Toilet Training

Spina Bifida and Toilet Training
Every child is different and it is advisable to watch for signs in the child's development which may suggest he/she is ready to begin potty training, such as; awareness that they are passing urine or having a bowel action, waking from naps with a dry nappy, asking to have their nappy changed.
For children with spina bifida, bladder and bowel continence should be addressed at the same time and the way the bladder works should be assessed in infancy in order to protect the kidneys from damage. There are many tests that can be done to check that the urinary system is functioning as well as possible.
Toilet training for a child with spina bifida is likely to be quite different from that of other children. Very often, damage to nerve pathways, which coordinate the bladder and bowel function and promote the sensations, mean that control cannot be learnt in the usual way.
Helping to Achieve Urinary Continence And Bowel Control?

The age at which a child begins to work toward urinary continence is individualised based on their physical capabilities and social situation. It is practical to consider urinary continence by the time a child enters school. While this is a realistic goal, it may not be appropriate for all children. In order to gain urinary continence it will be important to adhere to a consistent program. This program may include medications, intermittent catheterisation, and possibly operative reconstruction. When a urinary continence program is initiated, it should be continued while the child is in a structured school environment.
It is practical to consider bowel continence at the same time, or before a child is working toward urinary continence. It is essential for a child to maintain an appropriate stool consistency which can be achieved by a diet that includes plenty of fluid and fibre. Some children benefit from fibre supplementation. Even when the stool is of normal consistency, some children need to have assistance in eliminating the stool from their rectum and colon.
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Hydrocephalus and Toilet Training
Potty training for the child without a disability usually begins at around the age of 18 months to two years, and the child is usually 'trained' by day at around two-and-a-half years. 
Every child is different and it is advisable to watch for signs in the child's development which may suggest he/she is ready to begin potty training, such as: awareness that they are passing urine or having a bowel action; waking from naps with a dry nappy; asking to have their nappy changed. Start at a time when you can spend a lot of time with your child, when your child seems happy and there are no major distractions or stressful events in his/her life.
A young child with hydrocephalus may have difficulty balancing when sitting. The potty or toilet should provide a stable and secure position, with a comfortable, supportive seat. If necessary, rails will give stability to the upper body. The child should be able to place his/her feet flat on the floor or a box/plinth. An occupational therapist should be able to help with equipment if the child has poor sitting balance.
Many children with hydrocephalus learn better when there is a routine. Before you begin toilet training, plan what that routine will be and stick to it until a habit is established. Watch the child for times he/she is most likely to have a bowel action, e.g. after breakfast, and try those times first. Reinforce good behaviour, i.e. sitting on the potty, with praise. If nothing happens, say nothing. 
If it is acceptable to your family, take your child into the toilet when you or family members go, to reinforce what is expected. It may take much longer than with other children, so be patient. Only stop as the very last resort, as children with hydrocephalus can become used to wearing nappies through habit and this can be hard to break. Once a good habit is established, you can gently vary the routine, to allow your child to deal with changes and become more flexible.
Children with hydrocephalus may have relapses in toilet training when starting school; there is so much going on that the child may not listen to the body's signals. They may need reminding to go to the toilet and may need showing several times where the toilet is. Classroom staff should be made aware of this.

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