the bathroom and use the toilet, we are underestimating how much effort and skill it takes to do all of those pieces.

And so, imagine how it might feel for a child who maybe is afraid to sit on the toilet—or even afraid to go in the bathroom. If we jump straight to the goal of expecting them to sit on the toilet for an extended period of time, we’re probably going to get a lot of pushback. However, if we start with a small inchstone—like maybe your child gets a dry pull-up from the bathroom and changes right outside the bathroom, and maybe the next step is they change in the bathroom, and then maybe they willingly sit for a moment while they do their hygiene on the toilet, like their wiping. And finally, maybe they’re willing to sit to pee or poop.

And consider the very common situation of children who might not know when they need to poop and therefore are having poop accidents. They might have to start with a pretty regimented schedule of sitting after every meal with direction from an adult. And then maybe they sit on a schedule that they manage themselves. Or they sit when they’re prompted once a day. And finally, maybe they go poop independently.

So we hope that you’re going to start thinking about your toileting goals for your child. You probably have a goal around continence if you’re watching these videos—like peeing and pooping in the toilet and holding it in between. But you probably also have goals around independence—like wiping or clothing management. You may also have goals around self-initiation—like going to the toilet without reminders.

When you finish watching this video, I invite you to go and check out the goal-setting handout in the parent guide. The first thing you’ll do is write down your child’s continence milestones, if you know them. It’s a good time to ask.

And then look at the list of sample inchstones on the inchstone chart. See if there’s an inchstone on that list that sounds like the way that your child participates in a specific skill set—like hygiene or wiping. Circle it, or write it in if you don’t see anything that sounds like your child.

And you can also look back at your “Letting Down the Pressure” handout to see some reminders of how you perceived your child doing that skill.

So, using this handout as a guide, imagine your child’s next inchstone for that specific skill and write it down.

And we really encourage you to focus on having well-written inchstones. First of all, have an inchstone that will tell you when you’ve seen your child do that skill—and how you’ll know that the skill is improving. We also want you to write inchstones that are reasonable, and that are going to help you reach your eventual goals.

Here are some examples. We always want you to pick a goal that’s something that you can observe that your child does—not something they don’t do. If you’re looking for a specific behavior, it has to be something they do at a certain time.

So the old goal would be something like, “My child won’t have any accidents.” And if you’re working toward that, though, there’s no specific time that they don’t have an accident. It’s all or nothing.

An alternative would be something like, “My child will pee on the toilet three times today.” You can see it, you know when it’s happened. And if your child, in the past, peed on the toilet once a day, then three times would be a measurable increase.

Right. And then we also want that goal to be reasonable. Though eventually you might want your child to run to the bathroom with no reminders when they need to go, if your child is not doing that at all at this point, that’s probably not a reasonable inchstone. So you might say something like, “My kid will go to the toilet half the time with only her potty watch to remind her.” That is a more reasonable goal. And the potty watch is also a great stepping stone on the way to the bigger goal.

So, anytime you choose an inchstone for your child, ask the question: “What does it take to really complete this activity?” It’s usually more complicated than you might expect.

This is a Venn diagram of some of the skills that your child needs to wipe when they’re sitting on the toilet. We don’t expect you to know all of these, but I do hope that you’ll think of and remember the following if your child is showing resistance or hopelessness during an activity.

If your child is refusing, it’s usually a sign that something might be too hard or overwhelming. Smaller steps will build trust and confidence between you and your child.

Here are some guidelines. Remember that your child’s success is your goal. So come to the activity with a calm and caring presence. Check out our content on parenting and behavior for ideas about how to do this.

Making too many demands at once can cause stress for your child—and sometimes set you back. So choose right-sized goals, and not too many at a time.

Remember to focus on the big picture. You’ll want your child to be independent with things like transitioning to the bathroom and wiping. And focusing on things other than continence can give your child places to feel successful if the continence itself is coming slowly.

And keep using your toileting toolbox and your toilet teaching tools—like predictable schedules and visual timers and physical supports.

Parents often want their child to show all of the skills related to toileting all at once. And they will often say, “My child knows how to put on their clothes. They know how to wash their hands. They even know how to poop in the toilet. I just want them to do it.”

And I often compare it to something like cooking a huge meal for an event. You may know how to make all the dishes that come with that big fancy meal. But do you know how to make them for 40 people—or make them all come out hot and at the same time—or plate them beautifully and serve them?

You might find that even if one or two of those skills feels manageable and something you feel good about, putting them all together can feel overwhelming pretty quickly. And the full realm of toileting is really similar. It’s a lot of skills being expected all at once.

And by taking this process step by step—small inchstone by small inchstone—it builds to the milestones that you’re hoping to see.

You’ve got this. Thank you for your time.

The information contained in these videos 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.