The Potty Training Puzzle Guide
Understanding Your Child's Unique Path to Potty Training
By Christy Koraiban, RN BSN IBCLC | Every Baby Feeds
"He used the potty yesterday... so why is he having accidents today?"
If you've ever found yourself asking that question, you're not alone.
When we first started potty training my son, I constantly worried that I was doing something wrong. Every success made me think we had finally "figured it out." Then the next day would come, and we'd have accidents that seemed to make absolutely no sense.
How could he use the potty perfectly yesterday but not seem to notice today?
Was I starting too early?
Should I be pushing him more?
Should I stop altogether?
As the parent of a child with Down syndrome, I spent far too much time comparing our journey to everyone else's. Every parenting article seemed to focus on age or promise a three-day solution. Friends would ask if he was potty trained yet, and I never knew how to answer. The truth was... it wasn't that simple.
Looking back, I wish someone had explained one important concept to me:
Potty training isn't one skill. It's a puzzle.
Once I started thinking about potty training differently, everything began to make more sense. Instead of wondering why my son "wasn't getting it," I started asking a different question:
Which puzzle pieces does he still need support with?
That shift changed everything.
Potty Training Isn't About a Diagnosis
Parents often search for things like:
Potty training a child with Down syndrome
Potty training autism
Potty training cerebral palsy
Potty training speech delay
While every diagnosis has unique considerations, diagnoses don't actually tell us why a child is struggling.
Two children with Down syndrome may have completely different potty training challenges.
One may have excellent body awareness but struggle with low muscle tone.
Another may communicate beautifully but have severe constipation.
A child with autism may have excellent motor skills but significant sensory sensitivities.
Another may simply have difficulty recognizing when they need to use the bathroom.
Rather than focusing on your child's diagnosis, I encourage you to focus on the developmental skills involved in toileting.
That's where the puzzle comes in.
The Potty Training Puzzle
Successful potty training requires many different developmental skills working together.
Think about everything your child has to do just to successfully use the bathroom.
They need to:
Notice the feeling that they need to go.
Understand what that feeling means.
Pause what they're doing.
Get to the bathroom in time.
Manage their clothing.
Sit safely on the toilet.
Relax enough to urinate or have a bowel movement.
Wipe, flush, wash hands, and return to play.
That's a lot!
If just one or two of those skills are still developing, potty training can become frustrating for everyone involved.
The good news?
You don't need every section of this guide.
Instead, think about which puzzle pieces your child needs the most support with, then start there.
🧩 Puzzle Piece: Body Awareness (Interoception)
What is interoception?
Interoception is our brain's ability to recognize signals coming from inside our body.
These include things like:
Hunger
Thirst
Feeling too hot or too cold
Needing to use the bathroom
Some children simply don't recognize the feeling of a full bladder or bowel until it's too late.
You might notice:
Accidents seem to happen without warning.
Your child doesn't realize they're wet.
They don't tell you they need to go until after they've already gone.
Strategies
Use scheduled potty breaks rather than waiting for your child to ask.
Talk about body signals ("Your tummy feels full," "Your bladder is telling you it needs to go.")
Celebrate noticing body cues—not just staying dry.
🧩 Puzzle Piece: Communication
Children don't have to be verbal to be successful potty trainers.
They simply need a reliable way to communicate.
This may include:
Words
Signs
Gestures
Picture cards
AAC devices
Strategies
Teach one consistent way to ask for the bathroom.
Keep language simple.
Model that language or tool repeatedly
Watch your child's body language rather than waiting for words.
🧩 Puzzle Piece: Motor Planning (Apraxia/Dyspraxia)
Some children know exactly what they want to do but have difficulty planning all the steps.
Potty training involves a surprisingly long sequence.
Recognize the feeling...
Walk to the bathroom...
Pull pants down...
Sit...
Go...
Wipe...
Flush...
Wash hands...
For children with motor planning challenges, that's a lot to organize.
Strategies
Break the routine into small steps.
Use picture schedules, visual and/or auditory cueing
Practice the routine even when your child doesn't need to go.
Expect lots of repetition.
🧩 Puzzle Piece: Low Muscle Tone (Hypotonia)
Low muscle tone can affect more than gross motor skills.
It may make it difficult to:
Sit upright comfortably.
Maintain balance on the toilet.
Push during bowel movements.
Pull clothing up and down.
Transition on and off the toilet.
Strategies
Use a toilet seat reducer if needed.
Always provide a sturdy footstool so feet are supported (like a squatty potty).
Keep toilet sits short and positive.
Choose clothing that's easy to remove.
Monitor and manage constipation.
🧩 Puzzle Piece: Mobility
Some children have difficulty getting to the bathroom quickly or transferring safely onto the toilet. Others fatigue easily after repeated trips. This is a piece that really benefits from other members of your team like a physical therapist. They often can evaluate your bathroom situation and make personalized recommendations to increase independence.
Strategies
Reduce the distance to the bathroom when possible.
Consider adaptive equipment recommended by your child's therapists.
Choose clothing that promotes independence.
Allow extra time and avoid rushing.
🧩 Puzzle Piece: Sensory Processing
Bathrooms can be overwhelming.
Children may dislike:
Loud flushing
Bright lights
Cold toilet seats
Strong smells
The feeling of dangling feet
Others may become so focused on play that they don't notice body signals until the last minute.
Strategies
Make the bathroom feel predictable.
Support your child's feet.
Introduce new experiences gradually.
Reduce or eliminate negative sensory input when possible (i.e. flush toilet after child leave the room at first)
Never force sitting through distress.
🧩 Puzzle Piece: Attention & Executive Function
Some children become so engaged in an activity that stopping to use the bathroom feels almost impossible.
This is common in children with ADHD and can also occur in many other developmental differences.
Strategies
Build bathroom trips into predictable routines.
Use timers or visual reminders.
Give advance warnings before transitions.
🧩 Puzzle Piece: Emotional Readiness
Potty training is emotional.
Some children fear:
Flushing
Falling in
Public bathrooms
Leaving the security of diapers
Others simply aren't interested yet.
Progress usually happens faster when children feel safe, supported, and free from pressure.
Strategies
Avoid punishment or shame.
Celebrate effort, not perfection.
Read books about using the potty.
Keep experiences positive.
🧩 Puzzle Piece: Medical Considerations
Sometimes the biggest barrier isn't developmental—it's medical.
One of the most common examples is constipation.
Constipation can lead to:
Painful bowel movements
Stool withholding
Frequent accidents
Urinary accidents
Fear of using the toilet
If potty training seems unusually difficult, it's worth discussing medical concerns with your child's healthcare provider.
Other conditions may also affect toileting, including bladder dysfunction, mobility disorders, and neurological conditions.
RN Tip: If your child is having frequent accidents after previously doing well, don't assume they're being stubborn or "regressing." Constipation, urinary tract infections, illness, changes in routine, or even growth and developmental changes can all affect toileting. Looking for the reason behind the accidents is often more helpful than increasing the pressure to succeed.
Putting the Puzzle Together
Very few children struggle with only one puzzle piece.
Maybe your child has great communication but poor body awareness.
Maybe they have low muscle tone and constipation.
Or maybe they're physically ready but sensory differences make using the bathroom overwhelming.
Instead of trying to "fix" potty training as a whole, identify the skills your child is still developing and focus on supporting one skill at a time.
For example:
If body awareness is the challenge, scheduled potty breaks may be more successful than waiting for your child to tell you they need to go.
If communication is the challenge, teaching a consistent sign, picture, or AAC button may be the missing piece.
If low muscle tone is contributing, improving positioning with a footstool and toilet reducer may make sitting more comfortable.
If constipation is getting in the way, treating the underlying medical issue may make more of a difference than changing your potty training strategy.
As you begin to identify your child's puzzle pieces, remember that progress rarely happens all at once. One new skill often builds on another.
Practical Tips That Helped Our Family
Every family will find different strategies that work for their child, but there are a few simple routines that made a huge difference for us.
Build potty breaks into your day instead of waiting for your child to ask.
Many children—especially those still developing body awareness—don't consistently recognize the urge to go. Rather than relying on them to tell you, try making potty breaks part of your family's routine.
Some easy times to practice include:
First thing in the morning
Before leaving the house
As soon as you get home
Before meals
Before naps or bedtime
These predictable routines remove some of the pressure from both you and your child and create frequent opportunities for success.
Take your routine with you.
One of the biggest breakthroughs for our family came when I stopped thinking of potty training as something that only happened at home.
We kept a small travel potty in the trunk of the car, and it became part of our routine anytime we were out. Before leaving the park, before a long drive home, or whenever we arrived somewhere new, we'd offer a potty break. Sometimes that meant using the travel potty right at the car.
It wasn't glamorous—but it dramatically reduced accidents because we weren't trying to race inside to find a bathroom after my son finally realized he needed to go.
If you're often on the go, a portable potty can make it much easier to stay consistent with your routine.
Consistency matters more than perfection.
Some days will feel like huge steps forward.
Other days may feel like you're starting all over again.
That's normal.
Learning any new skill takes time, and potty training is no different.
Celebrate the small victories, even when they don't look like the finish line.
Progress isn't measured only by dry days. It's measured by every new skill your child gains along the way.
As a mom of a child with Down syndrome, I'm used to celebrating the small—but incredibly hard-earned—victories. Potty training is no different. Instead of focusing only on the end goal, take the opportunity to celebrate:
The first time your child recognizes they need to go.
The first time they tell you they need the bathroom.
The first time they willingly sit on the toilet.
The first successful trip using a public restroom.
The first time they pull their own pants down.
The first time they wash their hands independently.
The first dry outing.
The first dry morning.
Every one of those moments is another puzzle piece falling into place.
Additional Resources
The following organizations offer excellent evidence-based information for families:
American Academy of Pediatrics: Toilet training readiness and healthy toileting habits
HealthyChildren.org: Potty training articles and parent resources
National Down Syndrome Society: Toileting tips specific to Down Syndrome
Autism Speaks: Toileting tips specific to Autism
Childcare Answers: Short guide with additional resources and visual images
Autism Little Learners: Free visual toileting images
Your child's occupational therapist, physical therapist, speech-language pathologist, or pediatrician can also provide individualized recommendations based on your child's unique needs.
Have questions about your child's development or need help navigating the next steps?
Every Baby Feeds provides compassionate, individualized support for families of children with developmental differences and medical complexities. Whether you need help understanding developmental milestones, navigating healthcare resources, or finding the right support for your family, you're not alone.
— Christy Koraiban, RN BSN LC | Every Baby Feeds | Lactation Support, Education, Healthcare Navigation | North County San Diego