Toileting

Table of Contents

Children develop toileting skills at different ages and rates. Children may also have medical, physical or developmental conditions that have not been formally identified by their healthcare provider. Under federal laws, schools and school sponsored programs may not exclude a child because of a disability or developmental delay that affects toileting. Schools and programs collaborate with parents to maintain consistent routines between school and home, viewing toileting as a shared developmental goal. The focus is on access, support, skill building within the school or program environment.

Toileting refers to the implementation of a toileting schedule with delegated assistance from a paraprofessional, educator or program personnel. A toileting schedule is a planned and individualized routine that supports the child’s regular bathroom use during the day. The schedule helps prevent accidents, maintain dignity, promote independence, and support medical and developmental needs related to bladder and bowel function. The goal of the toileting schedule is to promote independence and decrease the amount of missed school or program instruction as much as possible while in the school setting, while also balancing the child’s needs. The schedule should match the child’s current level of physical, emotional and cognitive ability and not reflect solely on their age. The schedule is aimed to build skills one at a time, gradually using consistent routines, positive reinforcement, and dignity preserving support. School nurses collaborate with parents and educators to ensure expectations are realistic, the actions carrying out the schedule are documented, the schedule is monitored for progress, and the child’s independence is encouraged at their own pace.

School and program personnel understand that toileting schedules support the child’s health needs, access to instruction, comfort, and independence.

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Steps

  1. The school nurse reviews the child’s health records (if applicable) or educational program or plans (e.g. 504 or IEP if applicable)
  2. The school nurse collaborates with the parents and the child’s healthcare provider (if applicable) to understand and support the student’s usual toileting patterns and needs.
  3. The school nurse will ask the parent what matters most regarding the implementation of a toileting schedule and create a simple achievable SMART goal that focuses on independence (if applicable). The schedule is a document created by the school nurse after creation of an individualized health plan for the child for the receiving ongoing delegated health services delivery.
  4. Parents provide extra changes of clothes to the school to address accidents. If the parents do not provide additional clothes or return clothes, the school may request donations from the community or maintain changes of clothes at school.
  5. Clothes that are soiled are rinsed by the paraprofessional or trained personnel if necessary and returned to the parents double bagged or the school or program personnel may rinse and launder clothes at school (if applicable).
  6. The school nurse and parents collaborate to develop a toileting schedule that includes:
    1. Scheduled times based on the child’s school or program routine
    2. Specific assistance level using universal precautions by the paraprofessional or program personnel (e.g. independent, prompting required or physical assistance needed with changing soiled clothes)
    3. Include hygiene (assistance by the paraprofessional, trained school or program personnel with wiping or hand washing), privacy, or adaptive equipment requirements.
    4. The paraprofessional or trained individual will model washing their hands after care and have the child wash their hands.
    5. The school nurse will share the toileting schedule with the paraprofessionals, trained personnel and the child’s educators or program personnel.
  7. The paraprofessional or trained individual will implement and monitor the schedule by documenting and tracking the frequency, accidents and patterns observed.
  8. The paraprofessional or trained individual will guide the process calmly and positively while maintaining the child’s dignity.
  9. The school nurse will modify the toileting schedule as needed in collaboration with the child’s family and education team by sharing progress and adjusting strategies as the child gains skill or needs are changed.
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Parent Tips for Toilet Training

  1. Wait for readiness signs: Ask does your child stay dry for two or more hours, showing awareness of being wet or dirty, and can follow simple directions at home?
  2. Create a routine: Offer regular toilet times and maintain the schedule between home and school
  3. Use positive encouragement:
    1. Make sure to praise effort and not just success
    2. Never punish or shame accidents. They are part of learning
  4. Model and Teach: Verbalize and teach steps of toileting
  5. Dress for success: Dress the child for success by using easy to remove clothes and avoid complicated snaps or buttons
  6. Work with the school or program: Work with the school nurse, trained school personnel and paraprofessionals by sharing your routines and words used at home to help the school stay consistent
  7. Communicate with your child’s healthcare provider
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