We continue with the points that we have left to present from the last Webinar on the "potty training" that Cristina did for the great community that we form in VICON Method . We remind you, just in case, that you have the full video on our Facebook profile, as we told you. Today, again, Goodbye diapers for non-verbal children.

You have here the first part, to remember that we are left at point 12. The one that refers to some aids that we can use to make the moment easier for us. So that you can understand the following points that we tell you.

13. LEAKS OUT OF THE BATHROOM

If they do it , they should not be scolded, punished, or produce any moment of stress . Even though it may seem incredible, we have to say “pee” teaching them to identify what they are doing and little by little accompany them to the bathroom, even if we then have to clean the entire bathroom. path. We will proceed with the sit-in as if it were incidental but look at these opportunities for what they are, moments in which they will be able to know what pipi means first-hand, the best way to learn that they have and with the appropriate accompaniment and without punishments or alterations on our part. We involve the child in changing clothes so that they really begin to be aware that it is worth asking to pee or going to do it rather than wasting all that time cleaning and changing.

14. BOY ALSO SITTING

It is also very important to point out that it is recommended that children learn this habit while sitting , because later it will help us with the defecation or pooping process. If we do not tend to have children who poop standing up, because do not forget that we have very literal children and it is difficult for them to make changes in learning once internalized, so by saving a few steps and intermediate learning we will help our children learn this habit sitting down. . We will even use their hand to lower the penis and have them hold it themselves so that they do not get used to us being the ones who have to do the holding for them.

15. FIRST IS THE URINE, AND THEN, THE FECES.

Pee sphincter control is not the same as poop sphincter control, apart from the fact that they are different muscles, we return again to the reflection from before peeing so that it comes out we have to relax but when we talk about poop there is a chain of muscles that help us push and poop. And there I would like to go into a very important point: we have to control our children's constipation so that this process is as smooth and relaxed as possible . If our child does not have problems going to the bathroom, it is important that the diet does not vary in time or quantity, that it is abundant in liquids, and that if you choose to introduce feces as well, you include vegetables or foods that encourage going to the bathroom properly, such as seeds. linen, aloe vera... without the little one applying pressure, but in any case, you must understand that you have to give him time to understand the dynamics, and that due to repetition, it is easier for him to understand peeing first. A child who is in a controlled process of defecation should go to the bathroom once or twice a day. The same thing can happen to us with diarrhea and being able to rule out food intolerances and be able to control that edification before this adaptation process when going to the bathroom because otherwise there are variables that are playing against us and we have to have everything in our families' favor.

First we will attend to everything related to controlling the urinary sphincters of peeing and then move on to the defecation process.

When we talk about defecation and sometimes we have much more fixed schedules. When should we take it ? Well, about 10 minutes before the estimated time to evacuate (that is, if he usually poops at 11:30, around 11:20 a.m.) so that we give him time to relax. It is also advisable to put down some paper before peeing and/or defecating , since some children get scared when they hear feces falling or when they come into contact with splashing water.

16. CONSTIPATION

But what happens when there is no regularity in defecation, when we have the famous Constipation.

It is important to try to prevent and treat this constipation. We must make it easier for the child to poop: if he asks for a diaper, we put it on him; If he does it on himself, far from scolding him, we treat him naturally, exactly the same as with peeing. It is important to follow a diet rich in fiber (legumes, whole grain or fiber crackers and macaroni, fruits and vegetables...) and perhaps drink a little more water, but when the problem is established, it will probably not be enough. In case of a specific problem, if you haven't done anything for three days, a glycerin suppository may be useful. But if we have to resort to the suppository too frequently, it is better to administer a laxative every day. Whatever your pediatrician prescribes, which will usually be a safe, non-irritating laxative. Some children need to take laxatives for months to achieve a daily or almost daily bowel movement without effort.

An extreme case is Encopresis…

Sometimes a large mass of dry poop, a fecaloma, forms, which never comes out (or, when it comes out, a new one has already formed). Fecaloma irritates the rectal mucosa, which reacts by producing mucus that comes out mixed with a little liquid poop. The child leaks it, does it on himself, and parents may believe that he has diarrhea, when in reality it is serious constipation. The rectum must be completely evacuated, normally with enemas – not homemade, but following the pediatrician's recommendations – because suppositories are no longer effective when the rectum is dilated.

17. TOUCHING..

Sometimes we find children who tend to touch themselves during those moments of going to the bathroom, it is very natural when we discover parts that are normally hidden and that process of discovery appears, so let's try not to add another task to this process and treat it with naturalness. Also keep in mind that when the penis is erect there are more difficulties peeing so these are aspects that must be taken into account when subtly redirecting these behaviors. We also come across children who tend to put their finger in their butt and we begin to see that on many of those occasions they are symptoms of constipation, where the end of the anus is drier, and produces itching, so keep in mind to put creams, oils and control the whole issue of constipation in your children again so that we do not have an added problem that way.

Summing up... We understand what the muscles are like, that we need adequate and developed muscle tone, that the activity has to be relaxing and pay attention to the indicators, we also have to transmit that relaxation to help relax and produce that moment of urine release, that the moment of habituation to the bathroom has to be assumed, that we have some aids such as water, such as relaxation exercises and that we have to help with waiting times. That we do not have the same processes in controlling pee and poop and that they come at different times so we will first attend to the pee and meanwhile we will look at all the added problems in defecation.

18. POTTY YES, POTTY NO

Taking into account the generalization difficulties that our children with autism have, with communication difficulties going to the potty can lengthen the time we have to undertake the process of peeing in the toilet. Doing it with the potty anywhere is not adequately teaching you where these activities are done.

There are only some specific cases in which we recommend introducing the urinal. When we find rigid children who have selected, who have identified a specific place in the house, behind the sofa, behind the door to always pee, we can use in those cases the potty positioned in that favorite place to develop the skill there. and then be able to little by little bring her to the bathroom. Also in cases where there is a phobia of the bathroom, only in these cases is when we recommend the use of the urinal, when rigidity at a spatial level, when children have fear or phobia of the bathroom is when we recommend taking an intermediate step because we have an added difficulty and it is not possible to work on everything at the same time, always seeking that relaxation for the child.

19. FIRST DAY AND THEN NIGHT

It is not advisable to remove the day diaper and the night diaper at the same time , they are different processes and we consider it more appropriate to remove the day diaper first and once two weeks have passed without leaks during the day, and looking at indicators, try to remove the diaper during the night. Physical exercise and continuing the process of drinking water is very important, not just before going to bed but during the day.

Some indication that could tell us that he is ready to leave the diaper at night is if the diaper appears dry some night or even a large majority of nights . It is important because otherwise it will mean cutting off sleep to constantly go to the bathroom and you need to rest and be relaxed. Here it is important and helpful to keep a record , hence the most advisable periods for this are vacations, since our sleep as adults can be altered.

AND WHAT HAPPENS WITH ENURESIS?
The definition of nocturnal enuresis is “wetting the bed at least twice a week, after five.” That is, before the age of five, or when it only occurs once a week, it is neither enuresis nor anything.

Most children manage to fully control their peeing and pooping by the age of three/four, although until a few years later they may occasionally leak urine in moments of stress or confusion. If you wet the bed before the age of five, or only once a week, it is not considered enuresis. Many manage to control urine at night almost at the same time as during the day. But many others take several years. Let us keep in mind that this process is that of a typical child and we have a very different reality, generally associated with an immaturity of both language and communication as well as at a physiological level, and sometimes we do not have these difficulties and our children control this perfectly. ability but it is very normal for these natural or typical processes to extend over time in cases with disabilities, I think that is the reason why you are all here with me today.

Why does my child still wet the bed? In reality, enuresis is normal. Some children simply take longer than others. There is usually a hereditary component. The child does not do it on purpose, nor for convenience, nor for lack of interest, but because he cannot avoid it. You should never ridicule him. Some drugs have been used to treat enuresis; Its effectiveness is not wonderful either. I would not use a medication with possible side effects for such a minor “problem.” Nowadays, any store sells diapers for children of any age. This has helped many children and adolescents realize that they are far from the only ones who wet the bed.

20. PHOBIAS/FEARS

We have talked before... that toilet training is a challenge that often associates various problems ( matural delay, nocturnal enuresis, and refusal to use the toilet) and temporary setbacks associated with various events in children's lives (conflicts). family such as a divorce, the birth of a sibling, a move...etc). Both of them are a normal part of the training process and their appearance in your children does not constitute a failure.

But in the event that phobias or fears are detected, we try to work on them outside of these bath/toilet moments in much more controlled moments, moments in which he will be more receptive. Normally, working with phobias and fears are not usually overcome when they are worked on at the same moment they happen, but rather in more controlled moments where a posterior visualization of the moment is provoked when we are more relaxed and relaxed.

21. CONGRATULATIONS WITH MEASURE

As for praise, we must also measure our positive reactions. An overly effusive reaction can put pressure on our child to want to do things well that is totally unnecessary. It is also important that the family's life does not revolve around toilet time, that it is not a continuous topic of conversation, that it is not the first thing that grandparents and uncles ask when they see the child. You can congratulate him on his progress, but without going overboard, do not turn it into a kind of rite of passage, avoid phrases like: “Now you are a big boy.”

The more exaggerated the congratulations, the more painful the failure will be if it occurs. The more fabulous success is represented to us, the more painful failure is; and “failures” in this process are going to be inevitable and frequent. So I also tell you more... Don't be afraid to go back. If you start and feel that it is not your child's time, it is okay to put diapers on him again. Your time will come, and with patience and love it will come in a non-traumatic way. If there haven't been high expectations, you probably won't care.

22. COMMON BEHAVIORS AND WITHIN THE DEVELOPMENT PATTERN

At this time, children do strange things that should not be laughed at or scolded for.

• Some warn right after doing it to themselves.
• Others do it on the floor, right next to the urinal.
• Many hide to poop, for example behind a curtain, with or without a diaper (they know perfectly well that they are going to poop, it's not that they "escaped". But it's one thing to know that you're going to poop, and another thing. is to do it in the toilet). Many, I don't know why, have the habit of rolling themselves inside the curtain.
• Others, for a while, need a diaper to pee or poop. Some children, being on the beach naked, demand a diaper because otherwise they can't pee.
• Others believe for months or years that they have to ask permission to go to the bathroom every time they pee.

In any case, always remember that you are not doing it to be annoying... and that there is very little left. And when we find ourselves with really rigid children it is very important to give them a lot of time and even if we have not yet achieved sphincter control, limit always changing the diaper in the bathroom to at least work at a spatial and habit level on familiarization with the around. Keep in mind that all children end up acquiring the habit of going to the bathroom unless there are associated physical problems, we always manage to remove the diaper even if there are communication problems sooner or later.

Summarizing and recapitulating both posts on this blog. We are very clear about how this process of sphincter control, peeing and pooping, day and night, associated problems that we have to take into account, support that we can give in parallel or at the moment, the schedules and the routines that will help us achieve it, all the concrete communication that we have to implement, the visual supports that will help us in each of the spaces to understand all the routines, and be introduced to routines step by step, how we have to do that program of rewards, measured without generating too many expectations, assuming failures and going back if necessary, the entire system of records that can help us understand what our child is like and even generalize this skill in different bathrooms.

That we have to do it as a team, family, school and therapists and with coherent decisions focused on the child and his moment , on his abilities and his needs, not ours.

With these entries of Goodbye diapers for non-verbal children on the VICON Method blog we hope that you have been able to make clear aspects and that you have resonated with some of the parties and that you have really wanted to do it but in a relaxed and respectful way with your little ones .

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Thank you for always joining us… Now, what will the next webinar be? What would you like us to talk about?