Toilet training is supporting children and young people with or without a learning disability to achieve continence. Achieving this skill is important for our mental and physical wellbeing. Children and young people with a learning disability can find toilet training very difficult and may need additional help with this. What Might Help? Epston, D., & Betterton, E. (1993). Imaginary Friends: Who are they? Who needs them? Dulwich Centre Newsletter, 2, 38-39. Unfortunately, despite all efforts relapses are common, and final remission probably depends on physical maturity. Freeman, J., Epston, D. & Lobovits, D. (1997). Playful approaches to serious problems: Narrative therapy with children and their families. New York: Norton.

Epston, D., & White, M., &“Ben” (1995). Consulting your consultants: A means to the co-construction of alternative knowledges. In S. Friedman, (Ed.), The reflecting team in action: Collaborative practice in family therapy. (pp. 277-313). New York: Guilford. In most cases, the child is not aware that this happening. They arenot being lazy and punishment will not help solve the problem.

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Going into denial. You child may say: "I don't need a poo and I haven't had an accident" when you can clearly smell that they have! This is a classic stress response to a situation they feel embarrassed about but don't know how to stop or control. As therapists, we have been especially trained in the use of words. But practicing the language of externalizing conversations is for us, as for many others, not so much about learning a technique as about developing a particular way of seeing things. As Roth and Epston (1996a, p. 149) write: Roth, S. & Epston, D. (1996). Developing externalizing conversations: An exercise. Journal of Systemic Therapies, 15(1), 5-12. The bowel is a long tube-like organ which is part of our digestive system. This system begins when we put food into our mouths. Chewing food into little pieces makes it easier to swallow. In contrast to the common cultural and professional practice of identifying the person as the problem or the problem as within the person, this work depicts the problem as external to the person. It does so not in the conviction that the problem is objectively separate, but as a linguistic counter-practice that makes more freeing constructions available.

This third group, who continue soiling into their primary school years, is quite unlike the first two groups because there is - or is likely to be - a genuine physical reason for the continued soiling. There are lots of different signs and clues which show your child is trying to stop a poo from coming out. These include: For the child, externalization is like playing a game of “pretend.” Implicitly, or sometimes even explicitly, we are saying to the child, “Let’s pretend the problem is outside yourself and we’ll play with it from there.” As Paley (1990, p. 7) writes, “‘Pretend’ often confuses the adult but it is the child’s real and serious world, the stage upon which any identity is possible and secret thoughts can be safely revealed.”A GP may refer your child to a specialist for treatment if they think soiling could be caused by another medical condition. Things you can do at home to help with soiling Children who continue to wet during the day past the age of 5, and in the absence of any identifiable source of stress, are likely to have a physical problem with the retention of urine. If a child continues to wet after appropriate medical assessment and treatment, they may respond to a variation of the "Sneaky Poo" programme directed at being dry rather than being clean, but once again any success with this programme tends to be temporary until the child reaches an appropriate level of physical maturity. Night-time wetting