When Toileting Challenges Are More Than a Behavior
I had the best conversation with a mom today about a challenge that comes up in families but is often very private.
She shared that her son needs to take all of his clothes off in order to have a bowel movement on the toilet.
At first, she thought she should consult with his behavioral therapist. Fortunately, his behavioral therapist encouraged her to talk with me, his occupational therapist.
And I’m so glad she did.
Because what we discovered was that what looked like a behavioral issue might actually have something else going on underneath the surface.
Looking Beyond the Behavior
When a child does something that seems unusual or unexpected, it can be easy to focus on the behavior itself. We might wonder why they are doing it, whether it is a habit, or how we can help them stop.
But sometimes, the more important question is: What is making this behavior necessary for the child in the first place?
In this case, I learned that part of the challenge for this child was his postural stability.
He has difficulty maintaining a stable posture. When he sits on the toilet, he needs to spread his legs wide to create a wider base of support. This helps him feel safer and more stable on what his mom and I jokingly thought of as his porcelain throne.
From his perspective, this position may be helping him feel secure enough to use the toilet.
Taking all his clothes off may seem like an unusual requirement, but it is important to understand what he might be trying to accomplish through this routine before assuming it is simply a behavior that needs to change.
Why Postural Stability Matters During Toileting
Using the toilet requires more than knowing when you need to go.
Children need to coordinate their bodies, maintain a stable sitting position, and feel secure enough to relax and have a bowel movement. When maintaining that position is difficult, the toilet can feel less comfortable or stable than we might realize.
A child who struggles with postural stability may find that certain positions help them feel more secure. A wider base of support, for example, can make sitting feel more stable.
This is one reason occupational therapists look at the whole picture when a child experiences difficulties with daily activities. We consider how movement, coordination, sensory experiences, and the environment may be affecting participation.
Instead of asking only how to change a child’s behavior, we also want to understand what their body might be telling us.
When Understanding Changes the Conversation
One of the nicest parts of this conversation was how quickly Mom understood the connection.
Once we talked through the possibility that her son was trying to feel stable and safe, she began to see the situation differently. She even said that perhaps he simply needs to do it this way at home for now.
I also asked whether she noticed the same difficulty when they were on vacation or out at a restaurant.
She shared that he sometimes seemed reluctant to use the toilet in those settings, but he was able to do so.
That detail was helpful because it gave us more information about how he responds in different environments. It also reminded us that a child’s abilities and comfort can vary depending on the setting.
The goal isn’t to assume we know exactly why a child does something after one conversation. It’s to stay curious, ask thoughtful questions, and look for patterns that help us understand the child’s experience.
Sometimes, the Best First Step Is Understanding
I think this is a really good example of how something can look like a behavior issue, but when you look underneath the hood, you may discover an underlying challenge.
We can continue working on this child’s postural stability, strength, and balance through occupational therapy. Those skills may help him feel more secure and comfortable during toileting over time.
In the meantime, his parent can approach the situation with understanding and empathy, recognizing his need to feel stable on the toilet rather than treating the routine as something that must immediately be stopped.
That doesn’t mean every behavior needs to be accommodated indefinitely or that we should assume every toileting challenge has a motor component. It means we should understand what is happening before deciding how to respond.
When we identify the underlying difficulty, we can work toward a solution that supports the child’s needs rather than simply trying to eliminate what we see on the surface.
The Importance of Collaboration
I’m also grateful that this child’s behavioral therapist recognized that occupational therapy could be helpful and redirected the conversation to me.
Behavioral therapists and occupational therapists bring different areas of expertise to a child’s care. When professionals collaborate and recognize when another perspective is needed, families can gain a more complete understanding of what their child is experiencing.
A behavior that seems unusual may be connected to a child’s physical abilities, sensory experiences, emotional comfort, or environment. Sometimes, more than one factor is involved.
As occupational therapists, we can help families explore these possibilities and identify practical ways to support their children in everyday routines.
A Final Thought for Parents
If your child has a toileting routine that seems unusual, difficult, or hard to explain, you are not alone. These experiences can be private, and parents may not always know whom to ask for help.
Before assuming a behavior is simply something your child needs to stop doing, consider whether there might be an underlying reason. Does your child feel physically stable? Are they comfortable with the environment? Are there particular situations in which the challenge becomes easier or harder?
You don’t have to figure it all out on your own.
Pediatric occupational therapy can help explore how posture, movement, sensory experiences, and everyday routines may affect toileting and other daily activities.
Sometimes, understanding what a child needs is the first step toward helping them build new skills and feel more confident.
At TheraPeeps, we believe in looking beyond the surface, meeting children where they are, and helping families find supportive, practical ways forward.
