Toilet training can be an extremely stressful time for the child with cerebral palsy. Parents can feel pressurized into getting their child out of nappies in time for the start of playgroup or school. It is important to begin toilet training only when the child is developmentally ready, and then there should be a coordinated approach between all parties involved with the child. Children with developmental delay will generally take longer to learn the toileting routine. The child must be able to:
• understand the sensations in his bladder;
• be able to communicate his needs to a parent/caregiver.
And, as the child develops his new skills further and moves towards independence, he will need to:
• move to and transfer onto the toilet/potty;
• manage clothing;
Due to the intimacy of toileting tasks, the aim is to encourage and enable children to be independent so that as they get older they can have as much privacy as possible. Consider the following difficulties:
• non – verbal children will need an easily recognizable way to communicate their need to use the
• extra time is needed to remove a child from his supportive equipment, perhaps a standing frame
or seat – remove his/her clothing and then transfer him/her onto the toilet equipment;
• if the only toilet is upstairs it may be more practical to have alternative facilities downstairs for
ready access and use.
EQUIPMENT TO REDUCE BACK STRAIN FOR PARENTS/CARERS
There are many different tasks and activities associated with toileting. These include:
• removing and adjusting clothing;
• changing nappies/pads;
• transferring the child on and off the potty or toilet;
• supporting the child during bottom wiping.
The twisting and bending involved in these actions can increase the risk of back injury and this should be reduced where possible. This could be done in the following ways:
• by careful choice of clothing, e.g. elasticized waist bands, Velcro fastenings, stretchy fabrics;
• by using a changing bench set a height to meet the requirements of the caregiver, or by adjusting the height to make it possible for the child to get him/herself onto the bench;
• by using a hoist to assist with transfers;
• by installing a bidet/drying facility.
FOR YOUNG CHILDREN WHO NEED ADDITIONAL SUPPORT ON A TOILET
Some potties available from stores and shops have an integral backrest for additional support and are more like a chair as they are higher from the floor. These may provide adequate support for a child with mild difficulties.
• Potties with oval apertures provide a more comfortable and supportive seat than a round aperture, in which children with narrow hips tend to get their bottom stuck. A wide ledge each side for support under the bottom is also more comfortable with the result that the child performs more easily.
• Some potties have a pommel moulded into the front of them which will keep the legs apart and in a more relaxed position. This will also provide a splashguard for boys.
FOR OLDER CHILDREN WHO NEED ADDITIONAL SUPPORT ON A STANDARD ADULT TOILET
Trainer seats –
Trainer seats are secured either by positioning them under the standard toilet seat, or they snugly fit into the toilet seat aperture from above. Older children will need one that will take their extra weight. Those with a front splashguard are useful for keeping the legs apart. Consider the following:
• the child will find it easier to keep stable on the seat and will manage toileting tasks better if
feet are supported on a box step;
• a front pommel/splash guard will make it more difficult for the child to get on and off the toilet.
A box step should help with transfers;
• a child may also need wall rails or a toilet frame for additional support during transfers and
while sitting on the toilet.
Toilet support seats and frames –
These comprise a more supportive seat unit (usually incorporating a backrest, side support, lap strap or harness) that either clamps to the WC bowl or is freestanding. Any additional equipment used with a standard WC can be inconvenient for bowel evacuation is to have the feet supported, with the knees slightly higher than the hips – i.e. mimicking a squatting position;
• for children who find it difficult to sit up straight, check the level of support provided given by the straps and harnesses.
Treatment surgery center children symptom Mobility Exercises in Cerebral Palsy children Treatment surgery center children symptom India US UAE Europe Pakistan Nepal Bangladesh Sri Lanka Afghanistan Bhutan Russia Canada United States PR China Brazil Australia Argentina Kazakhstan Sudan Algeria Greenland Saudi Arabia Indonesia Mongolia Peru Niger South Africa Colombia Egypt Nigeria Venezuela Turkey Chile Zambia Ukraine Kenya France Thailand Spain Sweden Uzbekistan Morocco Iraq Japan Zimbabwe Germany Finland Malaysia Philippines Ecuador New Zealand Netherlands Switzerland Denmark Qatar
Need more information on how to organize your efforts to manage your child’s care?
Dr. Jitendra Kumar Jain
Like us on facebook : https://www.facebook.com/samvednatrustallahabad
follow us on Twitter : https://twitter.com/TrishlaOrthoped