The Vermont Continence Project, housed at the Center on Disability and Community Inclusion, has compiled a wealth of resources for caregivers, children, and educators and clinicians. These resources also cover specific topics and diagnoses, and regional training resources.

Navigate to Resources for Caregivers; Children; Educators and Clinicians; and Specific Topics and Diagnoses.

Please Note: The Continence Project values the empowerment, education, and self-determination of children and young adults with and without disabilities. For this reason, we use the terms “toilet learning” and “toilet teaching” rather than “toilet training” to highlight that the learner is an active and important participant. We also use Person-First Language, for example, “person with autism” rather than “autistic person,” to highlight that a person is much more than an identified disability or difference. While the resources we’ve offered here do not always use the language of self-determination and Person First identification, we use this language in our consults and technical assistance training as well.

Resources for Caregivers

Digital Resources

Visual Supports (video)

This video reviews easy to make visual supports families can use during toileting and instructions on how to make them. The Continence Project believes the mastery of toileting skills promotes inclusion at home, school, and in the community. We believe that current and accessible resources, information, and support should be available to each individual, parent/caregiver, and team who have identified toilet-learning as a priority goal and life skill.

 

Visual Schedule
Do2Learn

A visual schedule is a sequence of pictures that can help a person understand the sequence of events in their day, or complete a multi-step activity (task/reminder strip). Do2Learn’s visual schedule resources include images to use for a schedule (“Picture Cards”), and examples of daily schedules (“How to Use”) and task strips for toileting and other activities (“Reminder Strips”). This page also gives recommendations on ways to tailor your visual schedule to your child’s developmental level and needs.

Toilet Learning Data Sheet (docx)
Use this data sheet to keep track of a child’s/student’s elimination patterns. The Continence Project recommends using this in the short term (3-7 days) at the beginning of a new toileting program. The information can be used to create a toileting schedule that aligns with the child’s own timeline of voiding.  It will also serve as a measure of progress later in your program when compared to the original baseline. 

The Ins and Outs of Poop (PDF)
Stool Record Data Sheet
This data sheet can help families report changes in their child’s bowel movements over time. 

Supporting Toilet Learning: A Team Approach (video)
The Continence Project (2011)
This video, created by current and former UVM Continence Project and I-Team members,
outlines how to use an interdisciplinary approach to teaching toileting skills.

 

Incontinence Supplies

Diapers and Pull-ups from Medicaid and Dr. Dynasaur (PDF)
VT Department of Health Access
A layperson explanation of the process to get continence supplies for your child paid by Medicaid. 

Disposable Incontinence Supplies (PDF)
VT Medicaid Provider Bulletin
A detailed explanation of the process to get subsidized continence supplies through Vermont Medicaid insurance. 

The 2018 Guide to Medicaid and Incontinence Supplies
Home Care Delivered
An online resource that explains the process to apply for and receive incontinence supplies. Includes helpful tips beyond the VT Medicaid documents.

Vermont Diaper Banks
Several regions have or are developing diaper banks for emergency diapers. This website lists several throughout the state. You can also contact your regional parent-child center or a food shelf in your region. 

Resources for Children

Children’s books

Continence Books Amazon Wish List by UVM Continence Project staff
A list of children’s books addressing continence, constipation, bedwetting, and related body functions. Most of  books listed below are available for loan through the Continence Project. If you are interested in borrowing any of the titles, please contact the Continence Project at continence.project@uvm.edu.

Social Stories

Social stories are informational stories to help children understand specific topics.

Potty Training Social Story Video
William Wauch
This video social story is an example of a general toileting social story.

I Can Poop in the Toilet
Able2Learn
A general written/illustrated social story with PEC images. Can be printed or used on a device.

Don’t Play with Poop
Able2Learn
A written/illustrated story about touching/smearing feces. Can be printed or used on a device.

 

Toileting Videos

Daniel Tiger's Neighborhood Prince Wednesday Goes to the Potty Daniel Goes to the Potty
Two animated episodes of Daniel Tiger’s Neighborhood. Addresses pausing play to toilet, toileting in the community, and all the steps of toileting. Has both animated and video of toileting (boys and girls), and features a catchy song.

The Food to Poop Tube (animated)
The Ins and Outs of Poop 
An interactive flash animated model of the digestive system

 

Coloring Pages and Information Sheets for Kids

The Food to Poop Tube
The Ins and Outs of Poop 
Black and white and color images of the digestive tract. Children can color in the black and white image.
Download handouts in color (PDF)
Download handouts in black and white (PDF)

Bladder & Excretory System Handout (PDF)

outline of human head and torso showing digestive and excretory systems and organsSimple black and white image that a child can color to familiarize her/himself with the bladder and excretory system.

Correct Positioning for Sitting on the Toilet
Kids that Go
Simply illustrated poster that illustrates best posture to relax the body and release a full, easy bowel movement.

 

Apps (Available through the App Store unless otherwise noted)

Judy Lynn Software: Toileting: Male, Toileting: Female Child, Toileting: Female Adult ($0.99 each) iPad only
This app has clear animated videos, still images, and interactive sequencing activities. You can print pdfs of the still images, and the sequencing activity is compatible with some switch arrays. This app has a more mature interface, and may be better for older toilet learners.

Potty Training Social Story ($3.99)
Interactive social story customizable for boys or girls. It includes a visual schedule as well as a page of Frequently Asked Questions about toilet learning. Part of the “Self-Care Social Stories” app bundle ($8.99)

Little Star Toilet and Potty Training ($2.99)
Put your child in the starring role! Make photo visual supports and schedules which you can share with preschool/school. Includes tips for toilet learning.

Once Upon a Potty ($1.99)
For younger children. Features simple visuals which may also be appropriate for children with visual impairment. Prudence and Joshua learn about body parts and functions and what the potty is used for. Amusing sound effects, highlighted text, and sing-along potty song.

The New Potty - Little Critter ($1.99)
Join Little Critter's sister in this interactive book as she learns how to use her brand new potty.

Daniel Tiger’s Stop & Go Potty ($2.99)
Interactive app to complete toileting-related routines, including wiping, flushing, washing hands, original Mr. Rogers Neighborhood content on learning toileting, and the Daniel Tiger “Stop and Go Potty” song

Resources for Educators and Clinicians

The Legal Basis for Continence Support in Educational Settings - In Process
This document is under development. UVM Continence Project staff outlines some common roadblocks that caregivers and educators encounter when addressing toileting and continence in the school setting, and the legal basis for addressing continence in the school setting, based on current state and federal education laws and standards.

Profile of Toilet-Learning Skills (PoTS)
UVM Continence Project
This rubric identifies skills required to move towards independent continence and toileting. It can be used to determine a student’s current skills and strengths and to help a team identify goals and responsibilities.
Please contact continence.project@uvm.edu if you are interested in piloting this tool with your team.

Best Practice Tip Sheet for School-Based Providers (PDF)
Deb Sharpe, OTR, ATP

Sample Parental Consent Form for Restroom Assistance (docx)

Specific Topics and Diagnoses

Autism

Applying Structured Teaching Principles to Toilet Training
S. Boswell & D. Gray
Mastery of toileting skills can be challenging for children of all abilities. Many factors (social, medical, environmental, communication, physical, and cognitive) determine how easily toileting skills are learned. Teaching children with Autism Spectrum Disorder requires the development of an individualized program, taking into consideration the child's perspective and utilizing their unique strengths. This article compiles suggestions of teachers and consultants applying the elements of Structured Teaching.

BBB Autism: Toilet Training (PDF)
Gary J. Heffner
This article outlines methods and guidelines for teaching toileting skills to children with Autism. Extensive resource sheet included.

Toilet Training Children with Autism and Related Disorders
Ed Sbardellati, PhD
This page outlines 7 categories important in teaching toileting skills to a child with autism and related disorders. 

 

Cerebral Palsy

Teaching a basic function: Exploring several techniques to use when toilet training children with cerebral palsy
Ginny Paleg, PT
Occupational, physical, and speech-language therapists are often asked to assist classroom staff, caregivers, and families in teaching toileting skills to children with cerebral palsy. Here is a quick guide to how we can help. 

Rifton: Special Needs Toileting
Rifton has a variety of resources to support toileting in persons with special needs, maximizing independence with toileting, and achieving ideal transfers and positioning.

Constipation and Encopresis

Encopresis
University of Virginia Children’s Hospital
A guide to the causes, evidence, and treatment of chronic constipation and encopresis.

What is Encopresis or Functional Constipation?
Dr. Tom Duhamel
This page explains encopresis in simple terms and includes visuals. A helpful "first step."

Bristol Stool Chart (PDF)
An illustrated chart that can help you track and describe the form of your child’s bowel movements, and potentially correlate changes in bowel habits with diet, fluid intake, medications, exercise, and other factors. It is useful for discussing continence concerns with your physician.

Squatty Potties

This stool is considered ideal for allowing for a complete and easy bowel movement. The Squatty Pottymous is meant for the smallest children, and the Adjustable Squatty Potty is better for somewhat taller children and adults.
Squatty Pottymous
Squatty Potty, Adjustable

 

Deafblindness

The Baby with Deafblindness: Program of Care For Parents of the Deafblind Baby with Multiple Disabilities (docx)
Peggy Freeman, MBE
This extensive document describes the process of introducing and progressing with many self-care activities for a child with dual sensory impairment (deafblindness).

 

Down Syndrome

Potty Training and Down Syndrome
Rosellen Reif, MS
A family-/layperson-friendly guide to teaching toileting to a person with Down Syndrome. Can also apply to other diagnoses with cognitive and/or physical delays.

Powers MK, Brown ET, Hogan RM, Martin AD, Ortenberg J, Roth CC. Trends in Toilet Training and Voiding Habits among Children with Down Syndrome. J Urol. 2015;194(3):783-7.
This study examined patterns of continence development in children with Down Syndrome. Major findings include that an average age for completion of toilet learning for children with Down Syndrome is 5.5 years, with a range from 3-12. Almost half of children with Down Syndrome (46%) continue to have incontinence (accidents) after completion of toilet learning (day and/or nighttime). This study was not able to find any patterns that children with Down Syndrome are at greater or lesser risk for lower urinary tract dysfunction or infection. 

Catto-smith AG, Trajanovska M, Taylor RG. Long-term continence in patients with Hirschsprung's disease and Down syndrome. J Gastroenterol Hepatol. 2006;21(4):748-53.
Hirschsprung’s Disease, a bowel disorder, is more common in people with Down Syndrome than in the general population. Persons with both DS and Hirschsprung’s Disease commonly experience bowel incontinence, as well as inconsistent stool consistency. This article suggests there is some evidence that this gets better over time for some children. Food intolerances are very common among this population. 

Toilet Training Children with Down Syndrome (PDF)
Nancy Grace, Psy. Ph.D., Kennedy Krieger Institute
This article is helpful for caregivers and professionals to understand some of the challenges and important supports for teaching toileting to children with DS and other developmental differences.

 

General Toilet Learning Resources

Complete Guide to Special Needs Toilet Training
One Place for Special Needs
This website has a very extensive list of toilet training resources. Listed alphabetically, this site addresses specific topics such as autism, ADHD, deafblindness, cerebral palsy, down syndrome, and more.

Toilet Training for Children with Special Needs (video)
A free, two-hour training video, available online. It provides an overview of practical toilet training techniques and core principles for success. Curriculum developed by Dr. Susan Hepburn, Clinical Psychologist and Associate Professor of Psychiatry at the University of Colorado Denver, JFK Partners is presented as well as vignettes taking viewers through the toilet training process. The DVD concludes with a parent's perspective on the techniques presented and words of wisdom for other parents going through the toilet training process.

Toilet Training Steps for Boys (PDF) & Toilet Training Steps for Girls (PDF)
Continence Foundation of Australia
Includes a checklist of skills, a detailed progression of steps towards continence, and child-friendly visuals. Note: This resource uses European toileting language (eg. “wee”, “nappy”).

Sequential Acquisition of Toilet-Training Skills: A Descriptive Study of Gender and Age Differences in Normal Children
Schrum, T., Kolb, T., McAuliffe, T., Simms, M., Underhill, R., Lewis, M.
Toilet training is a universally acquired skill for normally developing children, yet there is no information about the requisite skills that children learn sequentially, beginning with the signs of readiness and ending with the successful completion of toileting. 

Toilet Training Non-Ambulatory Students (PPT)
Cindy Meyers

Toilet Training Children with Moderate-Severe Disability (PPT)
Dr. Lisa Samson-Fang, MD

Helping Children with Moderate-Profound Cognitive Disability (PPT)
Cindy Meyers