Tag: potty training

The ABC’s of Toileting Readiness for Kindergarten!

The ABC’s of Toileting Readiness for Kindergarten!

Kindergarten is a time filled with excitement and anticipation, but also marked by apprehension and changes in routine. Amidst this whirlwind of new experiences, one aspect that often proves challenging is toileting readiness. Feeling apprehensive about your kindergartener’s bathroom autonomy at school is entirely natural. Mastering the skills required can be daunting, especially for those encountering hurdles along the way. Achieving toileting success in kindergarten is a milestone for both children and their caregivers.

Here are some factors that contribute to kindergarten toileting success:

  • Awareness of bodily functions: This is called interoception, an important part of our sensory system. It allows your child to recognize when they need to use the bathroom, whether it’s for urination or bowel movements.
  • Communication with caregivers: The ability for your child to signal when they need to use the toilet and when they’ve had accidents.
  • Comfort with the bathroom environment: Being at ease with the sights, sounds, and smells of the bathroom is essential for successful toileting.
  • Understands toileting sequence: Knowing the steps involved in using the toilet, from undressing, sitting or standing, wiping, dressing, and washing hands with minimal assistance.
  • Independence on child-size toilet: Being able to get on and off the toilet seat without help and maintaining balance for a few minutes.
  • Comfort using bathrooms outside home: Transitioning to using toilets in unfamiliar settings, like at school.
  • Self-care skills: Pulling up and down pants and underwear and attempting to wipe independently with minimal assistance.

It’s helpful to remember that toileting success is a developmental milestone, and every child progresses at their own pace. While some children may quickly adapt to kindergarten toileting routines, others may require additional time and support. 

If your child needs extra assistance to prepare for kindergarten success, don’t hesitate to contact us. Our experienced therapists specialize in addressing toileting challenges, including avoidance, withholding, constipation management, and daytime and nighttime incontinence. With personalized interventions and compassionate support, we’re here to help your child navigate this important milestone with confidence. 

Written By: Andrea Turnell, DPT and Dana Bukala, PTA


Pediatric Incontinence
& Pelvic Floor Health

  • cutout incontinence

  • Toddler Incontinence

  • teenage incontinence

Find Answers & Get Started

what is pediatric incontinence therapy?

Pediatric incontinence occurs when children over the age of 4 have difficulty controlling their urine and have leakage. It can occur at night or during the daytime. This can add additional stress to the child, their parents, and impact participation in social events. Physical therapy and occupational therapy can help with this in a variety of ways.  

What could be involved?

Common symptoms associated with pediatric incontinence:

  • Bedwetting (Enuresis): 

Urination during the nighttime can be caused from constipation, increased production of urine at night, and/or intake of bladder irritants prior to bed.

  • Overactive bladder: 

This is a sudden and uncontrollable urge to urinate. Children may have accidents from not making it to the bathroom on time, and may often sprint to the bathroom to avoid an accident. 

  • Dysfunctional voiding: 

Children may have difficulty fully emptying their bladder and may be contracting the muscles that need to relax during urination. This leads to less emptying with occasional leaking.

  • Urinary urgency: 

Child may feel like they need to use the restroom frequently and without much warning.

  • Voiding postponement: 

Often associated with a low number of voids per day. A typical child voids 4-5 times a day. This can be related to low awareness of need to void as well as purposeful withholding.

  • Stress incontinence: 

This occurs when a small amount of urine leaks with exertion such as with playground activities. 

  • Giggle incontinence: 

A complete void occurs during or immediately after laughing with normal bladder function when not laughing.

What does a treatment session look like?

Physical or occupational therapists with pediatric incontinence training will meet with the child and their parent(s) and/or guardian to get a history of the current concerns. A physical examination is then completed to look at the muscles of the abdomen, legs, and back. The parent or guardian is present throughout the exam and the exam occurs over clothing. The findings of the exam are then sent to the referring physician to determine the most appropriate treatment plan for that child. Treatment sessions are one therapist to one child. They occur in a private treatment room with the children dressed and caregiver present. Our therapists incorporate a holistic approach that includes diet, sleep patterns, and other behavioral conditions that could be impacting the child’s continence. Our multidisciplinary team is able to collaborate to determine the best strategies for each child. These strategies may include:

  • Core strengthening
  • Biofeedback
  • Bladder re-training
  • Behavior and diet strategies
  • Body awareness to help realize the urge to go
  • Posture training
  • Sensory strategies to assist with tolerance for public bathrooms and toileting
  • Review of bathroom setup
  • Bowel and bladder logs
  • Increasing variety of foods and limiting bladder irritants
  • Modified O’Regan Protocol

What is biofeedback?

Biofeedback is a little machine that helps children learn to relax and contract their muscles that help them use the bathroom more efficiently. Little stickers are attached to their muscles and give feedback to a computer. This feedback is connected to a game that responds to the child’s relaxation or contraction of specific muscles. Biofeedback is commonly used for pediatric incontinence, but can also be used for body awareness to help strengthen specific muscles. Biofeedback sessions occur in a private treatment room with an adult caregiver present. 

Modified O’Regan Protocol (M.O.P.)

We have a M.O.P. ( Modified O’Regan Protocol) specialist, Andrea Turnell, PT, DPT, on staff that can support your child’s M.O.P journey and assist in interpreting your process!

Find Answers & Get Started

Starting Potty Training

Ready to start potty training your child? Are you unsure of where to begin? Do you feel hesitant to jump in without more information? Here are 6 ideas to do before you start the process of potty training. 

#1 READ! 

A great introduction to potty training for your child is to read books to increase the child’s understanding of what potty training means! There are numerous books available for your child’s understanding featuring their favorite TV characters, book characters, and many more. Some examples include A Potty For Me by Karen Katz, The Potty Book (one for boys and one for girls) by Alyssa Satin Capucilli, and Potty by Leslie Patricelli.


Next, make sure your little one’s feet are stable. Putting feet on a stable, flat surface, like a step stool, puts their pelvis in a perfect position to make going potty easier for the GI system.  It also helps kids feel safe and stable enough to relax and let things flow.


Encourage diaper changing in the bathroom to help kids begin to associate that potty stuff happens in the bathroom, making the transition to the toilet easier!


Have your child practice pulling pants and underpants up and down so they feel confident to remove clothing when an urgent need arises. Dress your child in easy to manipulate clothing so they can quickly undress themselves. 


If your child is sensitive to sights, sounds, or smells, the bathroom may be overwhelming. Remove any unnecessary visual distractions like excessive toys, decorations, or toiletry items that may clutter the room. Limit the use of air fresheners, scented soaps, or perfume. Reduce sounds by closing the doors and windows. If possible, dedicate one bathroom to use for potty training. 


It a great idea to have a daily schedule and routine for how often your child should go to the bathroom.  You can make a routine with steps the child needs to perform. A visual schedule of all the steps a child needs to complete can help them visualize what is next and reduce anxiety since they will know the expectations. 

Example Routine: signal to use the bathroom, goes to the bathroom, pulls down clothes, sits on the toilet, urinates or defecates, grabs toilet paper, wipe, flush, pull up clothes, wash and dry hands, leave the bathroom. 

Toilet training is a complex task to master! When your child understands what is expected of them during the potty training process, your child will feel confident. If you have attempted to potty train your child several times in the past and you feel like you have hit a roadblock, BDI Playhouse offers free screenings with an occupational therapist to provide additional strategies and interventions to assist with potty training. 

Written By: Megan Wilkison, Occupational Therapist

Potty Training Problems? 5 Strategies to Help your Child Avoid Bladder or Bowel “Accidents” 

Is your child still having potty training problems? Bowel and bladder accidents that persist after training or make potty training difficult, could have an underlying cause.

Researchers have found that 40-60% of children complete toilet training by the age of 3 and 25% of 5 year old children experience day or night accidents. Experiencing “accidents” in potty-trained kids is not a normal part of development. Constipation, discomfort with restrooms at schools, poor diet, and lack of exercise are some of the most common reasons a child can experience bladder or bowel accidents. 

Diet: Constipation can be one of the causes of bladder/bowel accidents. It is important for children of all ages to maintain a balanced diet. Fiber intake and enough fluid are important to help with bowel movements. To determine the appropriate amount of fiber a child should consume is to add the child’s age plus 5. For example, a child that is 4 years old should be consuming an average of 9 grams of fiber daily. Remember to increase fiber intake gradually and never increase fiber intake without increasing fluid intake. Picky eating can impact children’s ability to consume enough fiber and fluids.

Posture: The position children assume on the potty is also very important to help the appropriate muscles relax to make peeing and pooping successful. Make sure your child uses a stool to support his feet. Their knees should be slightly higher than their hips and the child should lean forward with their arms rested on their knees. Encourage your child to say “shhh” or “grr” instead of straining. This will help to relax potty muscles. 

Exercise: Children with poor postural and breathing control have increased chances of having “accidents”. Exercising helps to increase the strength of muscles responsible for posture and breathing. Some exercises that can be done to strengthen these muscles are: frog jumps, sit-ups, squats, diaphragm breathing and breathing into a straw. 

Voiding schedule: On average, a child that is 1-2 years old voids urine every two hours. At age 12, voiding is 5-7 times per day. Children should have a bowel movement at least every other day, depending on what he/she eats. Parents can keep a log to determine the frequency of voiding during the day. Record the number of Bristol Stool Scale, if there was pain with poop, and the number of daytime and/or nighttime accidents. Using a schedule helps to track progress, motivates the child, and increases communication between parents and children. 

Colon Massage: Colon massage helps to stimulate the gastrocolic reflex. Children who have constipation may have a delayed response to this reflex. The best time to perform colon massage is a few minutes after a meal, ideally at the same time every day. Colon massage is performed in the direction the poop moves in the colon. Start by having your child lay down, place your fingers in the right lower abdomen, and apply firm pressure (NO pushing down). Then move your fingers upward toward the ribcage, towards the left side, and downward to left lower abdomen. You can repeat this movement 10-15 times.  

If your child continues to have bowel/bladder accidents after trying these strategies, therapists at BDI Playhouse In Orland Park and Naperville, IL are here to help your child and family have an accident-free day and night. 


Hodges, S.J. It’s no accident: Breakthrough solutions to your child’s wetting, constipation, UTI’s, and other potty problems. 2012. Lyons Press; Guilford, Connecticut.

Physical Therapy

Pediatric Physical Therapy

  • Serial Casting

Questions about Physical Therapy? 




Schedule a screening

BDI Pediatric Physical Therapy

Pediatric physical therapy is for more than just injury rehab or treatment of a diagnosed motor condition. Many children need short term Physical Therapy to address minor challenges or concerns noted by parents. A diagnosis is not required or necessary.

Casting for Pediatric Orthotics

Physical Therapy can help with

  • Infant head shape: flat spots or other differences
  • Bladder and Bowel Training
  • Gross motor development
  • Milestones related to walking, sitting, crawling
  • Sports Performance
  • Scoliosis Intervention
  • Bike Riding
  • Difficulties in Gym and Physical Education Class
  • Muscle strengthening
  • Posture / postural control
  • Pre-gait and gait training
  • Neuromuscular function
  • Environmental adaptations / seating and positioning
  • Splinting / bracing / orthotics
  • Improving endurance
  • Coordination of movements
  • Balance training
  • Family education

If your child does have a diagnosed condition

If your child does have a diagnosed condition, you can feel confident in our collaborative team approach that brings multiple specialties together to address the whole picture and make sure nothing falls through the cracks.  Our therapists have a high commitment to continuing education and stay in tune with the latest research-proven methods for the treatment of:

  • Cerebral Palsy
  • Spina Bifida
  • Down Syndrome
  • Sports injuries
  • Scoliosis
  • Juvenile Rheumatoid Arthritis
  • Torticollis
  • Brachial Plexus injuries
  • Traumatic brain injuries
  • Spinal cord injuries
  • Decreased coordination
  • Incontinence
  • Various other motor conditions


Physical therapists assist children in reaching their fullest potential in functional independence and fitness.

Innovative programs are aimed at:

  • Enhancing strength, coordination and balance
  • Physical fitness
  • Wellness for optimal quality of life

If you have questions or concerns, a free 30 minute screening with a Pediatric PT is a GREAT place to start. Our therapists work with children with or without a diagnosis.

Schedule a screening

A-Z of our PT Services


Adaptive Sports

Aquatic Therapy



Ball Skills

Bike Riding

Bilateral Coordination


Bowel and Bladder Dysfunction




Developmental Screening

Dynamic Serial Casting


Early Intervention

Environmental Adaptations


Family Education


Gait Training

Gross Motor Skills


Health Promotion

Head Shape

Home Exercise Program


Incontinence Training

Infant Massage

Intensive therapy


Kinesiology Taping


Motor Learning

Myofascial Release


Neurodevelopmental Therapy (NDT)


Orthotic Assessment and Training


Pelvic Floor Education

Positioning to assist with feeding

Postural Awareness and Training

Prosthetic Training


Reflex Integration



Schroth Therapy

Serial Casting

Sports Injury Recovery



Toe Walking

Total Motion Release (TMR)



Visual Motor


Wheelchair Assessments

We are proud to collaborate with

Great Feedback from Great Families

My son Jayden is 11 and has been coming to BDI for the past 4 years. BDI has become family in the way they treat my son. I truly feel deep in my heart if it wasn’t for his PT my son wouldn’t be walking the way he is today. BDI hires only the BEST. Every child here is treated with respect and love and each parent is respected and appreciated for their role in their child’s treatment plan.”

Getting Started With Physical Therapy

Find answers here

Still not sure? Learn more about whether your child needs therapy here


Continue reading