Toileting and Interoception – How to Help Struggling Children

Mim Ochsenbein, MSW, OTR/L

This is a follow up article to the blog post titled This Hidden Sense Affects Potty Training and Toilet Accidents in Older Kids.

Helping children who are struggling with toileting should be approached as more of a marathon than a sprint. A child with toileting issues may actually be struggling with a little known sensory system called interoception.

Interoception refers to your ability to perceive and understand your internal sensations, like hunger, thirst, the need to use the bathroom, feeling hot or cold, and fatigue. If you understand what you are feeling, you can act to meet your need effectively. Many professionals, including doctors and occupational therapists, do not know about this 8th sensory system, and consequently children can struggle with toileting throughout their youth. Obviously, this can stifle self-esteem and social relationships.

Working with your child from a view of long term gains rather than quick fixes will help you stay patient as your child begins to learn about their own body in a way that they have previously been unaware of.

Before you begin any program focused on Interoception Intervention, all parents need to talk to their physician to make sure there are no other physiological issues that could be causing the problem, such as infections or issues related to hormones that release at night that help prevent night wetting). This should always be the first step. After that, if it is determined that this is an interoception issue, there are things that can be done to address the immediate need and to work on the overall issue.

There are 5 Steps of Interoception Intervention (adapted from Kelly Mahler):

1) Educate

2) Implement adaptions for reduced interoceptive awareness

3) Notice sensations

4) Give sensations meaning

5) Use interoception awareness to build related skills

1 - Educate

Parents: Learn as much as you can about interoception. Knowledge is power. Being better able to understand your child’s experience, an experience of the world that is different than most people’s, will mean you can help find more solutions while having more empathy.

2 - Implementing Adaptions

Often a child with interoceptive deficits will present with toileting needs requiring immediate attention while they work on interventions to improve their overall interoceptive awareness. Your child may need a few adaptations to what is currently being implemented. Here are some suggestions that can make a big difference. For adaptations geared more towards your child’s specific needs, please contact your Occupational Therapist.

  • Visual supports: Make a visual schedule of bathroom breaks (example: picture of bathroom sign related to child’s identified gender with “Bathroom Breaks: 9:00, 11:00, 1:00, 3:00” underneath)
  • Memorized rules: Always go to the bathroom 1 hour after drinking water; or always using the bathroom before leaving a place and when you arrive somewhere
  • Write and read social narratives: In story form or as a memo write out the process of when to use the bathroom as it pertains to that child’s daily schedule
  • Use Technology and Wearables:

3 - Notice Sensations

4 - Give Sensations Meaning

5 - Use Interoceptive Awareness to Build Related Skills

These remaining three steps (steps 3-5) for Interoception Intervention are all areas that a family/individual should work on with a trained Occupational Therapist. It requires assessment of interoception and developing interventions designed for that individual. Specific interventions should be designed by and implemented  with an Occupational Therapist trained in sensory processing. To work with a STAR Institute for SPD Occupational Therapist, please fill out the Child Intake Form or find a therapist in your area by using the Treatment Directory.


If you are looking for Sensory Processing treatment for yourself or your child fill out a child or adult intake form now to be treated at STAR Institute Treatment Center or search our Treatment Directory to find services in your area.

Photo of MimMim Ochsenbein, MSW, OTR/L has been a practicing pediatric occupational therapist for over 20 years. She has received advanced training in sensory processing (STAR Institute Intensive Mentorships, SIPT certification), listening therapy (Therapeutic Listening), feeding therapy (SOS) and infant massage (CIMI). Mim received her MSW in 2012. Her work with children and youth has occurred in a variety of settings including early intervention, school based, clinic based, mental health and private practice. In her role as STAR Insitute’s Director of Education, Mim creates and teaches STAR Institute trainings, oversees SPD University, and provides educational programming and resources for clients and families.