Frequent inquiries from the field about how to support children who need toileting support has prompted the creation of this resource document for schools. Ultimately, a public school district cannot refuse to enroll or serve a child who has toileting needs, nor should there be any punishment associated with soiling, wetting, or not using the toilet. Each School Administrative Unit (SAU) is encouraged to adopt sanitation and hygiene procedures for assisting with toileting and/or diapering that adequately protect the health and safety of all children and staff. The determination of which school personnel within a school setting can be asked to assist with toilet training/toileting support is a local employment and collective bargaining matter.
Transitioning into public school can be a time of trepidation and anxiety for many children and their families. Providing support, understanding, toileting routine, and consistent communication with the family will aid in a child becoming more independent.
Foundational Support
Consider using direct instruction on healthy toileting expectations for school in early elementary grades. Teach the behaviors that are expected; practice and reinforce the behaviors with all students. Establish a classroom routine and practice the routine with all students. Resources for providing direct instruction are included at this end of this document.
Keep in mind that there are cultural differences in how children are toilet trained. Building knowledge and understanding of these cultural differences is important as the expectations of school personnel may not be the same as a child’s family.
Provide visual directions in all bathrooms and stalls.
Targeted Support
Some students may need more targeted intervention in addition to the foundational support provided to all students.
If possible, work with the family to create a home and school plan that acknowledges the goals and desires of both parties regarding the child’s individual development towards independent toileting. A home-school liaison, teacher, school nurse, or representative(s) from an outside agency that is supporting the child may work directly with the parent to develop a plan for toilet training at home and school. If the child attends another out-of-home care setting, in addition to public school, be sure to include all teachers and family providers in the conversation. Build communication between parties as well as regular review to revise a plan that may not be effective.
Depending on the needs of the student, consider the following in building independence:
- Adaptive equipment (PT or OT)
- Visuals or social stories to teach steps in the routine
- Reinforcers (star/sticker chart, screen time, adult 1:1 attention, peer activities, etc.) can help students with the motivation to persist in learning bathroom skills
Communicate with the family to establish whether there are any medical needs or physical limitations involved. If there are medical needs, work with the family using an individual health plan of care to support the child and possibly a 504 plan if indicated.
The parent/legal guardian will need to supply clean clothes, underwear, pull-ups, and diapers (as appropriate).
Sanitation and Safety
Child size toilets or modified toilet seats with step stools are recommended. Potty chairs are not recommended for use in schools.
Children in soiled or wet clothing and/or diapers that require full assistance due to medical condition or disability shall be changed on a washable vinyl table or mat that is cleaned and sanitized after each use or has a disposable single-use cover.
All staff members must wash hands with soap and running water after assisting with toileting and/or diapering.
Any materials used for cleaning/changing (including any diapers and diapering materials) must be discarded in a covered, lined, foot-pedal-operated step can separate from other trash or must be tied up in a separate bag and removed to a covered garbage location.
Toileting and diapering areas shall be separated from areas used for cooking, eating or children’s activities.
Guiding Principles
- Bathroom independence is a fundamental skill for independent living and dignity. We want each student to be as independent as possible in the bathroom.
- Assume that students are capable of learning new skills and routines.
- Adults should model boundaries by telling students when and why they are touching the student’s private areas.
- Assume the student is listening to everything you say.
- Students who are not yet independent in the bathroom may be vulnerable.
- For the protection of both students and staff, it is highly recommended that two adults be present in the bathroom assisting the student with clothing removal, changing, or wiping.
- Consider using a bathroom that is in sight and/or audio vicinity of other adults
- In many early childhood classrooms, the bathroom might have a cloth curtain as a door, or a half-door as opposed to a full closing door.
- Other students should never be involved in the changing routine.
- Staff should protect themselves by using appropriate Personal Protective Equipment.
Toileting in Schools Resources
Autism Adventures: Toilet Training in the Classroom
J of Autism and Developmental Disorders Classroom Based Intensive Toilet Training for Children with Autism Spectrum Disorder
4.21 NY Guidance for Supporting Toilet Learning for Prekindergarten & Kindergarten Students
Bathroom Routine Visual – Indiana University Resource Center for Autism (docx)
Going to the Bathroom Visual – Indiana University Resource Center for Autism (docx)
Going to the Bathroom Step by Step – Indiana University Resource Center for Autism (docx)
Soiling (Encopresis) from Kids Health
U Can Poop Too
The Watson Institute, Toilet Training: Developing a Toileting Routine
Sample Procedure
Consider the environment and what is the least restrictive setting. A student bathroom is more typical/less restrictive than staff bathroom.
If physical transfer of student is necessary, ensure that staff doing transfer have been trained by the Physical Therapist on appropriate transferring procedure.
Have clean clothes available and a bag for wet/soiled clothes.
Waste disposal:
- Disposal should be in a covered can and appropriate bagging that minimizes odor.
- Work with your building custodial engineer to ensure that appropriate trashcan and bags are accessible and being removed from the building on a daily basis.
Personal Care Routine to be developed by a team, which may include OT or PT
Training on Personal Care Routine provided and documented
Basic procedure for full change (Remember, the goal is for the student to take over performing tasks as they are able):
- Inspect the designated changing area and make sure that all of the necessary equipment and supplies are available in the area (i.e., gloves, wipes, etc.)
- Bring student to changing area
- Prepare table/surface where student will be changed by wiping with a sanitized cloth and/or by placing protective paper on the table surface
- Wear appropriate Personal Protective Equipment — gloves (sleeves and apron if necessary)
- Talk to student about what you are doing and why (i.e., “I’m going to use the wipes to clean your buttocks now.”)
- Transfer student to changing table (per PT training) or standing position if able
- Remove soiled diaper and place in a covered waste receptacle
- Clean student using wipes
- Dispose of soiled gloves and put on clean pair of gloves
- Place clean diaper on student
- Transfer student from changing area
- Remove paper and clean surface with wipe
- Wash hands with soap and running water
Procedure developed from NYC United Federation of Teachers Safety and Health Department http://www.uft.org/files/attachments/uft-diapering-toileting-procedure.pdf
References
Maine Department of Education, Public Preschool Toileting Policy. Available from: https://www.maine.gov/doe/learning/earlychildhood/publicpreschool/health
National Resource Center for Health and Safety in Child Care and Early Education,
Caring for Our Children, Chapter 3.2 Hygiene. Available from: https://nrckids.org/CFOC/Database/3
New York City, United Federation of Teachers Safety and Health Department, Para Protocols, Diapering and Toileting. Available from: http://www.uft.org/files/attachments/uft-diapering-toileting-procedure.pdf
Virtual Lab School, Staying Healthy: Diapering and Toileting. Available from: https://www.virtuallabschool.org/infant-toddler/healthy-environments/lesson-3
Virtual Lab School, Changing Soiled Clothing. Available from: https://www.virtuallabschool.org/infant-toddler/healthy-environments/lesson-3/act/14126