Connection before correction. If you don't connect positively
with your child during this training, no way you can correct
his behaviour for you. You know the child is not going
to do it for you if it's there's no connection, so make it
positive. Playful play base, lots of
positive reinforcement in appropriate ways like.
This podcast shares personal stories and professional
insights, but it's not a substitute for medical advice or
therapy. If you're looking for support,
do speak to someone qualified and trained in child development
or special needs care. You'll find the full disclaimer
on the screen and in the show note.
Welcome to another episode of Adapting Together podcast.
I'm Sydney. I'll be one of the hosts today.
Together with me I have two Co hosts, Carmen and also Calvin.
Hello. OK, right.
So if you follow our previous episode, we were talking about
sleeping and today now is a continuation of the the the
recording. We also have Doctor Cindy in our
show today. So now we're going to talk about
I think that is also very important, which is
Constipation. So Doctor Cindy, let's just get
right into that that question. So when it comes to what
contributes to this in autistic children.
There are many factors. I think behavioral component is
an important one. And then the physiologic
component are like, like physically how they are wired
and all that. And of course a large part of it
is sensory issues in the terms of in in terms of what they are
willing to take in. So these are the common ones.
The behavioral ones are like they may be because if if you're
talking about kids with very profound difficulties related to
autism, the communication issues they can express when they are
uncomfortable, when they want to go, they can't direct that
communication to someone. They may feel uncomfortable, but
they don't have the social commutative abilities to direct
that request to someone. So if it's something and an
object you can just take and pick very tangible.
But when to ask to go to toilet, it's just a very vague concept.
You can't see it, you can't touch it, you can't lead.
And so so it takes time for some of these kids to understand that
this means have to go to toilet. And then a large part of it is
the society is the social difficulties that they have.
They don't understand why they've got to do it for you.
They don't understand why they've got to do it at a
certain place, you know. And so we have kids with some
verbal ability, but who are already 7-8 years old and still
they can request to pull, but they want to pull at a certain
corner of the house, usually behind the sofa and standing up.
Must have diaper on. That one is, you know, very
classic. Yeah.
So, yeah. So they they know they have the
the internal sensory, they are able to pick up the cues.
They can even request for diaper.
But the SOP, same place, you know, they must have that so
that that the rigidity is part of the behavioral part.
And then the second part is a physiologic function.
A lot of kids with autism also have medical Co occurring
difficulties with gut motility with their microbiome in their
gut. They either they're related to
what they've already started eating from the time they were
young, they're already picky, very fussy, very narrow.
And so that dietary preferences affect how their microbiome
developed as they grow older. And so they may have difficulty
with digesting certain types of food.
And that's partly because of the food that they were eating from
the beginning. Anyway, from the time they were
young, they really restricted what they want to accept.
And then gut motility. Some children have extra long
gut. Some kids, you know, have
motility issues. Even in typically developing
kids, you see that yeah, there are normal, normal development.
These kids in normal development, they may going to
the toilet 3 * 3 days was is quite normal for them.
So, but it's not an issue in the bigger scheme of things because
they can go when they want to and they can express distress
when they can't pull. But so kids with autism, they
are on the spectrum, and so they have social difficulties,
communication difficulties, sensory issues, many of them
with Constipation are picky eaters.
And there are kids who will not drink water.
They will only drink milk, you know, or they will only drink
ice bundle, you know, or Milo. Milo.
Milo yeah, I think Coco drinks yeah.
Milk is a is a common thing and they will not drink water if
they will drink water, they just take a sip or two and they run
off so they don't get enough fluids in to soften the stool
they're not taking enough fiber. Many of them have got Oromoto
difficulties, sensory issues, but because of difficulties with
motor coordination, they can't coordinate chewing.
And so they can only take things that are really meshed up and
not much of fiber inside. So these things that are meshed
up and with not much of fiber, they don't form the bulky stools
that help the stools to move along.
Most of them get absorbed up. And then so there's very little
bulk that reaches the large bowel.
And so the large bowel, the rectum, you know, it goes
through the large bowel and all that, the microbiome and the
motility and the food that they eat last, last which the rectum,
that's where the holding place is, right?
So for many of these kids who have chronic Constipation and
it's not tackled early or given medication, Bilapaloo, you know,
very irregular. No, not well planned, not
monitored. What happens is this children's
rectum, the large, the last bit of the large bowel gets
chronically distended. It gets some kids get even like
a mega colon kind of thing like big already used to that amount
that is big not being pushed out and it gets impacted.
And the longer the stools stay in the rectum, the more water is
absorbed. Our bodies will absorb every
last drop of water if possible, you know.
And So what happens is the child ends up with a rectum that is
chronically very long standing distended.
And the more distended it becomes over time, the as a
body's protective, the mechanism, the sensitivity that
that sensation to push becomes duller.
You know, the body's pain, discomfort, nerve, all the nerve
endings it down regulates. That means it becomes less
sensitive so that you can life can go on.
And So what happens is then the child can hold the stool for
five days a week. And then when it cannot, the
child cannot tolerate, wants to push.
What happens? Pain, Yeah.
It's a very bad experience for that.
Very painful bleeding fissure. And then finally what comes out
are the pellet pellets, you know like the tight camping pellet
pellet. First, sometimes parents will
realize they haven't pulled a few days this try try and get
more fluids in. So sometimes fluids will reach
the end. Then you have a distended
rectum. The large bulky pool is in the
middle. The water comes from the above,
nowhere to go. So the water will track down the
sites to escape and then you will see start staining on the
diaper or the pens. The soiling will happen.
OK. So the parents, the child does
pass motion, but actually it's just strict and pull the main
bulk of it is still there. Yeah.
So the overflow from the top will find water will always find
a way out, right. And so the overflow will check
down the side and bring with it little, little bits of pool that
are very watery. But it's not real pool, it's
actually the overflow that brought with bits of it.
So that is really a complication of long term neglected
Constipation. So for that kind of severe end
of the spectrum in terms of Constipation, we have to talk
about medical disinfection. This impact it with medication
if it's the child has no signs of bowel obstruction, not
vomiting Tami not distended yet can still pass flatter Saha can
pass wind then sometimes we can do it as outpatient.
But in my experience, we've had to admit occasionally we've had
to admit children, even teenagers for medical
disinfection in the ward because it's too, too chronic, too much.
And then the child may have signs of intestinal obstruction
with vomiting, cannot tolerate anything orally.
So we sometimes have to medically disinfect every few
hours. We will do the washout.
Yeah, colonic washout with very potent, stronger kind of
medication. So that is like worst case
scenario and once it happens, the child can be quite
traumatized. So we want to work on
Constipation issues on a regular basis when you know, on a
consistent basis tackle it when it's much milder.
But from what I hear from you, doctor, it seems like if it's
not addressed early, right, it will actually have a negative
reinforcement impact and it will become easier and easier for it
to stay there and Constipation. Will be afraid of pain and with
a child who cannot cannot communicate the the the safest
way for the child is holding in whole, whole, whole.
But holding it in can chronically distend the rectum
to such a point that the rectum loses some sensation to the
amount of stool. So the rectum will need more
stool to actually trigger pushing it.
Yeah, but by then you have a huge boulder there already.
So that causes the pain and it's a vicious cycle.
And then of course, when it's like that, the child's appetite,
they're not there to eat things don't not much appetite the Taji
because discomfort and then sleep.
Yeah, yeah. Oh, it's lousy.
And then don't sleep. Yeah, Doctor, how many days you
know that the kids don't go to the toilet pool, you know, then
only consider like it's a red flag for.
For the parents, so no hard and fast rule because the younger
the child is, the fewer days I will tolerate.
Maximum two to three days. If by the third day no pool, we
need to act on it or also poo every day.
But the amount is so small right?
Like little little bits come out or soiling a knee that is also
Constipation. Although the parent will say the
child pulls every day, but the amount is so little.
With the food that they they intake.
Yeah, it's so, so small amounts like a pallet, a knee or like
soiling streaks, a knee. Then another one is that there
are there's posturing some some children by the third day they
are posturing already. They are holding their tummy.
Or there are kids who are maybe those children with more
profound sensory issues. They may have what looks like
self injurious behavior. They may start injuring
themselves because of the pain and they bang, bang, bang
against the side of the of the table.
That's a common one. Or they like to bend over the
back of a chair to kind of relieve that that pain.
So if they are posturing, even if the child seems to pull every
every 2-3 days, I will still look hard for Constipation.
So sometimes if they allow me to examine, we'll examine the tummy
lying down. If you have good rapport with
the child, they will allow you can actually feel the fickle
mess, big, big lumps there. So even though the tummy is not
the standard and the parents deny it, but you can feel a big
lump. Yeah.
So it's not. Yeah.
Yes. So it's not about how many days.
It's like for every child, it's different.
It's how this how much discomfort the child has.
Yeah. So some children can go 5 days
with no discomfort. Some children every 3rd day
already have discomfort. The younger the child, the more
they, the less they can tolerate.
And of course, once when when we examine them, if we really can,
if we suspect that families cannot accept it, sometimes we
do an X-ray and you can see. Yeah.
Yeah, some parents, they also need visual support.
Yeah, we need to. See it and then?
Yeah. So and then from the X-rays, you
can see really loaded fecal latent and then with a big one
in the rectum. Yeah.
So sometimes we we do see that it's not just children autism.
We do see that in children with other neurodevelopmental
disorders as well. For for Constipation concerns
like issue like that right? What are some of the key steps
that parents can can can do to? Support.
Like. Better digestion, yeah.
So if this, these kids often they have delays in toilet
training. So when they, when the child is
not toilet trained, the child has no skills to go to toilet
when he wants to. So there's no option but to
communicate and rely on someone else, which for children in
autism is one more, one more obstacle.
So coiler training is actually very useful.
You can start even as young as 2-3 years old.
And if the child in the comfort areas, like say in the places
that he or she is very comfortable in, like in at home,
like usually at least the child has the, the, the ability or
the, or the option to go to toilet on his own without
requesting, without waiting, without queuing.
So I always try and advise toilet training start first,
whether or not the child successfully pulls it, just
start the process. So then we talk about toilet
training strategies, lots of visual support.
And I always say if you are dealing with SOP mind, make as
many skills SOP so that it's really how they learn, that's
how they learn. So even the things you say, make
it scripted so that it becomes the child's self talk, you know?
Actually this is also a very good practical way not just for
sleep and toileting routine but if we have a manual of SOP for a
particular child, it can become very important especially when
the parents no longer around. This is the SOP we can inherited
by the guardian or whoever is going to take care of the child
for the first time in your life. Yeah.
But the the thing about SOP is like, you know, during the COVID
times when they had a lot of SOP for these things, after a while
nobody looks at that. So because we all know the SOP,
so like all Sops, you no longer need to rely on something visual
when it becomes routine, a routine, it's internalized, it's
automatic. So when things are automatized,
it frees up your mind to to organize other things.
The key thing about toilet training is the timing, much
like sleep. So toileting or elimination
problems like sleep problems is very physiological.
So those physiological things, there's an internal clock.
What time you usually pull, what time you usually sleep, what
time you're hungry. Everybody has their own internal
clock, right? So understand what is your
child's internal clock? What time does he usually pull?
When he pulls, if it's every day, if it's three days, once.
If it's five days once, when does he usually pull on average?
Make an observation, chart it down if it's not written down.
People also often forget when they are handling their
multitasking. Yeah, families with neuros, with
neuro disabled or neuro diversity, they are always
multitasking. So write it down and I've got
charts that I will readily just give to parents so that they
don't have to go in Google or anything.
So then find the right time, choose that time to toilet train
first. So you optimize your chances.
Make it SOP step wise. If today get onto step two,
place the Step 2. See today we reach here,
tomorrow we try here. So it's very tangible what I can
see. And I know that all is not lost
if we didn't reach our ultimate goal.
So for the the child, progress is success already.
So step by step. So sometimes big SOP, big steps
can't work. Okay, that means the step is way
too big. Let's split the step up into
three other steps. So if the child who wants to sit
on the toilet seat you have. So this is pictures that I will
give to parents, I will e-mail to them.
I stop giving handouts, everybody.
Digital. Yeah, always e-mail stuff.
So if you talk to the kids that I work with, the parents all got
e-mail from me, my pictures and all that.
So we give them like a stool here you can see OK, so there's
always a foot rest there, bend forward.
So things like that. If the child can accept this and
all that, but insist on the diaper.
OK, let's breakdown the diaper stage into three separate steps
where the diaper sit there and put in the diaper.
OK, but set the set the stage. Tomorrow we are going to try no
diaper, still insist on diaper, cut a hole in the diaper.
Basically the expectation is we are going to get there, but I
will follow your pace. So the child is, You're teaching
the child two things by the training, but you're also
teaching the child how to adapt, how to negotiate in life, how to
resolve conflict. Because autistic minds are very
rigid minds, right? They can't negotiate, They can't
resolve conflict. So you've got to show them how
it's done. You cannot say if I'm the
father, I say. So you follow.
It's not going to work. Yeah.
You cannot fight fire if I. More meltdown.
Yeah, yeah. You cannot fight firefight.
So basically. I teach them conflict resolution
at the same time teaching them a life skill.
Yeah, correct. I'll meet you in the middle.
You give me a bit, I give you a bit.
But these are things that are maybe a little easier if you
have a child with some verbal ability.
With children with no verbal ability, that's fine.
I'll meet you in the middle. As I show you no picture.
I give you something to feature that helps you calm down.
Because when there is something in it for them, they have a
sense of control. And everybody needs that, right?
Everybody needs to win some. Yeah.
So step by step is always useful.
So in terms of the SOP, I think you can download anywhere.
There are lots of social stories.
But some kids, right? They really need things to be
real life. Yeah, their own toilet.
Picture their own toilet. Picture their own face.
Their own face. So I asked the parents, get your
child, put the toilet picture in your home, the one that he
likes. Get him to sit on it and take a
picture as well, because visualizing you sitting on the
toilet is very empowering for them.
They're already halfway there, you know, very visual way.
So for kids who can't really understand comedy or those kind
of like the illustration, we use the real life one.
Yeah. So this is like a Word document
that you can just adjust it according to your template.
Yeah. Some children love like Abcd's
numbers. Then we will.
I will ask the parents to just use that, use the numbers so
they know what's coming next. Yeah, so medication helps,
especially when they've given this a good goal.
The routine is in place, but still constipated.
Then it's a medical issue. Yeah.
Isn't it's not just behavioral. So then I explained to the
parents about the possibility that the large bowel, especially
the rectum, has kind of been desensitized.
And so we got to help nature along for a while so that it's
like a balloon, you know, once it's extended, it cannot
completely go back to this original stage.
So because give it time so it to help that some medication might
help. Doctor, is it normal or have you
seen children who even though after all the small steps and to
the extent that once the hole in the diapers is cut, they then
refuse to pee or poo because they know what we are trying to
do so they. Stop.
Yeah. So that's why I, I will say
don't never ever force, even with children with feeding
problems with autism, never ever force because they, these kids
with an autistic mind is very inflexible.
They're very rigid. They've got lots of sensory
issues that you and I have no idea because that's their whole
life. This is all they know.
And so for you to force them to do anything, it's really like
teaching them it, it's not OK, you know, to do this to my body.
So I will always take it very gradually and gently, very
gradually and gently. So in case we're very rigid,
right, the more anxious they are.
So if you traumatize any step of this toilet training, that's it.
You're like, go, go back to square one, take a number again,
you know, so it's, it's, it's a very everything must go through
from their point of view, follow their pace, follow their pace
from their point of view. If you put yourself in their
shoes, what will you feel if somebody made you sit there?
And also the rule of the HR, if the child is about 5, don't
force the child to sit there for half an hour, you know, maximum
also for 5 minutes. It's not the pool that comes
out. It's the ability to accept step
by step because if the child can finally sit on the toilet seat
with the foot rest, trousers down and diaper down, the child
needs to now be able to relax. If the child cannot relax on the
toilet seat, no way the anal sphincter ring is going to relax
anyway. Yeah, nobody is going to go.
No, you have to be able to relax.
Then nature will take its course and the inner sphincter muscles
will relax. Then you might get some success,
you know. So if training this creates
tension and anxiety, take a step back.
Everybody stand down, stand down, try again after this
thing. And then along the way, every
step of the way. I always also advise parents
connection before correction. If you don't connect positively
with your child during this training, no way you can correct
his behaviour for you. You know the child is not going
to do it for you if it's there's no connection.
So make it positive, playful play base lots of positive
reinforcement in appropriate ways, like increase every step.
Every step is success. Then eventually we're going to
get there and we're going to get there together.
So it's a connection factor that will make it successful.
So when children are traumatized, they usually have
been penalized, punished, scolded father, mother lost
temper, sometimes even smack. Then it happens.
It's human nature because parents tension, the anxiety
gets translated to the child and to the situation.
So in that case, reminder to grown up, everybody stand down.
This is not the end of the world.
Your child is healthy. For now, everybody just stand
down. Take a deep breath, take a deep
breath, stand down. Try again another week and then
let's go back and see which point you lose it.
At which point do parents lose it?
At which point does the child lose it?
And then there must be something at that step that makes that
person come undone, right? That unravel at that point.
Why is it because you have reached a point where you as a
parent, maybe it's overwhelming. Then you you stand down and
analyse. So it's very emotional, very
behavioral and very emotional, right?
Toilet training because it's such a socially unacceptable
behaviour if the child soils himself in public or when the
other extended families around, or when you know the child is so
big you can't even find diapers already to, to, to fit.
So when families are so financially cash strapped,
diapers are very expensive. So a lot of tension and all
that, that gets translated to a what should have been a natural
process. So take away the anxiety,
address the anxiety of all around toilet training and
actually half your battles already, less, less by half.
And then after that, make it SOP, make it positive in
connection with this whole process.
It's a very difficult thing. And then understand the child's
point of view in terms of why should I do this for you?
Teach the child, meet me in the middle.
You win a bit, I win a bit kind of thing.
And then medication, you know, as the circuit breaker.
Yeah, yeah, I always tell the even if you don't want to
consider medication, keep an open mind.
Keep an open mind. Yeah, so a lot of issues,
actually. It's nobody's fault.
Not the child, not the parents. Definitely.
It's absolutely. It's not anyone's fault, it's
not the parents fault and it's not the child's fault.
Common response is Doctor DI leave it to too late.
Is it too late now? It's never too late.
Your child is healthy. It's just time.
You are ready to address this now.
So then we address it. Doctor say any myth or
misconception about Constipation that you would in especially in
autism that you would like to clear up.
I think the biggest myth is that Constipation may be related to
diet as a cause of autism. You know that diet being causal
to the autism right now we, I know I'm not a researcher and I
don't proclaim to be the most well informed of biomedical
approaches. But what I do know based on
objective evidence that we have diet or nutritional factors as a
cause for autism and therefore therefore they have Constipation
or other gastrointestinal issues.
These are not not strongly supported by the evidence we
have right now. And autism is such a prevalent
condition the world over, however you look at it, there's
no denying that it's on the rise.
And so research is very active and research in diet also very
active, but very limited evidence that it cures autism,
that it causes autism. Now, having said that, diet
plays an important role in anybody's gut function, right?
And when you're talking about children with autism, picky
eater is so common. So we help to help the
Constipation is not just the plumbing issue, but what goes
inside. So we need to talk about
optimizing what the child is willing to take.
So if the child takes needs to take more water, OK, not sugary
drinks, but water in some way, even if the child is only
drinking, say, Milo, we work on diluting it.
Juice, we work on diluting it. Ice cubes, ice, ice ice cream,
Batang is Stillwater, you know, and with some diluted juice that
yeah, ice cube that they can suck on ice chips, things like
that. And then we work on hiding.
I said, but doctor, if I hide the fiber, then what the
channel? I said you, you will win some if
you have to lose some first. Yeah.
First, you know, get the bowels going.
Then you can talk about appetite going up and the child doesn't
feel uncomfortable. Then the child more willing to
eat more, you know. Yeah.
So then we talk about how to optimize the every mouthful the
child eats, the mom must make sure it's cow, cow full of, you
know, all the things that the child needs.
So we talk about micromanaging the the nutrition so that it's
nutrient dense. The fiber is also there in a way
that the child can take. We have dietary fiber that you
can sprinkle on top of food, different flavours.
You can easily buy that. And then medication, it's not
the fastest way. You still have to do the
behavioural intervention. You have to look into the diet
intake and and physical activity is important.
If a child is sedentary and not having enough vigorous activity
during the day, it doesn't help because our bodies are like
that. The brain is linked to our gut.
The gut is linked to our movement, our learning.
So it's all related. So if you are looking at the
young child, not going outdoors, not having vigorous activity,
not climbing, jumping, running, the gut is not going to move
very much. So everything helps.
Medication also helps. So a lot of parents and they
come to me, they've already bought over the counter
medication, but what they often buy are things that maybe 'cause
more discomfort, especially the, you know, some of the laxatives
are stimulant type, they make the bowels move.
So when you already have a distal obstruction and you try
to move the the beginning or it's going to cause more
discomfort, right? But there are more options, and
for me personally, I find that the osmotic laxatives are the
most gentle ones. Osmotic means it doesn't get
absorbed, it stays in the bowel and it absorbs liquids and then
it softens the stool. So there are stool softeners,
but they don't make the stool work harder to push it out.
So it doesn't it's very gentle and you can use it for months
every day of of course it should be monitored carefully so that
you're not overdosing or under dosing.
And many of these they have powder form also so you can
sprinkle on their food. If you put in a syrup form,
often the child sees run away already.
But if sprinkle first mouthful, get the child to eat.
So if the child is picky, I would say favorite food right in
the morning or afternoon, pick the time where the child is most
likely going to finish the meal first.
One to two mouthful, delicious favorite Food First, then OK,
third mouthful is when you put the and then we can get the 4th
mouthful. Yeah.
So these are small, small behavioralities.
Yeah, which is very helpful. Yeah, yeah.
So with medication, what helps is because you regulate the
power pattern, you give a chronically the standard rectum
a good chance to slowly get back to a more natural size.
And so you will need less distension to trigger the
sensation to push. Yeah.
And then also along the way, because the stools are softer,
they don't take so much effort to push out.
It's softer. So the child experiences less
pain when he does full. And so this helps the
behavioural routines that you put in place hand in hand.
Yeah. I think from what doctor has
shared, what I learned or realized is that everything
require us to detect it from the early stage, then it will mix
everyone's life a lot easier later.
Now the question is sometimes parents might be too busy and
for example, I hear from for sleep and digestion, right,
going out, it's important, but it might not be very easy to go
out like, you know, regularly, especially on the working day.
Plus, like my son, his schedule is also quite packed, so I think
his outdoor time has been reduced and hearing from you
now, I would want to make sure that we increase back some time
outdoor. We need to normalize children's
childhood. We need to normalize what they
need rather than make it wow so special.
Today we went out to the playground.
That should be what a young child needs every day.
During my time at least, you know, before school, after
school, during school. Now there are so many schools
with no playgrounds. Yeah, kindergartens or primary
schools. Some primary schools have no
playgrounds. The.
Playground is in basement. Yeah.
So that's not, that is just weird.
And then that's it's part of a bigger scheme of things.
What we set in motion. If we detect it, we realize it.
We need to undo some of it so that, you know, not just our
kids, but the whole community that we live in.
You know, everything is more, more sensible.
It's very sensible. Now, a lot of issues may
actually resolve by itself. Right?
Yeah. So, you know, the outdoor time,
physical activity, it regulates sleep, regulates bowel movements
for children in Constipation, it regulates picky eater appetite,
regulates mood, attention, social skills.
I don't see anything wrong with it, you know, But that is the
one thing that is decreasing in our kids.
And this thing is free. Yeah, Yeah.
There's like a lot of time when we see like a raining season for
a period of time, then we know that it's something not right
already because no outdoor, you know, Yeah, it must keep raining
in the evening so we can see the kids started to be a little bit
more easily agitated, sleepy. So if it's not and that positive
connections that you build with kids, right, being outdoors and
being active outdoors, it takes care of a lot of all those non
verbal, social, emotional skills that we are trying to teach our
autistic kids, you know? Yeah.
And being outdoors so allow them to observe other people more.
Yeah, it makes them adaptable to things that are not quite
routine in our. That we cannot create in our.
Yeah, they will pick up a lot of things that otherwise it's too
sheltered. Yeah.
And everything has a journey for my son.
The toilet training this month is already one year anniversary,
but we are not disheartened by although is already one year,
he's still undergoing toilet training, but we are able to
celebrate the small progress. I think it's incredibly
important. He's able to tell when he needs
a diaper. He recently he's telling his
therapist toilet toilet so he knows when he wants to go
toilet. But if he don't see this as a
progress, then everyone will be disappointed, correct.
And we are also very blessed because the therapist that
supporting my son, they have all the patients in the world to go
through the whole year. Actually I think it also reset
that right that there was a time he totally phobia with going to
toilet and sleeping. So sometimes we need to
understand why there's a sort of regression in that way.
Often it's an emotional thing. Behavior is tied to emotions.
You do have a different timeline.
Some can just pick up maybe one month or some few weeks already
learn it, but some will take extended.
But I think one thing that I agree with with Kevin is like,
don't be discouraged. Even your kid is taking a longer
time. Yeah, this is just correct.
Correct. Yeah.
Toilet training record book, I think or almost go yeah already
because for one year already it has a new one some more.
So we still have to keep hope and do what we need to do.
And don't discount all the progress or the little wins that
the small children has actually done.
It's not easy for them or don't in our eye like that.
It could be like that only, but to them that's a big milestone
already having. So these are the things that I
think we are really blessed and celebrate.
We want to celebrate more and doctor also mentioned, you know,
diapers is not cheap, which is true, but then what we learn
throughout this learning is that he since he's able to control
when he asked for diaper, that means he only use it one time
and we can change it off already.
So he. Started to.
Buy the very cheap one because it's just single use, so the
comfort level is no longer important because he wear it for
a very few minutes or 10 minutes or more.
So only night time we still buy back the very expensive one.
But the daytime one, we have two kind of diapers now, so which we
just look at the price and buy the night 1 is still the same
breath. So it does help this it keep the
diapers cost about half lower by half because the actual usage
during daytime is more than the night, night is one or two,
yeah, so different something we do.
And and it's important to find this.
A little humor in these little quirky things are when with our
kids I said was so quirky so funny just unique It's important
to have a laugh over it as well Yeah don't it's just this is one
of the things that you know when to OK everybody just stand down
you know and take a zoom out view of of things and.
We also laugh at the fact that he actually his usual pool spot.
He's next to where he sleep. Is he?
Oh, so he must feel very comfortable there.
So. He likes that.
Yeah, yeah, he's happy place, yeah.
That's why we try to lock the door because to, to adopt, it's
not hygienic. We lock the door, but then we
realize it's his comfort spot, so we don't want to take that
away from him. So what we can do is we allow
him to do that. Another tip before I forget that
when he still needs his diaper is clever already.
He knows already he can ask for that diaper.
Buy increasingly smaller size diaper.
Smaller, yeah. So like one day say getting
smaller, soon cannot soon cannot fit, already soon cannot fit.
So over a few weeks, maybe 1-2 months getting smaller.
So I think next week cannot fit already.
So again step by step by step, correct and it's step wise.
And so you are preparing him physique very tangible Ma
minimum smaller Ma the size is smaller you compare cannot fit
then he will physically he will have it's a cube.
That ready? Get the mind.
To be ready, get smaller and smaller in size I.
Hope you are now then. You feel so sad in skin so fast.
Everything. I hope he won't use the
underwear because. That is a comfort.
For him, I don't think so. I don't think so because he has
he's able to tell you he's able to differentiate.
Yeah. So every day you put on his
diaper to put getting smaller. I like the idea.
So cannot wear this. So cannot.
So the soon eventually cannot wear.
Yeah, but like me, I always tell myself shirt is getting tighter
so I buy a bigger size. OK I'm OK so need to reverse
one. So.
I feel like it's very important for parents to have a good
support system indeed, like like my son's journey, the therapist
and teacher is incredibly important for this whole toilet
training. Yes, yes, and.
Extended family use to. Help we have very good luck to,
you know, know all these great people who are here and we only
know them because we took the we had the chance to see doctor and
then Dr. tell us you need to do this.
Then only you know it all started from taking the doing
what we feel is able to do and the right first step.
Because I see many parents, they are worrying about a lot of
things, which is normal. But when we over worry a lot of
thing, we fail to identify what is the best next step.
And it's always the next step that leads to the next, next
step. So we just need to start from
the first step. Yeah, right.
So a favorite mantra of mine is you can only see as far as your
headlights. If you're driving a car in a
dark part of the road with no lights, you can only see as far
as your headlights show you. But if you know where you want
to go, you just need to get there.
And then the next step, the next step and somehow you will find
your way to your destination. So you don't need to know the
route, you just need to know where you hope to reach and then
take it one step at a time because there will always be
headlights, there will always be people to guide you, support you
if you reach out. Yes, if we don't isolate
ourselves, we will not be left alone.
Yeah, and I think this is also why we decided to spend our
energy and time to create a podcast called Adapting
Together. Our goal is always just to have
something to empower and inspire and support parents and
caregiver. And of course, it's not going to
be possible. It's just three of us alone.
We also need people who have experience working with children
across the spectrum, which is why we work very hard.
Carmen have been working very hard to invite different,
different expert to, to come and share across different topics.
And then we all are challenging ourselves and learning ourselves
everyday. So what we just asked and we
hope is that you find all this has been helpful.
And just now Doctor mentioned about dieting and whatnot.
And just a small preview, I think about two episodes from
now, we will talk about an episode which cover the topic of
feeding and dieting contents. Yeah.
So do come back and follow the podcast.
And of course, always I would like to just invite you to share
with people who might need it. Yeah, because Constipation, if
you detect it early, is very helpful.
But if we leave it a bit later, then it will become complicated
for everyone, which is avoidable.
Yeah. OK.
So with that, I think thank you, Doctor Cindy, for spending your
time. And yeah, thank you, everyone.
Bye. Bye.