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Key points

Rubinstein-Taybi syndrome Readiness for Toilet training Charlotte Mawby Independent Paediatric Continence Nurse May 2016 charlotte.mawby@outlook.com. Key points. Assessment : Is your child ready Plan: Toileting program Support: child – family – staff Referral: if required.

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Key points

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  1. Rubinstein-Taybi syndromeReadiness for Toilet trainingCharlotte MawbyIndependent Paediatric Continence NurseMay 2016charlotte.mawby@outlook.com

  2. Key points Assessment : Is your child ready Plan: Toileting program Support: child – family – staff Referral: if required

  3. Skills not disability

  4. What is normal usual age a child gains control Control of bowel asleep ~ 1 yr Control of bowel awake ~ 2 yrs ? Control of bladder awake ~ 3 yrs Control of bladder asleep ~ 5 yrs

  5. Habit trained or toilet regulated (Clean and dry when supported by adult) Uses the toilet when taken but does not indicate or request to use it Usually develops later into independent toileting (inline with other developmental milestones)

  6. Why some children struggle 1-2% have an underlying organic cause Limitation due to Physical / Learning abilities Healthy bladder & bowels Equipment Realistic expectations Appropriate teaching resources Offer toilet training support Behaviours & Compliance

  7. Anatomy rectal and anal sphincter Empty

  8. Anatomy rectal and anal sphincter During defecation

  9. Anal sphincter mechanism during defecation

  10. Drinkinghabits in children Often limited fluid intake at breakfast Little or no fluid taken during school day Fluid intake on return home until going to bed: reduced daytime opportunities to practice toileting skills very wet night nappy

  11. Daily intake

  12. Healthy Bowels Normal type 4 ~ 3 3 x a day to 3 x a week • what type • how often • Size – Diameter  4.5 cm • pain, distress • toilet, nappy, pants • pants: clean ~ soiled • medication

  13. Colon – mega colon‘diameter of stool’

  14. www.promocon.co.uk in section publications

  15. 5 pointToilet training readiness assessment • Ability to sit on the potty / toilet appropriately • Bladder to hold wee for at least 1 hour • Bowel that is not constipated • Some awareness of being wet • Some awareness of what toilet training is about Ref: Continence promotion for children with learning difficulties. J Rogers. (Shiloh healthcare)

  16. abilities / skills • mobility • dressing / undressing skills • response to basic commands • indicates needs ~ favourite dvd, books, foods, soiled, wet • any appropriate use of potty / toilet • abilities can be hampered by behavioural issues

  17. Equipment

  18. Equipment

  19. Specialist equipment Smirthwaite Rifton: HTS Rifton: Blue wave

  20. www.radar.org.uk Radar key www.changing-places.org Accessible toilets

  21. Complexities of toilet training Carer to understand / predict child’s needs Developing self help skills: door opening removing & replacing clothing getting on / off the toilet toilet sitting (1 minute for each year of age Max. 10) use of toilet paper flushing toilet wash and dry hands Keep the boys sitting until bladder & bowel routine is established

  22. Advice • Appropriate fluid intake • Routine: take to toilet at • regular intervals (5-6 x a day) • Sit & relax – bottom on toilet • seat, in order to perform • Extra sitting time after meals • to encourage bowel action • Don’t rush, wait until finished

  23. Disposable Nappy: Slip: Form Pants: pull ups Comfort: Flex Tena 4 men

  24. rewards

  25. Bottom wiping Teach hand over hand wiping

  26. Washable productsCudri : Abena : Ganmill

  27. Swim wear Incy wincy Ltd In-confidence PHP baby ERIC

  28. Toileting behaviours • Constipation  • Poos in nappy or pants • In the play ground, behind the sofa • Smearing in nappy, pants, wall • Where are soiled nappies / pants changed • Lying down / standing up • Regular toilet sitting for boys & girls • Early intervention - to change behaviour patterns • Child to stay in bathroom until routine is complete, assisting with bottom wiping, flushing, hand washing

  29. Consistency - Behaviours • Regular toilet sitting • 1 minute for each year maximum 10 minutes • Child must understand desired behaviour • Reward desired behaviour: sitting > performing • Give praise/ reward - desired behaviour • Agree a reward system - keep it simple • Make it fun

  30. Targets • Communication - verbal & pictorial prompt • Child to go into toilet area / cubicle • Assist with removal of clothes • Getting on / off toilet • Appropriate toilet sitting • Bottom wiping • Assist with replacement of clothes • Hand washing

  31. Working towards success Include toileting into the Childs Individual Education Plan / Statements Resources to aid communication Aids for safety & comfort when using a toilet Access into and onto the toilet Agreed & written ‘care plan’ – all care settings Agree use of appropriate products: washable ~ disposable

  32. Facilitating toileting program • Ensure: Healthy bladder & bowels • Appropriate equipment. Provision & usage • Written information, helps ensure consistency in all care settings • Support for training in all care settings • On going support, assessment & planning

  33. Toileting Plan - 1 Agree- routine – regular toilet sits • getting up • arrival at school • mid morning • before / after lunch • before home time • before evening meal • before bath / bed

  34. Toileting Plan - 2 • Agree communication: spoken, signing, PECs, visual timetable, talking photo album • Warning time – prior to • Visualisation of sitting time – egg timer • How sitting time will be increased • Reward: verbal – item – object

  35. Gauging success • How many wet – soils per day • Any reduction/increase in wet or soiled clothes • Indicates when wet / soiled • Can stop & start - in pants on toilet • Change in bowel routine • Ability to learn v behavioural issues • Won’t sit, won’t wear pants, won’t ………

  36. Any questions ?

  37. Additional support ERIC 0845 370 8008 • Help line: Education and resources for improving childhood continence Promocon 0161 834 2001 • Promoting Continence and product awareness

  38. Resources • Education and Resources for Improving Childhood Continence www.eric.org.uk product catalogue • Bedwetting: a guide for parents. ERIC • www.wateriscoolinschool.org.uk • www.bog-standard.org www.standards.dcsf.gov.uk/eyfs/resources/downloads/including_me.pdfIncluding me

  39. Resources www.promocon.co.uk/talkaboutpotty.pdf(Rogers.J. 2007) www.promocon.co.uk/talkabouttoilet.pdf(Rogers.J. 2004) www.promocon.co.uk/talkaboutdaytime.pdf(Rogers.J. 2005) www.promocon.co.uk/talkaboutconstipation.pdf(Rogers.J. 2004) www.promocon.co.uk/Talkaboutbedwetting.pdf(Rogers.J. 2004)

  40. Resources Books My very own potty time –girls / boys Big girls / boys use the potty The potty book for boys Potty time training pack DVD Bear in the big blue house Sesame street: Elmo’s potty time Potty power I gota go!

  41. Name Class Teacher Drinks 9 :00 : 10:40: 12:20 14:40 Arrival at school : Break : after lunch : before home Equipment Targets Communication - verbal & pictorial prompt Child to go into toilet area / cubicle Assist with removal of clothes Getting on / off toilet Appropriate toilet sitting Bottom wiping Assist with replacement of clothes Hand washing Record - toilet activity / progress

  42. Name Class Teacher Drinks Equipment Behaviours in toilet area Behaviours when pads are changed Concerns about introduction of toileting program Record - toilet activity / progress

  43. One step at a time A parents guide to toilet skills for children with special needs Continence Foundation of Australia http://www.continencevictoria.org.au/resources/children/

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