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So many children struggle with the process of independence with toileting skills and we’ve talked about it in previous episodes - check out the show notes for those episodes - but today we are going to break down the actual skills required for each step of the toileting process plus give you some activity ideas to address each skill!
In OT, we call this an activity analysis
So let’s jump into an activity analysis of toileting! What is required for this ADL? Listen in to find out!
AND make sure you listen to the very end, where we answer 2 listener questions!
Activity Analysis of Toileting - by OT Students in Dec. 2018
Episode 25 - Executive Function Skills
Episode 41 - All Things Poo 2.0
Episode 113 - Self Care Skills
Episode 143 - Teach the Skill, Not the Goal
Episode 191 - Toilet Training Tips
All Things Sensory Podcast Instagram
Freebies Page - Visual Schedule Template
Improving Focus & Behavior in the Classroom - Digital Course!
For many of us, going to the bathroom is something we rarely think twice about. However, learning to toilet independently can be complicated and often frustrating for children—particularly those with sensory processing challenges or developmental delays.
Mastering toileting involves more than just knowing when to go. It requires a blend of physical, cognitive, and sensory skills. Understanding these underlying elements can help parents, caregivers, and therapists support children more effectively on their journey to toileting independence.
At first glance, using the toilet seems straightforward. However, it involves a range of sensory, cognitive, and motor skills that must work together seamlessly.
Interoception is the sense that helps us recognize what’s happening inside our bodies—whether we’re hungry, thirsty, or need to use the bathroom. For children with difficulty processing interoceptive signals, recognizing the urge to go may come too late, leading to accidents.
This sense develops over time, but children with sensory processing issues often need extra support to learn how to interpret these body cues early and effectively.
Toileting requires a specific sequence of steps: recognizing the need to go, walking to the bathroom, undressing, using the toilet, wiping, redressing, and washing hands. For success, children need to recall and organize these steps, which involve key executive functioning skills like working memory, sequencing, and planning.
Both gross and fine motor skills are essential for toileting.
Gross motor skills help children walk to the bathroom, maintain balance on the toilet, and pull up their pants.
Fine motor skills come into play when manipulating buttons, zippers, or toilet paper and properly wiping.
Sitting securely on the toilet can be surprisingly tricky for children with poor postural control. Proper foot support and core stability make them feel safe and comfortable during toileting.
Proprioception—the sense of where our body is in space—and the vestibular system, which controls balance, are actively engaged during toileting. From walking to sitting and wiping, these systems must work in harmony.
Children who struggle with proprioceptive or vestibular processing may experience discomfort or difficulty with these movements, adding stress to an already challenging task.
Navigating the bathroom environment without bumping into objects—or understanding how to wipe oneself properly—requires solid spatial awareness. Children with poor spatial skills may struggle with these tasks, especially in confined spaces or busy public restrooms.
Bathrooms can be overwhelming environments due to various sensory inputs, such as smell, sound, temperature changes, and bright lights. Developing sensory modulation strategies is essential to help filter out these distractions and allow the child to concentrate on toileting.
If your child is facing challenges with toileting, there are several strategies you can implement to build confidence and independence:
Creating a visual schedule or social story can help children who struggle with sequencing or working memory. Breaking the toileting process down into visual steps provides a clear, easy-to-follow guide, making it more manageable for the child.
Aligning the body correctly is essential for optimal bowel and bladder function. Use a step stool or a squatty potty to ensure your child’s feet are supported, and their knees are higher than their hips.
If your child feels unstable, adding armrests or side handles can offer extra support and make them feel more secure.
Engaging your child in fun activities that challenge hand coordination can help build toileting and dressing skills. Button boards, zipping games, and snap practice can all help improve fine motor abilities in a low-pressure environment.
Obstacle courses are an excellent way to enhance motor planning, balance, and coordination. Set up a simple course at home with three or four steps that encourage your child to move their body creatively.
Not only does this build physical strength, but it also helps them practice motor planning, which is critical for tasks like toileting.
One fun way to work on this skill is to play games where your child twists to clean a balloon covered with peanut butter. This simple activity helps develop the necessary rotation and balance skills enjoyably.
If your child is sensitive to clothing textures, bathroom smells, or other environmental factors, gradually introduce sensory-based activities into their routine. Exposing them to different textures, smells, and sounds in a controlled and playful manner can help their sensory system become more accustomed to these stimuli.
Doing this outside of the bathroom may help reduce their sensory overload when it’s time to use the toilet. By breaking down the toileting process into its core components and focusing on these areas, you can help your child develop the skills they need to become independent and confident in the bathroom.
BORING, BUT NECESSARY LEGAL DISCLAIMERS
While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.
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