For children with either low muscle tone or spasticity, toilet training can be a real challenge. If it isn’t clothing management or making it to the potty on time, they can have a hard time perceiving that NOW is the time to start heading to the toilet.
Why? Often, their interoception isn’t terrific. What is interoception? Think of it like proprioception, but internal. It’s the ability to identify and interpret sensory information coming from organs and internal tissues. Among them, the pressure of a full bladder or a full colon. If you can’t feel and interpret sensation correctly, your only clue that you need the potty is when your pants are soiled. Uh-oh. A child with muscle tone issues is almost certainly going to have sensory issues. Tone will affect the amount and quality of sensory feedback from their body. When a child is sitting, interoceptive signaling from abdominal wall and bladder wall mechanoreceptors is diminished. This means that a child has to have more awareness and more active attention to feel elimination urgency. The truth? They would rather keep playing Roblox.
It’s a nerve thing. Sitting on the pudendal nerve in their pelvis will attenuate (diminish) signals from the bladder that it is full and they need to pee. Standing up takes the pressure off that nerve and heightens awareness. OOPS!
What can you do to help kids? The simplest, and the fastest solution I have found, is to tell them to stand up and see if they have changed their mind. Why? Because in a sitting position, the force of a full bladder or colon on the abdominal wall and the pelvic floor isn’t as intense. Gravity and intra-abdominal pressure increase those sensations in standing. More sensation can lead to more awareness.
So the next time your child tells you they don’t have to “go”, ask them to stand up and reconsider their opinion. Now, if they are trying to watch a show or play a game, you aren’t going to get very far. So make sure that they don’t have any competition for their attention!
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