How Do I Potty Train a Child with Prenatal Substance Exposure?

Parents and caregivers raising kids with prenatal substance exposure often express concerns about potty training their children. Every child is different, and even their peers with similar types and degrees of prenatal exposure to alcohol and drugs may have widely varied symptoms that can contribute to challenges or delays in potty training.

Why Kids with Prenatal Substance Exposure May Struggle to Potty Train

When a child comes to the typical potty-training age or stage but also has a history of prenatal substance exposure to alcohol or drugs, they may struggle to develop the necessary skills to learn and maintain their toileting habits.

Kids who were prenatally exposed may have some or all of the following impacts that, in turn, may impact their potty-training experience:

• Sensory issues – over-stimulated or under-responsive to stimuli
• Difficulty with change, transition, or new experiences
• Gross and fine motor delays
• Speech/language and cognitive delays
• Balance and coordination challenges (as toddlers)
• On target for some developmental milestones but well below for others
• Extremes in “on” days and “off” days
• Memory retention challenges
• Difficulty retaining skills already mastered
• Struggles to learn from their mistakes
• Attention differences, hyperactive, impulsive
• Executive function delays (organizing, planning, understanding abstract concepts, completing tasks)

A child with prenatal exposure doesn’t just have an occasional bad day. They display a cluster of signs, and their challenging behaviors occur in frequency, intensity, and duration. They don’t exhibit these symptoms only occasionally. Therefore, consistency and continual skill-building, like recognizing the need to go, remembering where to go, and attending to hygiene, can all be quite difficult for these kids.

How Do I Know My Child Is Ready for Potty Training?

It’s normal for kids with prenatal exposure to have more problems with potty training. Whether your child has known or suspected exposure, whether you have a diagnosis or not, you must consider your child’s stage and ability, not their chronological age.

The good news is that the signs of potty-training readiness for a child with prenatal substance exposure are the same as the signs for a typically developing peer. You might just be tackling the milestone later when they are developmentally ready.

The Signs of Potty-Training Readiness

Ask yourself these six questions to help you gauge your child’s readiness to be potty trained. If you are unsure of your ability to assess honestly or accurately, ask for your pediatrician’s or occupational therapist’s input.

1. Is your child aware of the difference between being wet and being dry?
2. Can they stay dry for at least two hours at a time?
3. Can they sense when he needs to urinate or have a bowel movement?
4. Can they reach the toilet or potty in time (perhaps with your help)?
5. Can they undress and dress themselves, or are they ready to learn?
6. Are they motivated at some level to take this next step?

Understanding Prenatal Exposure to Alcohol and Drugs

The How-To’s for Potty Training a Child with Prenatal Substance Exposure

Regardless of your child’s age, only when you can answer yes to all or most of the six readiness questions are you ready to start the process of potty training. Remember that potty training this child should not be compared to other children’s progress, even if you’ve successfully trained several other kids. Potty training this child may take longer and have more instances of stopping and starting, regressing, or other challenges to success.

Here are a few strategies to try, including input from some experienced parents in our online support community:

Record the child’s habits.

While your child is still wearing diapers or pull-ups, keep a journal. Track their habits on a schedule every fifteen to thirty minutes for 3 to 5 days.

Record what you find in their diaper (wet/dry/bowel movement). The more frequently and consistently you check, the more accurate your records will be.

Compile the data.

Chart all the information you collected onto one page to see the most likely times your child will pee or poop naturally. It can be as simple as a list of tally marks by hour of the day. Understanding their natural habits without the interventions of potty reminders will help you encourage them to try and go when it’s most likely already going to happen.

Lose the diapers and pull-ups. 

Based on the information you’ve collected, help your child go to the potty about five minutes before their most likely time to pee or poop.

Start by praising them each time they successfully get on the potty. Move quickly to also praising and rewarding any time they pee or poop. Don’t show any signs of anger, frustration, or disappointment when they don’t go.

Use visual prompts.

Create a visual schedule of their potty routine in the bathroom your child uses most frequently. You can find some examples here, courtesy of the Autism Little Learners resource site.

You should also consider visual rewards you can add to the schedule, like stickers or stars with pencil or dry-erase markers on the chart. The immediate gratification of a reward boosts their interest and engagement in the process.

A potty watch may work for some kids as another visual reminder.

Yet another visual prompt can be sign language for “wet,” “dry,” “need to go,” etc. These prompts are particularly helpful for our kids who have delayed language skills.

Teach them how to clean themselves up.

Any time your child has an accident outside the toilet, teach them to clean themselves up. Take it step by step and help them learn how to rinse out soiled clothes and put them in the wash. Be patient and consistent when teaching them these tasks.

Once clean-up from an accident is complete, have your child walk through the steps to their regular potty routine three times, even if they no longer need to use the potty. You are helping them build memory skills when you do so. You can make it fun and interactive, so they don’t resent the repetition.

When the three-times repetition is done, they should return to their regularly scheduled potty time.

Consider the obstacles to your child’s success.

Observe your child and consider what might be getting in the way of learning the necessary skills to succeed with potty training.

For example:

• Are they frightened of the sound of the flushing toilet?
• Maybe they are uncomfortable with the cold feeling of the toilet seat on their bottom.
• Some kids with sensory challenges might struggle with the smells of urine or bowel movements.

Consider how you can adapt their environment to support their fears, sensory challenges, or other discomforts.

Prioritize connection and positivity.

Do all you can to preserve and keep building your connection. Find fun ways to spend the time you sit with them while they do their business. Create songs or rhymes to help them remember the steps of their process.

Try to maintain reasonable expectations for yourself and this child so you can patiently and positively guide them to gain the success you know they can achieve with potty training.

4 Parenting Disciplines for Raising a Child with Prenatal Exposure

Be Patient, Consistent, and Methodical

Consider teaching your child these strategies one at a time, as each requires several mini processes. Remembering them all in order can be a lot for your child!

For example, it may be unrealistic to expect your child to learn to signal or announce their need to use the toilet, pull down their pants, use the potty, wipe their bottom, and wash their hands all at once. Again, remember that accomplishing the milestone of potty training a child with prenatal substance exposure will look quite different from how it does for this child’s typically developing peers. 

Potty training your child with prenatal substance exposure will take patience, consistency, and repetition over a longer, extended period to gain mastery. It might take several months to as long as a year. As challenging as that may be for you to consider, recognize how difficult it may be for your child. Your patience and can-do attitude will maintain your connection and instill confidence and a sense of capability in your child that can transfer to other life skills they learn along the way.

{This article is the first in a two-part series about potty training kids impacted by trauma, prenatal substance exposure, neurodiversity, or learning challenges. Part 2 is here.}

Image Credits: Elina Fairytale; Keira Burton; Towfiqu barbhuiya