We continue with the points that we have left to present from the last Webinar about the "potty training" that Cristina did for the great community that we form in VICON Method. We remind you just in case, that you have the full video on our profile Facebook, as we told you.
Here's the first part, as a reminder that we left off at point 12. This refers to some aids we can use to make things easier. This will help you understand the following points we'll share with you.
13. ESCAPES OUT OF THE BATHROOM
If they do it They should not be scolded, punished, or cause any moment of stress, even though it may seem unbelievable, we have to say "pee-pee," teaching them to identify what they're doing and gradually accompanying them to the bathroom, even if we have to clean up after them. We'll approach the sitting as if it were incidental, but we'll see these opportunities as what they are: moments in which they'll be able to know what pee-pee means firsthand, the best way for them to learn, with appropriate guidance and without punishment or disruption from us. We involve the child in changing clothes so they truly begin to understand that it's worth asking to pee or going to do it rather than wasting all that time cleaning and changing.
14. CHILD ALSO SEATED
It is also very important to point out that it is recommended that children learn this habit sitting down, because it will then help us with the defecation or pooping process. We don't tend to have children who poop standing up, because don't forget that our children are very literal and it's hard for them to make changes in learning once it's internalized. So by skipping a few steps and intermediate learnings, we will help our children learn this habit sitting down. We will even use their hand to lower the penis and let them hold it themselves so they don't get used to us having to hold it for them.
15. FIRST IS URINE, AND THEN, FECES.
Toilet training for pee is not the same as toilet training for poop, Aside from the fact that they're different muscles, we return again to the reflection from before: pee has to relax to come out. But when we talk about poop, there's a chain of muscles that help us push and poop. And here I'd like to address a very important point: We need to control our children's constipation so that this process is as smooth and relaxing as possible.If our child doesn't have toilet training problems, it's important that the diet doesn't vary in timing or quantity, that it's rich in liquids, and that if you choose to introduce stool, you also include vegetables or foods that promote proper toilet training, such as flax seeds or aloe vera, without causing the child to strain. However, in any case, you must understand that you need to give them time to understand the dynamics, and that due to repetition, it's easier for them to understand peeing first. A child who is undergoing a controlled defecation process should go to the bathroom once or twice a day. The same can happen with diarrhea, and we must be able to rule out food intolerances and monitor this development before this adaptation process to toilet training, because otherwise, there are variables working against us, and we need to have everything in our favor as families.
First, we'll address everything related to urinary sphincter control and then move on to the defecation process.
When we talk about defecation and sometimes we have much more fixed schedules. When should we do it?? Well, about 10 minutes before the estimated time to defecate (that is, if he usually defecates at 11:30, around 11:20) so that we give him time to relax. It is advisable to throw some tissue before peeing and/or defecating, since some children get scared when they hear feces falling or when they come into contact with water splashing.
16. CONSTIPATION
But what happens when there is no regularity in defecation, when we have the famous Constipation.
It's important to try to prevent and treat this constipation. We must make it easier for the child to defecate: if they ask for a diaper, we put it on them; if they do it on themselves, instead of scolding them, we treat it naturally, exactly the same as with peeing. It's important to follow a diet rich in fiber (legumes, whole-grain or fiber-rich crackers and macaroni, fruits and vegetables, etc.) and perhaps drink a little more water, but once the problem is established, this probably won't be enough. For a one-off problem, if they haven't done anything for three days, a glycerin suppository may be helpful. But if we have to resort to suppositories too frequently, it's better to administer a laxative every day. The one prescribed by your pediatrician, which will usually be a safe, non-irritating laxative. Some children need to take laxatives for months to achieve daily or almost daily bowel movements without straining.
An extreme case is Encopresis…
Sometimes a large mass of dried fecal matter forms, a fecal mass, that never comes out (or, when it does, a new one has already formed). The fecal mass irritates the rectal mucosa, which reacts by producing mucus that comes out mixed with a little liquid fecal matter. The child leaks, defecates on his own, and parents may think he has diarrhea, when in fact it's severe constipation. The rectum must be completely emptied, usually with enemas—not homemade ones, but following the pediatrician's recommendations—because suppositories cease to be effective when the rectum is dilated.
17. TOUCHING..
Sometimes we encounter children who tend to touch themselves during bathroom breaks. It's very natural when we discover parts that are normally hidden and that process of discovery begins, so let's try not to add another task to this process and treat it naturally. Also keep in mind that when the penis is erect, urinating is more difficult, so these are aspects that must be taken into account when subtly redirecting these behaviors. We also encounter children who tend to put their finger up their bottom, and we're beginning to see that in many of these cases, these are symptoms of constipation, where the end of the anus is drier and causes itching. So, consider applying creams, oils, and re-monitoring the entire issue of constipation in your children so that we don't have an additional problem along those lines.
In summary... We understand what the muscles are like, that we need adequate and developed muscle tone, that the activity has to be relaxing and pay attention to the indicators, we also have to transmit that relaxation to help relax and produce that moment of urine release, that the moment of bathroom habituation has to be assumed, that we have some aids like water, as relaxation exercises, and that we have to help with waiting times. We don't have the same processes in controlling pee and poop and that they come at different times, so we will first attend to pee and in the meantime, we will look at all the additional problems in defecation.
18. URINAL YES, URINAL NO
Considering the generalization difficulties our children with autism and communication difficulties have, using the potty can make it take longer for us to master the process of urinating on the toilet. Simply using the potty anywhere doesn't adequately teach them where these activities are done.
There are only a few specific cases in which we recommend introducing the potty. When we find rigid children who have selected, who have identified a specific place In the house, behind the sofa, behind the door to always pee, we can use the potty in that favorite spot to develop the skill there and then gradually bring it to the bathroom. Also in cases where there is a phobia of the bathroom, only in these cases do we recommend using the potty, when there is rigidity at the spatial level, when children have a fear or phobia of the bathroom, we recommend taking an intermediate step because we have an added difficulty and it's not possible to work on everything at the same time, always seeking that relaxation of the child.
19. FIRST BY DAY AND THEN BY NIGHT
It is not advisable to remove the day diaper and the night diaper at the same time., They are different processes and we consider it more appropriate remove the daytime diaper first And once two weeks have passed without leaking during the day, and you're looking at the indicators, try potty training at night. Exercise is very important, as is continuing the water drinking process, not just before going to bed, but throughout the day.
An indication that your baby is ready to stop using diapers at night is if the diaper appears dry some nights or even most nights.. It's important because otherwise it will mean cutting off his sleep to go to the bathroom constantly and he needs to rest and relax. Here it is important and helpful to do a record, hence the most advisable periods for this are holidays, since our sleep as adults can be altered.
AND WHAT ABOUT ENURESIS?
The definition of nocturnal enuresis is “wetting the bed at least twice a week, after the age of five.” That is, before the age of five, or when it only occurs once a week, it is neither enuresis nor anything else.
Most children achieve full control of their peeing and pooping by the age of three or four, although it may take a few years later for them to occasionally leak urine during moments of stress or distraction. Bedwetting before the age of five, or only once a week, is not considered enuresis. Many children manage to control their peeing at night almost as quickly as they do during the day. But many others take several years. Let's keep in mind that this process is that of a typical child, and we have a very different reality, generally associated with immaturity in both language and communication, as well as on a physiological level. Sometimes we don't have these difficulties, and our children perfectly control this skill. However, it's very normal for these natural or typical processes to take longer in cases with disabilities. I think that's the reason you're all here with me today.
Why does my child still wet the bed? In reality, bedwetting is normal. It's just that some children take longer than others. There's usually a hereditary component. The child doesn't do it on purpose, nor for convenience, nor out of lack of interest, but because they can't help it. He should never be ridiculed. Some medications have been used to treat enuresis; their effectiveness isn't amazing either. I wouldn't use a medication with potential side effects for such a minor "problem." These days, any store sells diapers for children of all ages. This has helped many children and teenagers realize that they are far from the only ones who wet the bed.
20. PHOBIAS/FEARS
We have talked before… that toilet training is a challenge that is often associated with various problems (developmental delay, nocturnal enuresis, and toilet refusal) and temporary setbacks associated with various events in children's lives (family conflicts such as divorce, the birth of a sibling, moving, etc.). Both are a normal part of the developmental process, and their occurrence in your children does not constitute a failure.
But if phobias or fears are detected, let's try to work on them outside of these bath/toilet moments, during much more controlled times, when the child will be more receptive. Typically, working with phobias and fears isn't usually overcome when they're worked on at the moment they happen, but rather in more controlled moments, where we visualize the moment afterward when we're more relaxed and at ease.
21. CONGRATULATIONS IN MEASURE
As for praise, We must also measure our positive reactions. An overly effusive reaction can put unnecessary pressure on our child to do things well. It's also important that family life doesn't revolve around toilet time, that it isn't a constant topic of conversation, that it isn't the first thing grandparents and aunts and uncles ask when they see the child. You can congratulate them on their progress, but don't overdo it; don't turn it into some kind of rite of passage; avoid phrases like, "You're a big boy now."
The more exaggerated the congratulations, the more painful the failure will be if it occurs. The more fabulous success is portrayed to us, the more painful the failure becomes; and "failures" in this process will be inevitable and frequent. So I'll tell you more... Don't be afraid to step back. If you start and feel it's not your child's time, it's okay to put them back in diapers. Their time will come, and with patience and love, it will come in a non-traumatic way. If there weren't high expectations, they probably won't mind.
22. COMMON BEHAVIORS AND WITHIN THE DEVELOPMENT PATTERN
At this age, children do strange things that shouldn't be laughed at or scolded for.
- Some people warn you right after they do it on themselves.
- Others do it on the floor, right next to the urinal.
- Many people hide to poop, for example behind a curtain, with or without a diaper (they know perfectly well they're going to do it, it's not like they "just let it slip." But it's one thing to know you're going to poop, and another thing to do it in the toilet). Many people, for some reason, have the habit of curling up inside the curtain.
- Others, for a while, need a diaper to be able to pee or poop. Some children, standing naked on the beach, demand a diaper because otherwise they can't pee.
- Others feel obligated to ask permission to go to the bathroom every time they pee for months or years.
In any case, always remember that you're not doing it to be annoying... and that it's almost over. And when we encounter truly rigid children, it's very important to give them plenty of time, and even if we haven't yet achieved sphincter control, limit diaper changes to the bathroom, at least working on the spatial and habit level of familiarizing them with the environment. Keep in mind that all children eventually acquire the habit of going to the bathroom, unless there are associated physical problems. We always manage to potty train, even if there are communication problems, sooner or later.
To summarize and recap both posts on this blog, we're very clear about the process of toilet training, peeing and pooping, day and night, the associated problems we need to consider, the support we can provide in parallel or at the same time, the schedules and routines that will help us achieve this, all the specific communication we need to implement, the visual aids that will help us understand all the routines in each space, and gradually introduce routines step by step, how we need to create this reward program, measured without generating too many expectations, accepting failures and backtracking if necessary, the entire system of records that can help us understand our child's behavior and even generalize this skill across different bathrooms.
That it We have to do it as a team, family, school and therapists and with Consistent decisions focused on the child and his or her time, in their abilities and their needs, not ours.
With these posts on the VICON Method blog, we hope you've been able to clarify some aspects and resonate with some of the parts, making you want to do it in a relaxed and respectful way for your little ones.
If you have any questions, you can ask us through our social media channels.
Thank you for always being with us… Now then, What will the next webinar be? What would you like us to talk about?