Understanding Toilet Training Challenges and How Occupational Therapy Can Help

Toilet training can be a stressful milestone—for both children and parents. While some kids take to it quickly, others face toileting challenges in children that leave families confused and frustrated. Maybe your child refuses to sit on the potty, insists on wearing a diaper even when ready, or won’t pull down their pants. Some children even hide or get upset if they think someone might see them during toileting.

These behaviors can feel overwhelming, but they often point to deeper sensory, motor, or emotional challenges. In this blog, we’ll explore the most common toileting challenges in children and how occupational therapy (OT) can support your child’s success in this important daily life skill.

1. Common Toileting Challenges in Children (and Why They Happen)

Let’s look at some real-life scenarios you might recognize:

• “My child hates the potty.”
  Some children resist sitting on the potty because it feels strange or cold, or they’re scared of falling in. Others don’t like the sound of flushing or the idea of using a toilet altogether.
• “They won’t sit long enough to go.”
  A child might be too distracted, hyperactive, or anxious to stay seated. They may jump up after a few seconds or avoid the bathroom altogether.
• “They won’t remove their pants.”
  Some children don’t like the feeling of being exposed or don’t understand how to manage their clothes. For others, tight clothing or unfamiliar routines may cause distress.
• “They hide when they need to go.”
  This is often a sign that a child is aware of the need but feels embarrassed or doesn’t want others to see them in that vulnerable moment.

These challenges are common and can happen for many reasons—none of which are your fault or your child’s. (For more guidance on real-life potty training difficulties, visit the American Academy of Pediatrics’ guide on toilet training problems.) The key is to understand what’s behind the behavior.

2. Sensory Issues and Toileting

Children with sensory processing challenges may be uncomfortable with:

• The coldness or hardness of the potty seat
• The loud flushing sound
• The feeling of wiping, or wearing certain undergarments
• The smell or brightness of the bathroom

Some children find sitting on the toilet too overstimulating—or not stimulating enough—and they either resist or get up quickly.

OT Solutions:
Occupational therapists can help by:

• Using sensory-friendly potty seats (padded, warm, familiar)
• Offering noise-canceling tools or preparing the child for the flush sound
• Creating a calm, sensory-friendly bathroom setup
• Introducing toileting gradually, through play and visual routines

3. Motor Challenges

Toileting isn’t just about knowing when to go—it involves coordination and independence:

• Pulling pants down and up
• Sitting steadily on the toilet
• Managing balance while wiping
• Using toilet paper or washing hands afterward

If a child has poor balance, low core strength, or weak hand skills, these tasks can be very frustrating.

OT Solutions:
OTs work on:

• Practicing dressing skills during non-bathroom play times
• Using adaptive clothing like elastic waistbands
• Teaching hand-over-hand techniques for wiping or flushing
• Recommending footrests or toilet inserts for better sitting posture

4. Cognitive and Emotional Challenges

Some children struggle with the routine or idea of toileting. They may:

• Forget the steps or get confused
• Resist change or cling to the comfort of diapers
• Feel anxious about accidents or getting dirty
• Be embarrassed about being seen using the toilet

OT Solutions:
Occupational therapists may introduce:

• Visual schedules to help kids learn each step
• Social stories to normalize toileting in a child-friendly way
• Reward systems to build positive associations
• Tips for creating privacy and respecting the child’s comfort

5. Creating a Supportive Environment

Every child is different. and toileting challenges in children don’t have a one-size-fits-all solution. That’s where OT can be so valuable—helping families create routines that suit their child’s unique needs.

OTs also guide parents on:

• Reading toileting cues
• Setting realistic expectations
• Staying calm and consistent
• Avoiding pressure or punishment

In Summary

Toileting is a big milestone that involves many skills—body awareness, sensory tolerance, motor coordination, emotional readiness, and independence. If your child is facing toileting challenges in children, you’re not alone. With the right guidance and support, especially from an occupational therapist, your child can move toward successful and stress-free toileting at their own pace.