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Connection between spinal cord, bladder,
and brain develops between 18 months
and 3 years
Gross motor development to walk to the
bathroom, sit up on the potty, and wipe is
Fine motor development to pull pants up
and down is necessary
Cognitive development to recognize wet
or soiled clothes is necessary
Boys develop later than girls
Children with Down syndrome are
usually ready to begin potty training
Signs of Readiness in the Child
Signs of being independent with routine activities
Interest in seeing others using the restroom
Uncomfortable with wet or soiled diapers
Holding bladder for 1 -2 hours at a time
Regular poop time or routine (crouches in a corner)
Has the physical development necessary to follow
the steps of using the restroom
Signs of Readiness in Parents
You are ready to dedicate time to the process
You are ready to do lots of laundry
You are ready to spend more time in the bathroom
You are ready for a $raise$ - no longer buying diapers
You will not be frustrated by how long it might take to fully potty
You are ready to take the leap NO more diapers
You have at least 2 weeks of data to show a pattern of water intake
Preparing to Potty Train
Begin by purchasing clothing that is very easy for little ﬁngers to pull up and down (leggings,
sweatpants, elastic waisted, etc.)
Buy pull-ups so your child can pull-up and down diaper. (Discontinue use when you actually start)
Teach your child to pull up and down their pants every time you change their diaper.
Include your child when you use the restroom, talk about each step and what you are doing.
Use a visual schedule of potty steps for yourself and show your child each step and relate to the visual.
Begin a potty journal of your child’s diaper changes.
Buy a see-through cup for your child and monitor intake in the potty journal.
Be familiar with Bristol Stool Chart to monitor for constipation.
Add more ﬁber to your child’s diet.
Start diluting juices or switching over to more water.
Create a potty routine with your child, have them dump from their diaper into the potty, use consistent
Involve family members and your child’s school/daycare about your routine and key words.
Bristol Stool Chart
Type 3-4 is
What does the Stool Chart tell us?
Type 1: Constipation
Type 1 stools are hard and appear in separate lumps, similar to nuts. They have a longer colon transit time and can
be diﬃcult to pass. Type 1 stools are a sure sign that you’re constipated.
Type 2: Constipation
Type 2 stools are lumpy, hard, and have a sausage-like appearance. They indicate constipation, toxic overload,
and the need for intestinal cleansing.
Type 3: Normal
Type 3 stools have an appearance similar to a sausage but smoother and with surface cracks. This type of stool is
Type 4: Normal
Type 4 stools are smooth and soft in the form of a sausage or snake, and like Type 3 stools, are also considered
Type 5: Lacking Fiber
Type 5 stools are soft blobs with clear-cut edges that pass quickly. They are a kind of soft diarrhea. Type 5 stools may
be a sign your diet is lacking ﬁber or of a toxic overload in your system.
Type 6: Diarrhea
Type 6 stools have ﬂuﬀy pieces with ragged edges. These are mushy and almost resemble diarrhea. These stools are
a sure sign of toxic overload.
Type 7: Diarrhea
Type 7 consists of soft, watery stools with no solid pieces. This kind of stool has spent the least amount of time in the
colon and may indicate a bacterial or viral infection. 8
More Water, More Fiber, More Exercise
Age Range Gender
4 to 8 years
9 to 13
14 to 18
Daily Minimum Fluid Requirements
Add Fiber with…
Whole grain bread
High ﬁber cereal
Berries with seeds
Every Little Blessing
We have had great success with our methods for
children with and without disabilities.
It takes a team where everyone is on the same page
about the process for quickest success.
Pull-ups are only allowed at sleep times overnight.
Water intake is pushed and monitored.
A schedule of sitting on the potty every 30 minutes at
Children sit on the potty for 2-3 minutes at ﬁrst, sit
times are adjusted to meet the needs of the child.
Children clean themselves after accidents, adults
monitor, give step-by-step instructions, and assist as
least as possible.
All sit times, accident times and water intake is
tracked on a sheet in the restroom.
Rewards and incentives are based on individual
need; group celebrations are for everyone!
What about Rewards
Rewards can help some children.
The type of reward has to be highly motivating
to the child and can only be given for potty
success and celebration.
Think outside the box, rewards do not have to be
bought, do not have to be food.
Use puppy pads in the car seat or at nap time
Look for double potty seats like this one
Prepare with lots of extra clothes, extra shoes
Put a few drops of blue or red food coloring in the potty so you can tell if your child went pee
Get a step for the toilet; teach your child to use a step to get up on the potty independently
Use the timer on your phone to stay on schedule
Involve your child in the last box of diapers, talk about getting bigger
Look for books about potty training especially ones that have high interest characters for your
Don’t go backwards - every time you put your child back in a diaper or pull-up after you begin
you take 5 steps backward and it will take much longer to fully potty train.
Date Time Pee/Poop Water intake
4/16 6:30 am Pee Just woke up
7:30 am Pee Milk 1/2 cup
9:30 am Pee Juice watered down 1 cup
10:30 am Pee/Poop Juice watered down 1/4 cup
11:30 am Dry None
12:30 pm Pee water 1 cup
1:00 pm Dry None / before nap
2:45 pm Pee None / nap
3:45 pm Pee Juice watered down 1 cup
Dr. Eddy Bettermann, MD
Katz, Terry, PhD:
NDSC Conference from your Couch 2020. Ditching the Diapers: How to Move
Forward with Toileting
National Down Syndrome Society:
Vanderbilt Kennedy Center:
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