Assessing Toileting Readiness from an OT Perspective

Toilet training is a complex process requiring the integration of motor skills, sensory processing and cognitive sequencing. For many families, toilet training can feel like a big -and sometimes stressful – milestone. Instead of focusing on pressure or timelines, it helps to look at your child as a whole and notice the small skills they’re already building. 

The Developmental Sequence of Toileting Skills 

Toileting doesn’t start with sitting on the potty. Most children move through these stages: 

1. Noticing a dirty diaper. Your child shows discomfort or wants to be changed. 
2. Getting curious. They show interest in the bathroom or potty. 
3. Communicating awareness. They tell you -or show you- when they’re going or need to go. 
4. Trying with help. They sit on the toilet but still need help wiping. 
5. Managing clothes. They begin pulling pants up/down and help with fasteners. 
6. Toileting independence. They use the toilet and perform hygiene tasks independently. 
7. Hand washing. They finish the full toileting routine. 

Every child moves through mastering these skills at their own pace and that’s completely normal. 

Signs Your Child May Be Ready 

You might notice your child is getting close to ready if they show: 

• Sensory awareness. They verbalize or gesture while going in a diaper or pull-up. 
• Predictive alerting. They alert a caregiver before they go. 
• Environmental association. They associate the bathroom and the toilet with going potty. 
• Tactile sensitivity. They want to be changed right away after they go. 

Why the Bathroom Can Feel Like a Big Deal 

Toileting is actually a very complex sensory experience. Some kids need extra time to get comfortable with: 

• Body signals. Learning what “I need to go” feels like. 
• Bathroom sounds. Flushing, echoes, fans. 
• Environmental influences. Sitting on a cold seat, lighting or unfamiliar surroundings. 
• Touch. Wiping and managing clothes. 

If your child resists the bathroom, it may not be behavior -it may just feel overwhelming. 

Simple Ways to Support Your Child 

Here are several practical, parent-friendly ways to help: 

1. Make the bathroom a comfortable place. Let your child spend time there without pressure. Try reading books, playing or just sitting on the toilet while fully clothed at first. 
2. Teach the steps. Use simple language, books or pretend play to show what happens: “Pants down → sit → wipe → flush → wash hands.” 
3. Create a routine: Try sitting on the toilet at predictable times, such as after meals or before bed, to build consistency. 
4. Help them notice their body. Instead of asking “Do you need to go?”, try asking: “Does your tummy feel full?” or “Do you feel pressure in your tummy?” This helps them learn their body signals. 
5. Set them up for success physically. Use a small potty or a toilet seat with a footstool and make sure their feet are supported, as this helps them relax and go more easily. 
6. Let them feel the difference. Switching from diapers to underwear can help kids notice when they’re wet, which builds awareness. 
7. Celebrate effort, not just success. Praise trying, sitting on the toilet or telling you about when they need to go, not just using the toilet successfully. 

When to Consider Extra Support 

Some children take longer to learn this skill, especially if they have challenges with sensory processing, motor skills or communication. If toileting feels especially difficult or stressful, support from a pediatric occupational therapist can help by: 

• Breaking the process into small, doable steps. 
• Suggesting and creating tools (like visual charts or seating supports). 
• Giving you strategies tailored to your child. 

Final Thought 

Toilet training isn’t a race. It’s a learning process that builds over time. Small signs of progress, like showing interest or communicating, are just as important as using the toilet itself. If you focus on readiness and support instead of pressure, your child is much more likely to succeed!  

References and/or Sources: 

Frolek Clark, G., Kingsley, K. L. (2020). Occupational therapy practice guidelines for early childhood: Birth–5 years. American Journal of Occupational Therapy, 74(3), 7403397010p1–7403397010p42. doi.org/10.5014/ajot.2020.743001 

Gronski, M. P. (2021). Occupational therapy interventions to support feeding and toileting in children from birth to age 5 years. American Journal of Occupational Therapy, 75(5), 7505390010. doi.org/10.5014/ajot.2021.049194 

Smet, N., Lucas, C. (2020). Occupational therapy view of child development. In J. O’Brien & H. Kuhaneck (Eds.), Case-Smith’s occupational therapy for children and adolescents (8th ed.). St. Louis: Elsevier. 

Written By: Maddie Fish, OTD, OTR/L