By Michelle Beckwith, OTR/L

In my fieldwork experience during occupational therapy school, I treated a sweet 8 year old girl who was still wearing diapers and unable to indicate when she needed to use the toilet. One day, the girl drew a picture of herself; her picture included her head and face with her arms and legs sticking out of her head. No body. And suddenly it clicked, no wonder she was having so much difficulty with toilet training when she didn’t even perceive herself as having a body!

Just like our interoceptive system indicates to us that we are hot, cold, thirsty, or hungry (or hangry, if we have a decreased sense of interoception), it also indicates to us when we need to use the toilet. Those with a typical sense of interoception will know almost immediately when it’s time to go; children with decreased interoceptive sensation may not realize until it’s too late, may be unable to discriminate whether they need to urinate or have a bowel movement, or may have difficulty coordinating the necessary push to go, making toilet training difficult.

It is important to foster empathy for the child who has difficulties with toilet training. Toilet training, or lack of, can be a source of insecurity or low self-esteem for the low-registration child, when it is simply something their body is not ready to learn yet. Learning about and understanding how interoception is an important first step to take on the journey to independent toileting.

It is difficult to specifically target the interoceptive sense during sensory activities, as the sensory receptors are located within the gut and organs ( However, Angie Voss, OTR ( suggests that focusing on the power sensations: vestibular, proprioceptive, and tactile, can have a positive effect on children’s ability to make a “brain-body connection”. Focusing on these sensations provides the foundation for overall sensory integration and regulation, which includes the interoceptive sense.

While focusing on power sensations may be helpful in the long run, some other strategies can be utilized in the meantime. Some parents may find visual schedules, set times to use the toilet each day, or establishing toilet “rules”, such as going each time the child leaves or arrives home ( helpful. Voss ( also suggests use of a vibrating pillow while the child is seated on the toilet to speed the process along. Finally, Kelly Mahler, OTR/L suggests that interoceptive sense can be improved through mindfulness and meditation strategies. These strategies can be adapted to be more play-based depending on the child’s abilities ( Helpful activities may include body scanning, where the child is encouraged to focus on one body part and think about how that specific area feels, or drawing the child’s body on paper and labeling each part. For a simpler approach, even Simon Says is a useful game to encourage overall body awareness.

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