The day has come when we as parents start to think of freedom. That freedom comes in three simple words…NO More Diapers!!! You may think you have the perfect plan set up to begin this adventurous, sometimes messy journey to freedom; however, potty training a child with hemiplegia can throw a few curves into your plan that you may not have considered. Here are a few things to think about before you start.
Lack of sensation or muscle strength
We know that our child’s arm and leg is affected because we can actually see this, but what about what goes on inside their bodies? They may have problems with the muscles that control the bladder and bowel movements. It is possible that they may not be able to actually feel when they have to go and it may take them time and practice to learn what this sensation feels like. Longer dry spells between diaper changes, and when bowel movements take place on a somewhat consistent basis are both signs that the muscles are strengthening.
If your child is not able to understand the terms involved in potty training, or is unable to follow simple instructions, potty training should probably be put on hold until they are able to. Also, if your child can only concentrate on one task at a time and has difficulty processing their thoughts from one thing to another, you may have to use constant reminders or set a timer which will help both of you to remember that it is time to try to go. Even if they don’t go at that time, it will still reinforce the fact that they should use the potty and not use their diaper.
Stability of potty chair
Finding the “right” potty chair is extremely important due to the balance issues the children may have. There is nothing scarier than the feeling that you may fall in! There are many potty chairs that are made to start on the floor and then can be adapted to the regular toilet when the time comes. Some of them also have rails on the sides so they are able to hold on. Your child may feel more secure if you place a stool under his feet so he feels more grounded. He may feel more secure if seated facing the tank because this allows him to hold on.
Placement of toilet paper roll
If the toilet paper roll is located on their affected side, if possible, have it changed so it is easily accessible for them to reach using their non- affected side.
Pulling pants up and down
Start practicing this before you begin potty training. Many times not being able to do this quick enough will cause unexpected accidents. Many children do this one handed by alternating from one side of the pants to the other and adding a little wiggle in to help.
Stay away from any pants that have zippers, buttons, or snaps. Loose fitting elastic waist pants allow them the freedom to get them up or down much easier by themselves. You may even want to consider just letting them run around in their underwear when first starting. Talk with your child about the big boy/girl underwear and take them to the store and let them pick out their favorite ones, this way they also feel proud of the fact that they picked them out all by themselves.
After they do go, or even if they didn’t but sat on the potty chair, offering them assurance in the form of a reward makes them feel that they did a great job. Rewards can come in many different ways, some of them are: using a sticker chart, putting a cute stamp on their hand, some use M&M’s, skittles, etc., even just a big hug and high five work.
These are just a few suggestion to help with potty training. Last, but not least, sometimes it is better to not put so much stress on yourself as a parent and on your child. You may also think they are potty trained and all of a sudden they regress, this is normal. You may notice this especially after they have become sick or something happens that changes the normal routine they have been used to. It may take longer for you to potty train your child because they have so many other obstacles to overcome, but one day, all of a sudden, it will click for them and the diaper days will be something of the past.
Potty Training Children with Hemiplegia – Additional information for Teachers and Day Care Providers
Children with hemiplegia often take longer to potty train. While their body may not be cooperating, they are still very eager and capable of learning. Please promote these children to the age appropriate classroom, regardless of whether they’re still in diapers or pull ups. The rare caregiver who insists on the child staying in with children who are still in diapers is doing a grave disservice to the child and delaying his learning from peers. Being with same-aged peers helps stimulate the brain growth of a child with hemiplegia. The caregiver who recognizes this will feel great satisfaction at making a difference in this child’s lifelong learning. So don’t contribute to delays – promote the child with hemiplegia at the same age you would promote other children.
Please allow the child with hemiplegia to use the bathroom as soon as they’ve asked permission. These children often have decreased sensation and may have little warning before they have an urgent need to go. Do not ask them to wait until the class break, even if it’s just a few minutes. Delay in going to the bathroom can be physically harmful and can also result in accidents, which not only cause time away from the classroom for clean up, but also result in much embarrassment for the child. Perhaps you can arrange for the child to give you a special signal that they need to go and you signal back giving them permission. This will result in less disruption in the classroom and will allow the child to reach the bathroom as quickly as possible.
Thank you to Jackie Haley for her contributions to this article.