Toileting is often a taboo topic, making it difficult for families to find honest, practical guidance. For people with disabilities, toileting skills may take more time due to cognitive, physical or sensory challenges. Supporting personal care extends beyond the home into schools and community settings. It is a journey that calls for patience, compassion and an understanding of individual needs. We spoke with therapists, educators, and families across San Diego to share practical tips and tools for supporting toileting at every stage of life.
The Challenges
Communication, sensory or medical issues can complicate toileting. In some cases, apraxia—a brain–body disconnect—makes it difficult to initiate physical action, leading to understandable frustration and setbacks.
Occupational Therapy (OT) Strategies
When we spoke with Teresa Altamirano, OTR/L, from Abilities Pediatric Physical Therapy, she shared these tips for children with special needs who are learning to use the bathroom:
- Assess readiness—are they indicating they’re wet or staying dry for longer periods?
- Use a consistent routine (ie: every 30 minutes).
- Use communication supports such as visuals, sign language or simple phrases.
- Provide positive reinforcement—a reward system such as stickers.
- Practice in simple steps—pulling down pants, sitting, flushing, washing hands, etc.
- Assess the need for adaptive equipment, such as grab bars, raised toilet seat or adapted toilet chair.
“There are three major areas that are school-based,” says Magen Brown, OT in the San Diego Unified School District. These key practices should continue at home and in the community.
- Positioning — Use adaptive equipment such as toilet chairs, ring reducers or footstools to support individuals with physical disabilities, differences or vestibular insecurity.
- Environmental modifications — Collaborate with staff to create a sensory-friendly bathroom environment. This may include not flushing while a student is present, avoiding loud air dryers, or using noise-canceling headphones.
- Strength and fine motor development — Build the skills needed to manage clothing and fasteners independently. An OT may also help determine safe and effective positioning during diaper and clothing changes.
Regression
“Sometimes it’s necessary to bring back tools that a child had previously moved past,” says
Marie Bacsik, Director of A.R.C.C. Center. “Visuals can be a great relief…instead of being told something over and over. When speaking with professionals about [toileting], I suggest that parents give more information than they think is needed.”
When toileting regression occurs, take a step back and consider what might be causing the change and what adjustments could help the individual move forward again. Some of the most common reasons for regression include:
- Stress or major changes — such as starting a new school, moving homes or the birth of a new sibling
- Not being fully ready — the individual may have progressed too quickly or needs more support
- Medical concerns — including urinary tract infections, constipation or abdominal discomfort
- Seeking attention — especially during times when routines shift or demands increase
Smearing
A topic rarely spoken about is smearing behaviors in the bathroom, which can be distressing for families and caregivers. Smearing can happen for several reasons, such as:
- A form of sensory exploration or stimulation
- Potentially communicating frustration or distress
- To exert control or avoidance (if toileting is difficult)
- Behavioral challenges—expressing unmet needs or seeking attention
While smearing behavior can be upsetting, it is rarely intentional. Approaching it with calm, consistency and problem-solving—not punishment—can help reduce the behavior over time. Consult with occupational or behavioral therapists for valuable support and to help identify underlying causes. Offer appropriate sensory alternatives and reinforce clear routines.
Changing an Adult on the Go
Cindy Spiva of San Carlos is mom to Cormac, age 22, with a rare genetic disorder called Hemimegalencephaly. The two of them love to get out and explore San Diego. Since Cormac is in a wheelchair and is incontinent, they have been involved with organizations like Team Hoyt, a nonprofit that assists families with inclusion in sports, running and races, which includes travel. Cindy doesn’t let toileting needs prevent them from leaving home.
“Don’t limit your child’s experiences because you’re afraid of having to change a diaper in public,” says Cindy. “When our kids are little, we don’t think about it too much because it’s very easy with a small person. But there are options for changing diapers out in the world.”
Cindy always has a fully stocked bag in her van, and a backpack with Cormac. She’s even mastered changing on an airplane. There are some places that have special bathrooms with settees. Or you can use the first aid station in places like the San Diego Zoo. The tip is to find where there are medical stations with a cot or someplace to lay down a full-size adult. Cindy purchased a travel tent that attaches to the back of her van so she can change Cormac while they are out on the road.
With patience, structure and encouragement, toileting is achievable. It’s important to remember every child develops at their own pace, and some may need extra time or ongoing support. Cognitive, sensory and behavioral challenges can affect readiness, and struggling does not mean failure. Work alongside a therapist who can help adjust strategies and find what works best for your family. You may need to take a break to ease stress and help ensure that when you try again, the experience feels calmer, more confident and more supportive.
Toileting Resources
Car Cabana: Large tent that attaches to a hatchback vehicle to create a private changing area
www.carcabana.com
Youth Crews: Diapers designed for ages 4–17
www.youthcrews.com
No-Cost Diapers and Supplies: Sarah Franco, Assistant Director of Client Services, Early Childhood at San Diego Regional Center, says many families can get support through community programs like California Children’s Services (CCS), Medi-Cal, private insurance or local diaper banks. Service Coordinators often have resources to help.
Ellen Hildebrand has a Masters in Education, special education credentials and classroom experience, and is a local mother of an adult son with autism.
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