Toilet Training Your Child with Down syndrome

Step 1: Determining A Child’s Readiness

Many parents are eager to start a toilet training program for their children. However, some parents may be ready to start before their children are ready. Starting before a child displays the necessary readiness signs will most likely increase the amount of time it takes for the child to learn this skill as well as decrease the amount of success the child experiences. Starting too early can also lead to other problems, such as an increase in undesirable behaviors related to toilet training and high frustration levels in the parent. To ease the toilet training process and ensure that it is a positive experience for everyone involved, it is recommended that parents assess their child’s toilet readiness skills. Important signals of readiness are as follows:

  1. Age – The child has reached an appropriate age. It is recommended to wait until after the second birthday to begin considering toilet training. For children with Down syndrome, it has been found beneficial to wait until after the third birthday to begin the process. While age is an important component of readiness, parents should consider other factors as well when considering toilet training.
  2. Bladder Control – The child completely empties his or her bladder when voiding and remains dry for at least one and one half hours during the day.
  3. Predictable Stooling Patterns – The child’s bowel movements follow a regular and predictable pattern.
  4. Motor Skills – The child demonstrates the abilities to walk to and from the bathroom independently and to pick up objects.
  5. Behavior – The child can sit on the toilet (or potty chair) comfortably for two to five minutes. He or she may be allowed to look at preferred books or play with preferred toys while sitting on the toilet.
  6. Instructional Readiness – The child can follow a few simple directions (e.g. sit down).
  7. Indicates Needs – Through facial expressions, postures, gestures, pictures or words, the child indicates needing to go to the bathroom.

Step 2: Determining Your Readiness

Before starting a toilet training program, parents need to be ready to dedicate time and effort to implement an effective program. If their child displays the necessary readiness signs but their own schedules do not allow them the amount of time needed to take their child to the bathroom on a consistent schedule every day, they may want to consider waiting to start until their schedules allow time.

Below is a form to help parents assess their child’s bladder control, ability to demonstrate a need to go, and voiding pattern. Every 30 to 60 minutes, parents should check their child’s diaper. They can then place a check mark in each corresponding time slot that the child indicated a need to go. They should keep the data for two weeks. If, at the completion of two weeks, the chart shows that their child consistently remained dry for at least one and one half hours, consistently indicated a need to go, and displayed a voiding pattern, then the child may be ready for toilet training. If after two weeks, the data show that the child does not display the necessary skills, parents can decide to continue taking data or to stop and restart at a later date. Click here for a Data Collection Checklist you can print.

Step 3:  Get set, go!

  1. Your days should look like this:  Wake up, take off wet diaper, go to the bathroom. Put on big boy underwear or big girl panties.
  2. Go to the bathroom when you anticipate need to urinate or to stool. (Refer to your Toilet Training Readiness Data Sheet.)
  3. Make it fun!  Allow your child to read a favorite book or play with a favorite toy while sitting on the toilet.
  4. Use a visual schedule to reinforce verbal directions to child.
  5. Use a reinforcer.
  6. Change your reinforcers from time to time.

Visual Schedules can be used to teach/remind your child the steps to take.  Here’s an example of a Visual Schedule you can print and use with your child.


NDSS thanks Karen Summar, MD for providing this information.


Toliet Training Tips/Advice from Parents

There is no magic potty training formula that will work for all children with Down syndrome.  Parents will have to try a variety of methods and reinforce what has been learned.   Don’t give up and have LOTS of patience!

  • Once toilet training starts, always change your child in the bathroom so they will make the connection between eliminating and the bathroom.
  • Put underwear on your child under the pull-up so that the child “feels” wet. The pull-ups or diapers pull away all the moisture making it hard for a child to feel the sensation of wet next to their skin.  Talk about the difference between “wet” and “dry”.  Emphasize staying dry.
  • Children love to look at pictures of themselves. Create a going potty story using pictures of your child. You can use Word or something similar to put a picture and the steps on each page with a short instruction under it.  Read the story regularly and especially after they have had an accident.
  • Hang a laminated sheet with the steps with pictures in the bathroom as a reminder.
  • Create a short video of your child using the bathroom and let them watch it regularly.
  • Show your child where the bathroom is at each new place you go – family or friends home, restaurant, store, etc.
  • Keep an entire change of clothes (even socks, shoes and wipes) with you for SEVERAL months.
  • Use a reward for trying or successfully using the toilet. Something tangible is better than checklist.  Some ideas are a small piece of candy, gold fish cracker, bubbles, stamp their hand, etc.
  • If your child has an accident, have them help as much as is possible with the natural consequences (remove wet clothing, wipe skin, put on dry clothing, take wet clothes to the laundry area). This should not be fun for the child in hopes that they realize it is just easier to stop what they are doing and go to the bathroom.
  • If the child just won’t stop what they are doing to go, you may need to restrict access to whatever the child was doing when they had the accident (if he/she was watching TV, didn’t stop to go potty and had an accident, then no TV for xx minutes).
  • Keep a special book that they can only have access to in the bathroom.
  • Put your child in fairly loose pants/shorts so they can more easily pull them down.
  • Our OT did a great job of helping us focus on developing a clear routine around toileting very early, rewarding any behavior she could do herself, and focus on the routine rather than success with toileting. We have tried lots of lots of different ideas and tools, but I think that this excellent advice was the most helpful. And being patient, very patient.
  • Buy a doll that has its own potty chair. Keep the doll potty chair in the bathroom as well. The doll can “go potty” while the child does.

Articles Online

From the National Down Syndrome Society

Written by: Vanderbilt Kennedy Center

Title: Toilet Training Children with Developmental Delays

Potty Training a Child with Special Needs

Facebook Group (Down Syndrome Potty Training):


Books in the DSAGSL Library

(can be checked out for a period of 6 weeks – call to see if available)

The No-Cry Potty Training Solution by Elizabeth Pantley

Toilet Training in Less Than a Day by Nathan H. Azrin and Richard M. Foxx

Toilet Training Persons with Developmental Disabilities by Nathan H. Azrin and Richard M. Foxx

Toilet Training for Individuals with Autism and Other Developmental Issues by Maria Wheeler


Books on Amazon

Toilet Training Success: A Guide for Teaching Individuals with Developmental Disabilities


See Me Potty