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In this installment of Clinician’s Corner, Dr. Melanie Nelson provides some guidance on how to handle elimination during time out sequences.

Q: What are some strategies therapists can use to address a child wetting or soiling themselves (or their surrounding area) during a time-out?

A:
1)     Have the child use the bathroom immediately before session (an ounce of prevention and all that). That way chances are better if they are complaining that they need to go to the bathroom it is an attention-seeking behavior and not the real thing. If needed, they could also use the bathroom when switching parents for coaching, just to be sure.

2)      For a child that is completely toilet trained, ignoring pleas to use the bathroom or actual wetting/soiling until the time-out is complete because you and the parents know they just went.

3)      For a child who is still in the process of toilet training (as some preschoolers are), it is harder to tell. If the parent is still using pull-ups when they take the child in public, it may be that they can wear a pull-up during session, and then you can ignore (change pull-up like usual after time-out is complete). If they are in real underpants and complaining they need to go (and the parent believes they really do need to go—parents often know these things), The parent, all without saying anything or otherwise giving them attention, can escort them to the bathroom, give them an opportunity to use it, and then return them to the time-out chair. This strategy may be appropriate with a toilet-trained child if the parent genuinely believed the child needed to use the bathroom despite having gone just before session.
4)      If a child does wet or soil themselves during a time-out, which certainly does happen sometimes, and it is ignored as an attention seeking behavior, the parent can give some kind of clean-up command as the follow-up command after the original command is obeyed, (e.g., “get your clean pants out of the bag” or “please wipe up the mess you made on the chair”). Of course, the child isn’t actually going to be able to completely sanitize the mess. That’s usually up to the therapist (all the more reason to remember to send them ahead of time).