Toileting Issues and
Toilet Training for parents

Whether you're just getting started with the potty, wondering why progress has stalled, or looking for support with constipation or bedwetting - you're in the right place. Our free Pants4School programme has helped over a thousand families get their child with Down syndrome out of nappies and into pants. We're here to help you do the same.

You don't have to wait!

Many parents are told to “wait until your child is ready.” But there’s no evidence base for waiting and for children with Down syndrome, early action makes a real difference.

Children with Down syndrome need the skills for toilet training to be broken down and taught step by step. Those skills don’t tend to come naturally, but they can generally be learned.  Parents frequently share that the earlier you begin gently building these skills, the easier the overall journey can be.
 
You can begin from as early as six to nine months old at the same time as weaning. If your child is older, don’t worry. It is never too late to start.

"We've supported and  enabled  children as young as 19  months and as old as 12 years to  be able to stop wearing daytime nappies and go into pants  - the programme works at every age."

The Pants4School Programme

Our free Pants4School programme breaks toilet training into four manageable steps, so you can make progress at your child’s pace – whatever their age or stage.

Step 1
Getting started
(around 6–9 months)

The nappy doesn’t come off yet. This step is about getting the right equipment in place, building healthy eating and drinking habits to help prevent constipation, and introducing your child to short sits on the potty.

Step 2
Regular potty or toilet times

Gradually build up the time your child sits on the potty or toilet, working towards around one minute per year of their age, up to a maximum of five minutes. Offer sits at natural times in the day – when they wake up, after meals and drinks, before bath time and before bed.

Step 3
Timed toileting

Once your child is sitting happily and occasionally using the potty, it’s time to match toilet visits to their natural bladder pattern. Use a baseline bladder and bowel chart (see resources below) to find out how long they can stay dry between wees. Take them to the potty or toilet at that interval – but no more than once an hour.

Step 4
Going into pants

When around half of your child’s wees and poos are happening on the potty or toilet, it’s time to remove the daytime nappy. Some accidents are to be expected – this is a normal part of learning. Have plenty of pants, spare clothes and waterproof covers ready.

Constipation issues

Constipation is very common in children with Down syndrome and can be one of the main reasons toilet training feels difficult or becomes stalled. It’s important to know about it early, because in many cases it can be prevented – and where it does develop, it responds well to the right treatment.
Our constipation page covers everything you need to know, including how to recognise constipation, ways to prevent it, and how to access effective support and treatment through your GP.

Hirschsprung's disease and ano-rectal malformations

Around one in 10 babies with Down syndrome is born with Hirschsprung’s disease or an ano-rectal malformation (ARM). Both conditions affect the bowel and usually require surgery.  If your child with Down syndrome has Hirschsprung’s disease or an ARM, we have dedicated information and a closed support group for families.

Toileting issues at school or nursery

Schools and nurseries have a legal obligation to support children with toileting needs. If your child needs help with toileting at school, their setting must make reasonable adjustments – it is not acceptable for a school to ask parents to come in to change their child, or to suggest returning to nappies.

Our resources for schools and nurseries explain what schools should be doing and provide a template intimate care plan to share with your child’s setting.

Frequently asked questions

This is more common than you might think – and understandably frustrating. Some children are happy to sit for a wee, but not a poo. Often they’ll choose to do a poo in their pants instead.

Here are a few things to consider:

  • Your child may be looking for privacy. Some children prefer to go off into another room or hide behind furniture. Try offering them some quiet, private time on the potty or toilet.
  • Pooing might feel uncomfortable for them, especially if they’re a bit constipated. This can lead them to want to stand up instead, which gives them a feeling of control. If poos seem hard or painful, speak to your GP or pharmacist about a suitable softener.
  • It could also be a learned behaviour – in their mind, wees go in the toilet, but poos go in pants.

Try using videos like ‘Tom’s Toilet Triumph’ or a personalised social story to help them understand where poos go. These can be really effective tools for many children.

It’s really common for children not to be bothered by being wet – you’re not alone here! If they were bothered, toilet training might be a whole lot easier. The first step is helping your child understand the difference between wet and dry:

  • You can make it a game – show them a pair of dry pants and a pair of wet ones and help them feel and talk about the difference.
  • Keep the focus on praising dry pants.
  • If they have an accident, respond calmly and reinforce the message: “wees go in the toilet or potty.”
  • Praise them when their pants are dry – get them to check with you and celebrate
    those moments!

We have some great resources around teaching wet/dry, clean/dirty etc on Twinkl.

No. Children with delays in speech or mobility are successfully toilet trained every day. You may need to adjust your approach – for example using Makaton signs, picture cards or physical support to sit – but the goal is absolutely achievable.

What do I do if my child refuses to sit on the toilet to do a poo?Yes. It’s very common to feel stuck, and it usually means the timing or approach wasn’t quite right for your child at that stage. Going back to the step that matches where your child is now, and making sure everyone involved is following the same approach, can make a big difference. Our Toilet Training Bootcamp is specifically for families in this situation.

Yes. When the nappy comes off, children feel wetness properly for the first time. This often leads to a start-stop pattern of frequent small wees while the child gets used to the different sensations. Most children improve noticeably within a few days. We’d encourage you to stick with it rather than returning to nappies.

No. We never say never and our programme is adaptable for all children regardless of their age. There may be different challenges when toilet training older children, but we can offer lots of advice and support. Giving children every opportunity to reach their full potential is important.

No you don’t have to wait. In the first instance you can support your child on the potty as in the photograph below. However do speak with your Occupational Therapist (O/T) as they may be able supply a potty chair and other toileting equipment. Unfortunately not every area has this service but it is always worth asking!
 
doll on the potty - toilet training representation image

Consistency is key to success. Whoever is caring for your child – whether that’s nursery staff, school, a childminder, or a relative – needs to follow the same approach that’s happening at home.

It’s really helpful if everyone understands DSUK’s 4-step toilet training programme #pants4school and the reasons behind it. That way, they can support your child in the same way, every day.

There’s detailed guidance on toilet training for professionals available on the DSUK website, and we encourage nurseries and schools to look. Families can also direct settings to Twinkl, where there are a number of useful DSUK resources available. 

Want expert support?

Toilet training bootcamp

If you're finding it hard to make progress, our four-week online Bootcamp with June Rogers MBE gives your family a personalised plan, direct expert support and a group of other families going through the same thing at the same time.