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Connection before correction. 
If you don't connect positively 

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with your child during this 
training, no way you can correct

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his behaviour for you. 
You know the child is not going 

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to do it for you if it's there's
no connection, so make it 

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positive. 
Playful play base, lots of 

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positive reinforcement in 
appropriate ways like. 

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This podcast shares personal 
stories and professional 

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insights, but it's not a 
substitute for medical advice or

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therapy. 
If you're looking for support, 

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do speak to someone qualified 
and trained in child development

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or special needs care. 
You'll find the full disclaimer 

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on the screen and in the show 
note. 

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Welcome to another episode of 
Adapting Together podcast. 

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I'm Sydney. 
I'll be one of the hosts today. 

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Together with me I have two Co 
hosts, Carmen and also Calvin. 

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Hello. 
OK, right. 

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So if you follow our previous 
episode, we were talking about 

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sleeping and today now is a 
continuation of the the the 

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recording. 
We also have Doctor Cindy in our

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show today. 
So now we're going to talk about

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I think that is also very 
important, which is 

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Constipation. 
So Doctor Cindy, let's just get 

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right into that that question. 
So when it comes to what 

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contributes to this in autistic 
children. 

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There are many factors. 
I think behavioral component is 

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an important one. 
And then the physiologic 

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component are like, like 
physically how they are wired 

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and all that. 
And of course a large part of it

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is sensory issues in the terms 
of in in terms of what they are 

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willing to take in. 
So these are the common ones. 

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The behavioral ones are like 
they may be because if if you're

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talking about kids with very 
profound difficulties related to

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autism, the communication issues
they can express when they are 

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uncomfortable, when they want to
go, they can't direct that 

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communication to someone. 
They may feel uncomfortable, but

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they don't have the social 
commutative abilities to direct 

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that request to someone. 
So if it's something and an 

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object you can just take and 
pick very tangible. 

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But when to ask to go to toilet,
it's just a very vague concept. 

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You can't see it, you can't 
touch it, you can't lead. 

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And so so it takes time for some
of these kids to understand that

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this means have to go to toilet.
And then a large part of it is 

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the society is the social 
difficulties that they have. 

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They don't understand why 
they've got to do it for you. 

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They don't understand why 
they've got to do it at a 

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certain place, you know. 
And so we have kids with some 

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verbal ability, but who are 
already 7-8 years old and still 

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they can request to pull, but 
they want to pull at a certain 

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corner of the house, usually 
behind the sofa and standing up.

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Must have diaper on. 
That one is, you know, very 

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classic. 
Yeah. 

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So, yeah. 
So they they know they have the 

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the internal sensory, they are 
able to pick up the cues. 

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They can even request for 
diaper. 

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But the SOP, same place, you 
know, they must have that so 

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that that the rigidity is part 
of the behavioral part. 

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And then the second part is a 
physiologic function. 

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A lot of kids with autism also 
have medical Co occurring 

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difficulties with gut motility 
with their microbiome in their 

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gut. 
They either they're related to 

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what they've already started 
eating from the time they were 

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young, they're already picky, 
very fussy, very narrow. 

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And so that dietary preferences 
affect how their microbiome 

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developed as they grow older. 
And so they may have difficulty 

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with digesting certain types of 
food. 

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And that's partly because of the
food that they were eating from 

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the beginning. 
Anyway, from the time they were 

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young, they really restricted 
what they want to accept. 

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And then gut motility. 
Some children have extra long 

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gut. 
Some kids, you know, have 

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motility issues. 
Even in typically developing 

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kids, you see that yeah, there 
are normal, normal development. 

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These kids in normal 
development, they may going to 

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the toilet 3 * 3 days was is 
quite normal for them. 

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So, but it's not an issue in the
bigger scheme of things because 

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they can go when they want to 
and they can express distress 

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when they can't pull. 
But so kids with autism, they 

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are on the spectrum, and so they
have social difficulties, 

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communication difficulties, 
sensory issues, many of them 

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with Constipation are picky 
eaters. 

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And there are kids who will not 
drink water. 

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They will only drink milk, you 
know, or they will only drink 

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ice bundle, you know, or Milo. 
Milo. 

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Milo yeah, I think Coco drinks 
yeah. 

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Milk is a is a common thing and 
they will not drink water if 

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they will drink water, they just
take a sip or two and they run 

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off so they don't get enough 
fluids in to soften the stool 

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they're not taking enough fiber.
Many of them have got Oromoto 

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difficulties, sensory issues, 
but because of difficulties with

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motor coordination, they can't 
coordinate chewing. 

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And so they can only take things
that are really meshed up and 

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not much of fiber inside. 
So these things that are meshed 

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up and with not much of fiber, 
they don't form the bulky stools

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that help the stools to move 
along. 

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Most of them get absorbed up. 
And then so there's very little 

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bulk that reaches the large 
bowel. 

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And so the large bowel, the 
rectum, you know, it goes 

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through the large bowel and all 
that, the microbiome and the 

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motility and the food that they 
eat last, last which the rectum,

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that's where the holding place 
is, right? 

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So for many of these kids who 
have chronic Constipation and 

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it's not tackled early or given 
medication, Bilapaloo, you know,

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very irregular. 
No, not well planned, not 

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monitored. 
What happens is this children's 

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rectum, the large, the last bit 
of the large bowel gets 

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chronically distended. 
It gets some kids get even like 

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a mega colon kind of thing like 
big already used to that amount 

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that is big not being pushed out
and it gets impacted. 

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And the longer the stools stay 
in the rectum, the more water is

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absorbed. 
Our bodies will absorb every 

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last drop of water if possible, 
you know. 

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And So what happens is the child
ends up with a rectum that is 

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chronically very long standing 
distended. 

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And the more distended it 
becomes over time, the as a 

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body's protective, the 
mechanism, the sensitivity that 

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that sensation to push becomes 
duller. 

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You know, the body's pain, 
discomfort, nerve, all the nerve

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endings it down regulates. 
That means it becomes less 

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sensitive so that you can life 
can go on. 

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And So what happens is then the 
child can hold the stool for 

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five days a week. 
And then when it cannot, the 

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child cannot tolerate, wants to 
push. 

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What happens? 
Pain, Yeah. 

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It's a very bad experience for 
that. 

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Very painful bleeding fissure. 
And then finally what comes out 

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are the pellet pellets, you know
like the tight camping pellet 

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pellet. 
First, sometimes parents will 

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realize they haven't pulled a 
few days this try try and get 

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more fluids in. 
So sometimes fluids will reach 

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the end. 
Then you have a distended 

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rectum. 
The large bulky pool is in the 

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middle. 
The water comes from the above, 

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nowhere to go. 
So the water will track down the

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sites to escape and then you 
will see start staining on the 

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diaper or the pens. 
The soiling will happen. 

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OK. 
So the parents, the child does 

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pass motion, but actually it's 
just strict and pull the main 

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bulk of it is still there. 
Yeah. 

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So the overflow from the top 
will find water will always find

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a way out, right. 
And so the overflow will check 

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down the side and bring with it 
little, little bits of pool that

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are very watery. 
But it's not real pool, it's 

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actually the overflow that 
brought with bits of it. 

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So that is really a complication
of long term neglected 

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Constipation. 
So for that kind of severe end 

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of the spectrum in terms of 
Constipation, we have to talk 

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about medical disinfection. 
This impact it with medication 

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if it's the child has no signs 
of bowel obstruction, not 

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vomiting Tami not distended yet 
can still pass flatter Saha can 

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pass wind then sometimes we can 
do it as outpatient. 

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But in my experience, we've had 
to admit occasionally we've had 

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to admit children, even 
teenagers for medical 

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disinfection in the ward because
it's too, too chronic, too much.

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And then the child may have 
signs of intestinal obstruction 

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with vomiting, cannot tolerate 
anything orally. 

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So we sometimes have to 
medically disinfect every few 

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hours. 
We will do the washout. 

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Yeah, colonic washout with very 
potent, stronger kind of 

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medication. 
So that is like worst case 

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scenario and once it happens, 
the child can be quite 

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traumatized. 
So we want to work on 

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Constipation issues on a regular
basis when you know, on a 

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consistent basis tackle it when 
it's much milder. 

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But from what I hear from you, 
doctor, it seems like if it's 

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not addressed early, right, it 
will actually have a negative 

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reinforcement impact and it will
become easier and easier for it 

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to stay there and Constipation. 
Will be afraid of pain and with 

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a child who cannot cannot 
communicate the the the safest 

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way for the child is holding in 
whole, whole, whole. 

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But holding it in can 
chronically distend the rectum 

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to such a point that the rectum 
loses some sensation to the 

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amount of stool. 
So the rectum will need more 

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stool to actually trigger 
pushing it. 

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Yeah, but by then you have a 
huge boulder there already. 

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So that causes the pain and it's
a vicious cycle. 

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And then of course, when it's 
like that, the child's appetite,

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they're not there to eat things 
don't not much appetite the Taji

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because discomfort and then 
sleep. 

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Yeah, yeah. 
Oh, it's lousy. 

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And then don't sleep. 
Yeah, Doctor, how many days you 

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know that the kids don't go to 
the toilet pool, you know, then 

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only consider like it's a red 
flag for. 

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For the parents, so no hard and 
fast rule because the younger 

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the child is, the fewer days I 
will tolerate. 

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Maximum two to three days. 
If by the third day no pool, we 

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need to act on it or also poo 
every day. 

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But the amount is so small 
right? 

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Like little little bits come out
or soiling a knee that is also 

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Constipation. 
Although the parent will say the

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child pulls every day, but the 
amount is so little. 

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With the food that they they 
intake. 

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Yeah, it's so, so small amounts 
like a pallet, a knee or like 

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soiling streaks, a knee. 
Then another one is that there 

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are there's posturing some some 
children by the third day they 

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are posturing already. 
They are holding their tummy. 

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00:12:29,000 --> 00:12:32,520
Or there are kids who are maybe 
those children with more 

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profound sensory issues. 
They may have what looks like 

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self injurious behavior. 
They may start injuring 

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themselves because of the pain 
and they bang, bang, bang 

200
00:12:42,920 --> 00:12:45,680
against the side of the of the 
table. 

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00:12:45,680 --> 00:12:48,080
That's a common one. 
Or they like to bend over the 

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00:12:48,080 --> 00:12:51,480
back of a chair to kind of 
relieve that that pain. 

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00:12:51,680 --> 00:12:55,240
So if they are posturing, even 
if the child seems to pull every

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every 2-3 days, I will still 
look hard for Constipation. 

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So sometimes if they allow me to
examine, we'll examine the tummy

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lying down. 
If you have good rapport with 

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the child, they will allow you 
can actually feel the fickle 

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mess, big, big lumps there. 
So even though the tummy is not 

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00:13:13,400 --> 00:13:16,960
the standard and the parents 
deny it, but you can feel a big 

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lump. 
Yeah. 

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00:13:18,600 --> 00:13:20,000
So it's not. 
Yeah. 

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00:13:21,080 --> 00:13:23,600
Yes. 
So it's not about how many days.

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It's like for every child, it's 
different. 

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00:13:26,520 --> 00:13:29,960
It's how this how much 
discomfort the child has. 

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00:13:30,240 --> 00:13:32,480
Yeah. 
So some children can go 5 days 

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with no discomfort. 
Some children every 3rd day 

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already have discomfort. 
The younger the child, the more 

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they, the less they can 
tolerate. 

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And of course, once when when we
examine them, if we really can, 

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if we suspect that families 
cannot accept it, sometimes we 

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00:13:51,560 --> 00:13:55,560
do an X-ray and you can see. 
Yeah. 

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00:13:56,200 --> 00:13:58,680
Yeah, some parents, they also 
need visual support. 

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00:13:59,280 --> 00:14:01,000
Yeah, we need to. 
See it and then? 

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00:14:01,160 --> 00:14:03,760
Yeah. 
So and then from the X-rays, you

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00:14:03,760 --> 00:14:08,600
can see really loaded fecal 
latent and then with a big one 

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00:14:08,600 --> 00:14:11,240
in the rectum. 
Yeah. 

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00:14:11,240 --> 00:14:14,600
So sometimes we we do see that 
it's not just children autism. 

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00:14:14,600 --> 00:14:17,880
We do see that in children with 
other neurodevelopmental 

229
00:14:17,880 --> 00:14:23,320
disorders as well. 
For for Constipation concerns 

230
00:14:23,320 --> 00:14:26,120
like issue like that right? 
What are some of the key steps 

231
00:14:26,120 --> 00:14:30,440
that parents can can can do to? 
Support. 

232
00:14:30,800 --> 00:14:32,840
Like. 
Better digestion, yeah. 

233
00:14:32,840 --> 00:14:37,760
So if this, these kids often 
they have delays in toilet 

234
00:14:37,760 --> 00:14:40,840
training. 
So when they, when the child is 

235
00:14:40,840 --> 00:14:46,800
not toilet trained, the child 
has no skills to go to toilet 

236
00:14:47,400 --> 00:14:52,760
when he wants to. 
So there's no option but to 

237
00:14:52,880 --> 00:14:56,040
communicate and rely on someone 
else, which for children in 

238
00:14:56,080 --> 00:14:58,840
autism is one more, one more 
obstacle. 

239
00:14:59,120 --> 00:15:01,960
So coiler training is actually 
very useful. 

240
00:15:01,960 --> 00:15:04,400
You can start even as young as 
2-3 years old. 

241
00:15:04,840 --> 00:15:08,200
And if the child in the comfort 
areas, like say in the places 

242
00:15:08,200 --> 00:15:11,760
that he or she is very 
comfortable in, like in at home,

243
00:15:11,760 --> 00:15:17,600
like usually at least the child 
has the, the, the ability or 

244
00:15:17,600 --> 00:15:23,440
the, or the option to go to 
toilet on his own without 

245
00:15:23,440 --> 00:15:25,600
requesting, without waiting, 
without queuing. 

246
00:15:25,720 --> 00:15:28,960
So I always try and advise 
toilet training start first, 

247
00:15:29,160 --> 00:15:33,280
whether or not the child 
successfully pulls it, just 

248
00:15:33,280 --> 00:15:37,040
start the process. 
So then we talk about toilet 

249
00:15:37,040 --> 00:15:40,320
training strategies, lots of 
visual support. 

250
00:15:41,160 --> 00:15:45,360
And I always say if you are 
dealing with SOP mind, make as 

251
00:15:45,360 --> 00:15:50,480
many skills SOP so that it's 
really how they learn, that's 

252
00:15:50,480 --> 00:15:54,640
how they learn. 
So even the things you say, make

253
00:15:54,640 --> 00:15:59,080
it scripted so that it becomes 
the child's self talk, you know?

254
00:15:59,520 --> 00:16:03,720
Actually this is also a very 
good practical way not just for 

255
00:16:03,720 --> 00:16:10,960
sleep and toileting routine but 
if we have a manual of SOP for a

256
00:16:11,000 --> 00:16:14,280
particular child, it can become 
very important especially when 

257
00:16:14,280 --> 00:16:18,160
the parents no longer around. 
This is the SOP we can inherited

258
00:16:18,160 --> 00:16:22,000
by the guardian or whoever is 
going to take care of the child 

259
00:16:22,000 --> 00:16:23,840
for the first time in your life.
Yeah. 

260
00:16:24,280 --> 00:16:28,800
But the the thing about SOP is 
like, you know, during the COVID

261
00:16:28,800 --> 00:16:31,400
times when they had a lot of SOP
for these things, after a while 

262
00:16:31,400 --> 00:16:33,440
nobody looks at that. 
So because we all know the SOP, 

263
00:16:33,960 --> 00:16:37,840
so like all Sops, you no longer 
need to rely on something visual

264
00:16:37,840 --> 00:16:41,800
when it becomes routine, a 
routine, it's internalized, it's

265
00:16:41,800 --> 00:16:44,880
automatic. 
So when things are automatized, 

266
00:16:45,120 --> 00:16:49,280
it frees up your mind to to 
organize other things. 

267
00:16:49,800 --> 00:16:53,560
The key thing about toilet 
training is the timing, much 

268
00:16:53,560 --> 00:16:56,880
like sleep. 
So toileting or elimination 

269
00:16:57,160 --> 00:17:00,720
problems like sleep problems is 
very physiological. 

270
00:17:01,280 --> 00:17:04,880
So those physiological things, 
there's an internal clock. 

271
00:17:05,960 --> 00:17:08,920
What time you usually pull, what
time you usually sleep, what 

272
00:17:08,920 --> 00:17:12,079
time you're hungry. 
Everybody has their own internal

273
00:17:12,079 --> 00:17:15,160
clock, right? 
So understand what is your 

274
00:17:15,160 --> 00:17:18,480
child's internal clock? 
What time does he usually pull? 

275
00:17:18,520 --> 00:17:21,640
When he pulls, if it's every 
day, if it's three days, once. 

276
00:17:21,640 --> 00:17:25,720
If it's five days once, when 
does he usually pull on average?

277
00:17:25,920 --> 00:17:29,920
Make an observation, chart it 
down if it's not written down. 

278
00:17:29,960 --> 00:17:32,920
People also often forget when 
they are handling their 

279
00:17:32,920 --> 00:17:37,240
multitasking. 
Yeah, families with neuros, with

280
00:17:37,240 --> 00:17:40,680
neuro disabled or neuro 
diversity, they are always 

281
00:17:40,680 --> 00:17:44,760
multitasking. 
So write it down and I've got 

282
00:17:44,760 --> 00:17:47,720
charts that I will readily just 
give to parents so that they 

283
00:17:47,720 --> 00:17:49,760
don't have to go in Google or 
anything. 

284
00:17:50,120 --> 00:17:53,960
So then find the right time, 
choose that time to toilet train

285
00:17:53,960 --> 00:17:56,280
first. 
So you optimize your chances. 

286
00:17:56,520 --> 00:18:01,240
Make it SOP step wise. 
If today get onto step two, 

287
00:18:01,600 --> 00:18:03,960
place the Step 2. 
See today we reach here, 

288
00:18:04,120 --> 00:18:08,160
tomorrow we try here. 
So it's very tangible what I can

289
00:18:08,160 --> 00:18:10,840
see. 
And I know that all is not lost 

290
00:18:10,840 --> 00:18:13,440
if we didn't reach our ultimate 
goal. 

291
00:18:13,600 --> 00:18:16,960
So for the the child, progress 
is success already. 

292
00:18:17,240 --> 00:18:21,560
So step by step. 
So sometimes big SOP, big steps 

293
00:18:21,880 --> 00:18:24,440
can't work. 
Okay, that means the step is way

294
00:18:24,440 --> 00:18:26,680
too big. 
Let's split the step up into 

295
00:18:26,880 --> 00:18:30,280
three other steps. 
So if the child who wants to sit

296
00:18:30,280 --> 00:18:33,880
on the toilet seat you have. 
So this is pictures that I will 

297
00:18:33,880 --> 00:18:36,240
give to parents, I will e-mail 
to them. 

298
00:18:36,240 --> 00:18:37,880
I stop giving handouts, 
everybody. 

299
00:18:39,120 --> 00:18:41,480
Digital. 
Yeah, always e-mail stuff. 

300
00:18:41,680 --> 00:18:44,360
So if you talk to the kids that 
I work with, the parents all got

301
00:18:44,360 --> 00:18:46,400
e-mail from me, my pictures and 
all that. 

302
00:18:46,800 --> 00:18:52,760
So we give them like a stool 
here you can see OK, so there's 

303
00:18:52,760 --> 00:18:54,960
always a foot rest there, bend 
forward. 

304
00:18:55,160 --> 00:18:57,520
So things like that. 
If the child can accept this and

305
00:18:57,520 --> 00:18:59,880
all that, but insist on the 
diaper. 

306
00:19:00,200 --> 00:19:04,000
OK, let's breakdown the diaper 
stage into three separate steps 

307
00:19:04,520 --> 00:19:07,160
where the diaper sit there and 
put in the diaper. 

308
00:19:07,520 --> 00:19:14,360
OK, but set the set the stage. 
Tomorrow we are going to try no 

309
00:19:14,360 --> 00:19:19,880
diaper, still insist on diaper, 
cut a hole in the diaper. 

310
00:19:20,360 --> 00:19:25,440
Basically the expectation is we 
are going to get there, but I 

311
00:19:25,440 --> 00:19:30,080
will follow your pace. 
So the child is, You're teaching

312
00:19:30,080 --> 00:19:33,040
the child two things by the 
training, but you're also 

313
00:19:33,040 --> 00:19:38,160
teaching the child how to adapt,
how to negotiate in life, how to

314
00:19:38,160 --> 00:19:41,800
resolve conflict. 
Because autistic minds are very 

315
00:19:41,800 --> 00:19:45,600
rigid minds, right? 
They can't negotiate, They can't

316
00:19:45,600 --> 00:19:49,360
resolve conflict. 
So you've got to show them how 

317
00:19:49,360 --> 00:19:52,240
it's done. 
You cannot say if I'm the 

318
00:19:52,240 --> 00:19:54,000
father, I say. 
So you follow. 

319
00:19:54,040 --> 00:19:56,280
It's not going to work. 
Yeah. 

320
00:19:56,480 --> 00:19:58,800
You cannot fight fire if I. 
More meltdown. 

321
00:19:58,800 --> 00:20:00,720
Yeah, yeah. 
You cannot fight firefight. 

322
00:20:00,720 --> 00:20:04,000
So basically. 
I teach them conflict resolution

323
00:20:04,000 --> 00:20:06,080
at the same time teaching them a
life skill. 

324
00:20:06,080 --> 00:20:08,320
Yeah, correct. 
I'll meet you in the middle. 

325
00:20:08,480 --> 00:20:10,640
You give me a bit, I give you a 
bit. 

326
00:20:10,960 --> 00:20:14,640
But these are things that are 
maybe a little easier if you 

327
00:20:14,640 --> 00:20:16,720
have a child with some verbal 
ability. 

328
00:20:17,760 --> 00:20:20,400
With children with no verbal 
ability, that's fine. 

329
00:20:20,800 --> 00:20:25,080
I'll meet you in the middle. 
As I show you no picture. 

330
00:20:25,200 --> 00:20:28,960
I give you something to feature 
that helps you calm down. 

331
00:20:29,320 --> 00:20:34,240
Because when there is something 
in it for them, they have a 

332
00:20:34,240 --> 00:20:37,200
sense of control. 
And everybody needs that, right?

333
00:20:37,240 --> 00:20:40,000
Everybody needs to win some. 
Yeah. 

334
00:20:40,200 --> 00:20:43,120
So step by step is always 
useful. 

335
00:20:43,320 --> 00:20:47,720
So in terms of the SOP, I think 
you can download anywhere. 

336
00:20:47,720 --> 00:20:49,280
There are lots of social 
stories. 

337
00:20:49,560 --> 00:20:52,120
But some kids, right? 
They really need things to be 

338
00:20:52,120 --> 00:20:54,000
real life. 
Yeah, their own toilet. 

339
00:20:54,000 --> 00:20:56,440
Picture their own toilet. 
Picture their own face. 

340
00:20:56,600 --> 00:20:59,800
Their own face. 
So I asked the parents, get your

341
00:20:59,800 --> 00:21:02,960
child, put the toilet picture in
your home, the one that he 

342
00:21:02,960 --> 00:21:05,800
likes. 
Get him to sit on it and take a 

343
00:21:05,840 --> 00:21:10,480
picture as well, because 
visualizing you sitting on the 

344
00:21:10,480 --> 00:21:13,520
toilet is very empowering for 
them. 

345
00:21:13,520 --> 00:21:16,640
They're already halfway there, 
you know, very visual way. 

346
00:21:16,800 --> 00:21:20,840
So for kids who can't really 
understand comedy or those kind 

347
00:21:20,840 --> 00:21:25,960
of like the illustration, we use
the real life one. 

348
00:21:26,640 --> 00:21:29,520
Yeah. 
So this is like a Word document 

349
00:21:29,520 --> 00:21:32,400
that you can just adjust it 
according to your template. 

350
00:21:32,760 --> 00:21:35,800
Yeah. 
Some children love like Abcd's 

351
00:21:35,800 --> 00:21:37,120
numbers. 
Then we will. 

352
00:21:37,120 --> 00:21:40,760
I will ask the parents to just 
use that, use the numbers so 

353
00:21:40,760 --> 00:21:45,880
they know what's coming next. 
Yeah, so medication helps, 

354
00:21:46,240 --> 00:21:48,400
especially when they've given 
this a good goal. 

355
00:21:48,400 --> 00:21:51,400
The routine is in place, but 
still constipated. 

356
00:21:51,400 --> 00:21:54,200
Then it's a medical issue. 
Yeah. 

357
00:21:54,200 --> 00:21:57,800
Isn't it's not just behavioral. 
So then I explained to the 

358
00:21:57,800 --> 00:22:01,960
parents about the possibility 
that the large bowel, especially

359
00:22:01,960 --> 00:22:04,400
the rectum, has kind of been 
desensitized. 

360
00:22:04,600 --> 00:22:08,240
And so we got to help nature 
along for a while so that it's 

361
00:22:08,240 --> 00:22:10,480
like a balloon, you know, once 
it's extended, it cannot 

362
00:22:10,480 --> 00:22:13,320
completely go back to this 
original stage. 

363
00:22:13,320 --> 00:22:17,760
So because give it time so it to
help that some medication might 

364
00:22:17,760 --> 00:22:23,600
help. 
Doctor, is it normal or have you

365
00:22:23,600 --> 00:22:28,360
seen children who even though 
after all the small steps and to

366
00:22:28,360 --> 00:22:32,360
the extent that once the hole in
the diapers is cut, they then 

367
00:22:32,360 --> 00:22:37,040
refuse to pee or poo because 
they know what we are trying to 

368
00:22:37,040 --> 00:22:37,920
do so they. 
Stop. 

369
00:22:38,120 --> 00:22:40,520
Yeah. 
So that's why I, I will say 

370
00:22:41,320 --> 00:22:44,480
don't never ever force, even 
with children with feeding 

371
00:22:44,480 --> 00:22:48,720
problems with autism, never ever
force because they, these kids 

372
00:22:48,720 --> 00:22:51,240
with an autistic mind is very 
inflexible. 

373
00:22:51,400 --> 00:22:53,480
They're very rigid. 
They've got lots of sensory 

374
00:22:53,480 --> 00:22:56,560
issues that you and I have no 
idea because that's their whole 

375
00:22:56,560 --> 00:22:58,120
life. 
This is all they know. 

376
00:22:58,520 --> 00:23:02,120
And so for you to force them to 
do anything, it's really like 

377
00:23:02,120 --> 00:23:07,120
teaching them it, it's not OK, 
you know, to do this to my body.

378
00:23:07,320 --> 00:23:11,960
So I will always take it very 
gradually and gently, very 

379
00:23:11,960 --> 00:23:15,400
gradually and gently. 
So in case we're very rigid, 

380
00:23:15,440 --> 00:23:17,520
right, the more anxious they 
are. 

381
00:23:18,200 --> 00:23:22,720
So if you traumatize any step of
this toilet training, that's it.

382
00:23:24,080 --> 00:23:27,520
You're like, go, go back to 
square one, take a number again,

383
00:23:27,560 --> 00:23:33,720
you know, so it's, it's, it's a 
very everything must go through 

384
00:23:34,320 --> 00:23:37,560
from their point of view, follow
their pace, follow their pace 

385
00:23:37,560 --> 00:23:40,280
from their point of view. 
If you put yourself in their 

386
00:23:40,280 --> 00:23:43,440
shoes, what will you feel if 
somebody made you sit there? 

387
00:23:43,760 --> 00:23:47,720
And also the rule of the HR, if 
the child is about 5, don't 

388
00:23:47,720 --> 00:23:50,920
force the child to sit there for
half an hour, you know, maximum 

389
00:23:50,920 --> 00:23:54,200
also for 5 minutes. 
It's not the pool that comes 

390
00:23:54,200 --> 00:23:58,400
out. 
It's the ability to accept step 

391
00:23:58,400 --> 00:24:02,920
by step because if the child can
finally sit on the toilet seat 

392
00:24:02,920 --> 00:24:07,280
with the foot rest, trousers 
down and diaper down, the child 

393
00:24:07,280 --> 00:24:13,120
needs to now be able to relax. 
If the child cannot relax on the

394
00:24:13,120 --> 00:24:17,120
toilet seat, no way the anal 
sphincter ring is going to relax

395
00:24:17,120 --> 00:24:20,200
anyway. 
Yeah, nobody is going to go. 

396
00:24:20,440 --> 00:24:22,920
No, you have to be able to 
relax. 

397
00:24:22,920 --> 00:24:27,480
Then nature will take its course
and the inner sphincter muscles 

398
00:24:27,480 --> 00:24:30,280
will relax. 
Then you might get some success,

399
00:24:30,720 --> 00:24:34,160
you know. 
So if training this creates 

400
00:24:34,360 --> 00:24:37,160
tension and anxiety, take a step
back. 

401
00:24:38,120 --> 00:24:42,840
Everybody stand down, stand 
down, try again after this 

402
00:24:42,840 --> 00:24:45,240
thing. 
And then along the way, every 

403
00:24:45,240 --> 00:24:47,760
step of the way. 
I always also advise parents 

404
00:24:48,400 --> 00:24:53,240
connection before correction. 
If you don't connect positively 

405
00:24:53,240 --> 00:24:56,720
with your child during this 
training, no way you can correct

406
00:24:56,720 --> 00:25:00,280
his behaviour for you. 
You know the child is not going 

407
00:25:00,280 --> 00:25:03,880
to do it for you if it's there's
no connection. 

408
00:25:03,880 --> 00:25:08,720
So make it positive, playful 
play base lots of positive 

409
00:25:08,720 --> 00:25:13,240
reinforcement in appropriate 
ways, like increase every step. 

410
00:25:13,800 --> 00:25:17,040
Every step is success. 
Then eventually we're going to 

411
00:25:17,040 --> 00:25:19,840
get there and we're going to get
there together. 

412
00:25:20,040 --> 00:25:25,360
So it's a connection factor that
will make it successful. 

413
00:25:25,600 --> 00:25:28,560
So when children are 
traumatized, they usually have 

414
00:25:28,560 --> 00:25:32,640
been penalized, punished, 
scolded father, mother lost 

415
00:25:32,640 --> 00:25:38,400
temper, sometimes even smack. 
Then it happens. 

416
00:25:38,400 --> 00:25:43,160
It's human nature because 
parents tension, the anxiety 

417
00:25:43,160 --> 00:25:47,520
gets translated to the child and
to the situation. 

418
00:25:47,640 --> 00:25:52,320
So in that case, reminder to 
grown up, everybody stand down. 

419
00:25:53,120 --> 00:25:54,560
This is not the end of the 
world. 

420
00:25:54,960 --> 00:25:58,080
Your child is healthy. 
For now, everybody just stand 

421
00:25:58,080 --> 00:25:59,880
down. 
Take a deep breath, take a deep 

422
00:25:59,880 --> 00:26:02,960
breath, stand down. 
Try again another week and then 

423
00:26:02,960 --> 00:26:05,240
let's go back and see which 
point you lose it. 

424
00:26:06,040 --> 00:26:08,160
At which point do parents lose 
it? 

425
00:26:08,520 --> 00:26:10,480
At which point does the child 
lose it? 

426
00:26:10,880 --> 00:26:14,640
And then there must be something
at that step that makes that 

427
00:26:14,640 --> 00:26:18,160
person come undone, right? 
That unravel at that point. 

428
00:26:18,160 --> 00:26:21,400
Why is it because you have 
reached a point where you as a 

429
00:26:21,400 --> 00:26:26,880
parent, maybe it's overwhelming.
Then you you stand down and 

430
00:26:26,880 --> 00:26:29,840
analyse. 
So it's very emotional, very 

431
00:26:29,840 --> 00:26:32,280
behavioral and very emotional, 
right? 

432
00:26:32,520 --> 00:26:37,080
Toilet training because it's 
such a socially unacceptable 

433
00:26:37,080 --> 00:26:41,800
behaviour if the child soils 
himself in public or when the 

434
00:26:41,840 --> 00:26:46,600
other extended families around, 
or when you know the child is so

435
00:26:46,600 --> 00:26:49,800
big you can't even find diapers 
already to, to, to fit. 

436
00:26:50,000 --> 00:26:53,480
So when families are so 
financially cash strapped, 

437
00:26:53,840 --> 00:26:57,840
diapers are very expensive. 
So a lot of tension and all 

438
00:26:57,840 --> 00:27:02,920
that, that gets translated to a 
what should have been a natural 

439
00:27:03,160 --> 00:27:07,040
process. 
So take away the anxiety, 

440
00:27:07,120 --> 00:27:11,320
address the anxiety of all 
around toilet training and 

441
00:27:11,320 --> 00:27:16,080
actually half your battles 
already, less, less by half. 

442
00:27:16,280 --> 00:27:20,920
And then after that, make it 
SOP, make it positive in 

443
00:27:20,920 --> 00:27:22,880
connection with this whole 
process. 

444
00:27:22,880 --> 00:27:26,040
It's a very difficult thing. 
And then understand the child's 

445
00:27:26,040 --> 00:27:28,800
point of view in terms of why 
should I do this for you? 

446
00:27:29,120 --> 00:27:31,000
Teach the child, meet me in the 
middle. 

447
00:27:31,000 --> 00:27:33,280
You win a bit, I win a bit kind 
of thing. 

448
00:27:33,920 --> 00:27:37,880
And then medication, you know, 
as the circuit breaker. 

449
00:27:38,080 --> 00:27:41,520
Yeah, yeah, I always tell the 
even if you don't want to 

450
00:27:42,080 --> 00:27:44,520
consider medication, keep an 
open mind. 

451
00:27:44,520 --> 00:27:47,680
Keep an open mind. 
Yeah, so a lot of issues, 

452
00:27:47,680 --> 00:27:49,480
actually. 
It's nobody's fault. 

453
00:27:49,480 --> 00:27:51,840
Not the child, not the parents. 
Definitely. 

454
00:27:51,840 --> 00:27:56,480
It's absolutely. 
It's not anyone's fault, it's 

455
00:27:56,480 --> 00:27:59,560
not the parents fault and it's 
not the child's fault. 

456
00:28:00,120 --> 00:28:04,000
Common response is Doctor DI 
leave it to too late. 

457
00:28:04,120 --> 00:28:06,760
Is it too late now? 
It's never too late. 

458
00:28:06,760 --> 00:28:09,360
Your child is healthy. 
It's just time. 

459
00:28:09,360 --> 00:28:11,480
You are ready to address this 
now. 

460
00:28:11,880 --> 00:28:16,480
So then we address it. 
Doctor say any myth or 

461
00:28:16,480 --> 00:28:21,640
misconception about Constipation
that you would in especially in 

462
00:28:21,640 --> 00:28:23,640
autism that you would like to 
clear up. 

463
00:28:24,400 --> 00:28:28,560
I think the biggest myth is that
Constipation may be related to 

464
00:28:29,280 --> 00:28:34,560
diet as a cause of autism. 
You know that diet being causal 

465
00:28:34,560 --> 00:28:38,680
to the autism right now we, I 
know I'm not a researcher and I 

466
00:28:38,680 --> 00:28:43,880
don't proclaim to be the most 
well informed of biomedical 

467
00:28:44,000 --> 00:28:47,560
approaches. 
But what I do know based on 

468
00:28:47,880 --> 00:28:54,400
objective evidence that we have 
diet or nutritional factors as a

469
00:28:54,400 --> 00:28:58,240
cause for autism and therefore 
therefore they have Constipation

470
00:28:58,240 --> 00:29:00,400
or other gastrointestinal 
issues. 

471
00:29:01,040 --> 00:29:07,040
These are not not strongly 
supported by the evidence we 

472
00:29:07,040 --> 00:29:11,040
have right now. 
And autism is such a prevalent 

473
00:29:11,040 --> 00:29:14,520
condition the world over, 
however you look at it, there's 

474
00:29:14,520 --> 00:29:16,680
no denying that it's on the 
rise. 

475
00:29:16,920 --> 00:29:21,480
And so research is very active 
and research in diet also very 

476
00:29:21,480 --> 00:29:25,800
active, but very limited 
evidence that it cures autism, 

477
00:29:25,800 --> 00:29:31,080
that it causes autism. 
Now, having said that, diet 

478
00:29:31,080 --> 00:29:34,960
plays an important role in 
anybody's gut function, right? 

479
00:29:35,200 --> 00:29:38,040
And when you're talking about 
children with autism, picky 

480
00:29:38,040 --> 00:29:41,760
eater is so common. 
So we help to help the 

481
00:29:41,760 --> 00:29:45,440
Constipation is not just the 
plumbing issue, but what goes 

482
00:29:45,440 --> 00:29:47,480
inside. 
So we need to talk about 

483
00:29:47,520 --> 00:29:50,360
optimizing what the child is 
willing to take. 

484
00:29:50,720 --> 00:29:55,120
So if the child takes needs to 
take more water, OK, not sugary 

485
00:29:55,120 --> 00:29:58,520
drinks, but water in some way, 
even if the child is only 

486
00:29:58,520 --> 00:30:01,520
drinking, say, Milo, we work on 
diluting it. 

487
00:30:01,680 --> 00:30:07,880
Juice, we work on diluting it. 
Ice cubes, ice, ice ice cream, 

488
00:30:07,880 --> 00:30:12,800
Batang is Stillwater, you know, 
and with some diluted juice that

489
00:30:12,800 --> 00:30:15,720
yeah, ice cube that they can 
suck on ice chips, things like 

490
00:30:15,720 --> 00:30:17,760
that. 
And then we work on hiding. 

491
00:30:18,200 --> 00:30:21,000
I said, but doctor, if I hide 
the fiber, then what the 

492
00:30:21,000 --> 00:30:25,000
channel? 
I said you, you will win some if

493
00:30:25,000 --> 00:30:27,000
you have to lose some first. 
Yeah. 

494
00:30:27,080 --> 00:30:29,320
First, you know, get the bowels 
going. 

495
00:30:29,480 --> 00:30:33,440
Then you can talk about appetite
going up and the child doesn't 

496
00:30:33,720 --> 00:30:36,080
feel uncomfortable. 
Then the child more willing to 

497
00:30:36,080 --> 00:30:37,800
eat more, you know. 
Yeah. 

498
00:30:37,800 --> 00:30:41,200
So then we talk about how to 
optimize the every mouthful the 

499
00:30:41,200 --> 00:30:45,600
child eats, the mom must make 
sure it's cow, cow full of, you 

500
00:30:45,600 --> 00:30:47,160
know, all the things that the 
child needs. 

501
00:30:47,160 --> 00:30:51,720
So we talk about micromanaging 
the the nutrition so that it's 

502
00:30:51,720 --> 00:30:56,360
nutrient dense. 
The fiber is also there in a way

503
00:30:56,360 --> 00:30:59,720
that the child can take. 
We have dietary fiber that you 

504
00:30:59,720 --> 00:31:02,720
can sprinkle on top of food, 
different flavours. 

505
00:31:02,880 --> 00:31:08,600
You can easily buy that. 
And then medication, it's not 

506
00:31:08,600 --> 00:31:10,680
the fastest way. 
You still have to do the 

507
00:31:10,680 --> 00:31:14,600
behavioural intervention. 
You have to look into the diet 

508
00:31:14,600 --> 00:31:18,360
intake and and physical activity
is important. 

509
00:31:18,480 --> 00:31:22,680
If a child is sedentary and not 
having enough vigorous activity 

510
00:31:22,680 --> 00:31:27,680
during the day, it doesn't help 
because our bodies are like 

511
00:31:27,680 --> 00:31:29,760
that. 
The brain is linked to our gut. 

512
00:31:29,760 --> 00:31:33,360
The gut is linked to our 
movement, our learning. 

513
00:31:33,480 --> 00:31:36,720
So it's all related. 
So if you are looking at the 

514
00:31:36,720 --> 00:31:40,560
young child, not going outdoors,
not having vigorous activity, 

515
00:31:40,560 --> 00:31:44,560
not climbing, jumping, running, 
the gut is not going to move 

516
00:31:44,560 --> 00:31:46,640
very much. 
So everything helps. 

517
00:31:46,840 --> 00:31:50,480
Medication also helps. 
So a lot of parents and they 

518
00:31:50,480 --> 00:31:52,840
come to me, they've already 
bought over the counter 

519
00:31:52,840 --> 00:31:57,720
medication, but what they often 
buy are things that maybe 'cause

520
00:31:57,720 --> 00:32:02,120
more discomfort, especially the,
you know, some of the laxatives 

521
00:32:02,120 --> 00:32:05,760
are stimulant type, they make 
the bowels move. 

522
00:32:06,440 --> 00:32:09,440
So when you already have a 
distal obstruction and you try 

523
00:32:09,440 --> 00:32:12,880
to move the the beginning or 
it's going to cause more 

524
00:32:12,880 --> 00:32:15,920
discomfort, right? 
But there are more options, and 

525
00:32:15,960 --> 00:32:20,120
for me personally, I find that 
the osmotic laxatives are the 

526
00:32:20,120 --> 00:32:24,080
most gentle ones. 
Osmotic means it doesn't get 

527
00:32:24,080 --> 00:32:29,080
absorbed, it stays in the bowel 
and it absorbs liquids and then 

528
00:32:29,080 --> 00:32:32,280
it softens the stool. 
So there are stool softeners, 

529
00:32:32,560 --> 00:32:36,120
but they don't make the stool 
work harder to push it out. 

530
00:32:36,120 --> 00:32:39,640
So it doesn't it's very gentle 
and you can use it for months 

531
00:32:39,680 --> 00:32:44,480
every day of of course it should
be monitored carefully so that 

532
00:32:44,480 --> 00:32:46,800
you're not overdosing or under 
dosing. 

533
00:32:47,320 --> 00:32:50,720
And many of these they have 
powder form also so you can 

534
00:32:50,720 --> 00:32:54,360
sprinkle on their food. 
If you put in a syrup form, 

535
00:32:54,360 --> 00:32:56,560
often the child sees run away 
already. 

536
00:32:57,240 --> 00:33:01,560
But if sprinkle first mouthful, 
get the child to eat. 

537
00:33:02,240 --> 00:33:05,240
So if the child is picky, I 
would say favorite food right in

538
00:33:05,240 --> 00:33:07,920
the morning or afternoon, pick 
the time where the child is most

539
00:33:07,920 --> 00:33:09,880
likely going to finish the meal 
first. 

540
00:33:09,880 --> 00:33:14,240
One to two mouthful, delicious 
favorite Food First, then OK, 

541
00:33:14,520 --> 00:33:18,280
third mouthful is when you put 
the and then we can get the 4th 

542
00:33:18,280 --> 00:33:19,280
mouthful. 
Yeah. 

543
00:33:19,840 --> 00:33:22,160
So these are small, small 
behavioralities. 

544
00:33:22,440 --> 00:33:24,960
Yeah, which is very helpful. 
Yeah, yeah. 

545
00:33:24,960 --> 00:33:29,600
So with medication, what helps 
is because you regulate the 

546
00:33:29,600 --> 00:33:33,360
power pattern, you give a 
chronically the standard rectum 

547
00:33:33,440 --> 00:33:39,720
a good chance to slowly get back
to a more natural size. 

548
00:33:39,960 --> 00:33:44,240
And so you will need less 
distension to trigger the 

549
00:33:44,360 --> 00:33:46,440
sensation to push. 
Yeah. 

550
00:33:46,440 --> 00:33:49,680
And then also along the way, 
because the stools are softer, 

551
00:33:50,480 --> 00:33:52,800
they don't take so much effort 
to push out. 

552
00:33:53,280 --> 00:33:55,840
It's softer. 
So the child experiences less 

553
00:33:55,840 --> 00:34:00,480
pain when he does full. 
And so this helps the 

554
00:34:00,480 --> 00:34:05,200
behavioural routines that you 
put in place hand in hand. 

555
00:34:05,440 --> 00:34:09,400
Yeah. 
I think from what doctor has 

556
00:34:09,400 --> 00:34:13,719
shared, what I learned or 
realized is that everything 

557
00:34:13,719 --> 00:34:18,840
require us to detect it from the
early stage, then it will mix 

558
00:34:19,520 --> 00:34:21,639
everyone's life a lot easier 
later. 

559
00:34:22,199 --> 00:34:26,800
Now the question is sometimes 
parents might be too busy and 

560
00:34:26,800 --> 00:34:30,639
for example, I hear from for 
sleep and digestion, right, 

561
00:34:31,400 --> 00:34:36,800
going out, it's important, but 
it might not be very easy to go 

562
00:34:36,800 --> 00:34:40,440
out like, you know, regularly, 
especially on the working day. 

563
00:34:40,440 --> 00:34:45,000
Plus, like my son, his schedule 
is also quite packed, so I think

564
00:34:45,000 --> 00:34:49,280
his outdoor time has been 
reduced and hearing from you 

565
00:34:49,280 --> 00:34:53,120
now, I would want to make sure 
that we increase back some time 

566
00:34:53,159 --> 00:34:56,760
outdoor. 
We need to normalize children's 

567
00:34:56,760 --> 00:34:59,640
childhood. 
We need to normalize what they 

568
00:34:59,640 --> 00:35:03,480
need rather than make it wow so 
special. 

569
00:35:03,480 --> 00:35:05,400
Today we went out to the 
playground. 

570
00:35:05,400 --> 00:35:09,560
That should be what a young 
child needs every day. 

571
00:35:09,560 --> 00:35:12,720
During my time at least, you 
know, before school, after 

572
00:35:12,720 --> 00:35:16,160
school, during school. 
Now there are so many schools 

573
00:35:17,120 --> 00:35:20,640
with no playgrounds. 
Yeah, kindergartens or primary 

574
00:35:20,640 --> 00:35:23,440
schools. 
Some primary schools have no 

575
00:35:23,440 --> 00:35:24,840
playgrounds. 
The. 

576
00:35:25,200 --> 00:35:28,720
Playground is in basement. 
Yeah. 

577
00:35:28,840 --> 00:35:32,080
So that's not, that is just 
weird. 

578
00:35:32,560 --> 00:35:35,600
And then that's it's part of a 
bigger scheme of things. 

579
00:35:35,840 --> 00:35:38,920
What we set in motion. 
If we detect it, we realize it. 

580
00:35:38,920 --> 00:35:42,560
We need to undo some of it so 
that, you know, not just our 

581
00:35:42,560 --> 00:35:45,360
kids, but the whole community 
that we live in. 

582
00:35:45,640 --> 00:35:49,560
You know, everything is more, 
more sensible. 

583
00:35:50,440 --> 00:35:53,280
It's very sensible. 
Now, a lot of issues may 

584
00:35:53,280 --> 00:35:55,640
actually resolve by itself. 
Right? 

585
00:35:55,720 --> 00:35:58,560
Yeah. 
So, you know, the outdoor time, 

586
00:35:58,560 --> 00:36:02,760
physical activity, it regulates 
sleep, regulates bowel movements

587
00:36:02,760 --> 00:36:07,080
for children in Constipation, it
regulates picky eater appetite, 

588
00:36:07,360 --> 00:36:10,040
regulates mood, attention, 
social skills. 

589
00:36:10,080 --> 00:36:13,160
I don't see anything wrong with 
it, you know, But that is the 

590
00:36:13,200 --> 00:36:15,520
one thing that is decreasing in 
our kids. 

591
00:36:15,920 --> 00:36:18,360
And this thing is free. 
Yeah, Yeah. 

592
00:36:18,760 --> 00:36:21,440
There's like a lot of time when 
we see like a raining season for

593
00:36:21,440 --> 00:36:23,520
a period of time, then we know 
that it's something not right 

594
00:36:23,520 --> 00:36:28,080
already because no outdoor, you 
know, Yeah, it must keep raining

595
00:36:28,080 --> 00:36:32,440
in the evening so we can see the
kids started to be a little bit 

596
00:36:32,440 --> 00:36:38,080
more easily agitated, sleepy. 
So if it's not and that positive

597
00:36:38,080 --> 00:36:41,560
connections that you build with 
kids, right, being outdoors and 

598
00:36:41,560 --> 00:36:47,320
being active outdoors, it takes 
care of a lot of all those non 

599
00:36:47,320 --> 00:36:50,720
verbal, social, emotional skills
that we are trying to teach our 

600
00:36:50,760 --> 00:36:52,720
autistic kids, you know? 
Yeah. 

601
00:36:53,280 --> 00:36:56,480
And being outdoors so allow them
to observe other people more. 

602
00:36:56,760 --> 00:37:01,320
Yeah, it makes them adaptable to
things that are not quite 

603
00:37:01,320 --> 00:37:04,040
routine in our. 
That we cannot create in our. 

604
00:37:04,680 --> 00:37:08,960
Yeah, they will pick up a lot of
things that otherwise it's too 

605
00:37:09,000 --> 00:37:10,640
sheltered. 
Yeah. 

606
00:37:11,320 --> 00:37:14,360
And everything has a journey for
my son. 

607
00:37:14,800 --> 00:37:18,920
The toilet training this month 
is already one year anniversary,

608
00:37:19,680 --> 00:37:24,160
but we are not disheartened by 
although is already one year, 

609
00:37:24,160 --> 00:37:27,400
he's still undergoing toilet 
training, but we are able to 

610
00:37:27,400 --> 00:37:30,240
celebrate the small progress. 
I think it's incredibly 

611
00:37:30,240 --> 00:37:34,800
important. 
He's able to tell when he needs 

612
00:37:34,800 --> 00:37:37,720
a diaper. 
He recently he's telling his 

613
00:37:37,720 --> 00:37:41,720
therapist toilet toilet so he 
knows when he wants to go 

614
00:37:41,720 --> 00:37:44,560
toilet. 
But if he don't see this as a 

615
00:37:44,560 --> 00:37:47,400
progress, then everyone will be 
disappointed, correct. 

616
00:37:47,400 --> 00:37:49,920
And we are also very blessed 
because the therapist that 

617
00:37:49,920 --> 00:37:54,400
supporting my son, they have all
the patients in the world to go 

618
00:37:54,400 --> 00:37:58,160
through the whole year. 
Actually I think it also reset 

619
00:37:58,160 --> 00:38:01,040
that right that there was a time
he totally phobia with going to 

620
00:38:01,040 --> 00:38:03,560
toilet and sleeping. 
So sometimes we need to 

621
00:38:03,640 --> 00:38:08,120
understand why there's a sort of
regression in that way. 

622
00:38:08,120 --> 00:38:12,960
Often it's an emotional thing. 
Behavior is tied to emotions. 

623
00:38:12,960 --> 00:38:14,720
You do have a different 
timeline. 

624
00:38:14,720 --> 00:38:18,760
Some can just pick up maybe one 
month or some few weeks already 

625
00:38:19,080 --> 00:38:21,320
learn it, but some will take 
extended. 

626
00:38:21,320 --> 00:38:26,320
But I think one thing that I 
agree with with Kevin is like, 

627
00:38:26,320 --> 00:38:29,320
don't be discouraged. 
Even your kid is taking a longer

628
00:38:29,320 --> 00:38:32,040
time. 
Yeah, this is just correct. 

629
00:38:32,080 --> 00:38:32,960
Correct. 
Yeah. 

630
00:38:33,280 --> 00:38:37,400
Toilet training record book, I 
think or almost go yeah already 

631
00:38:37,400 --> 00:38:40,560
because for one year already it 
has a new one some more. 

632
00:38:40,920 --> 00:38:44,440
So we still have to keep hope 
and do what we need to do. 

633
00:38:44,440 --> 00:38:48,120
And don't discount all the 
progress or the little wins that

634
00:38:48,120 --> 00:38:50,000
the small children has actually 
done. 

635
00:38:50,120 --> 00:38:53,600
It's not easy for them or don't 
in our eye like that. 

636
00:38:53,600 --> 00:38:56,600
It could be like that only, but 
to them that's a big milestone 

637
00:38:56,600 --> 00:39:00,080
already having. 
So these are the things that I 

638
00:39:00,080 --> 00:39:02,720
think we are really blessed and 
celebrate. 

639
00:39:02,840 --> 00:39:07,920
We want to celebrate more and 
doctor also mentioned, you know,

640
00:39:07,920 --> 00:39:11,240
diapers is not cheap, which is 
true, but then what we learn 

641
00:39:11,440 --> 00:39:14,880
throughout this learning is that
he since he's able to control 

642
00:39:14,880 --> 00:39:19,040
when he asked for diaper, that 
means he only use it one time 

643
00:39:19,040 --> 00:39:20,360
and we can change it off 
already. 

644
00:39:20,360 --> 00:39:21,560
So he. 
Started to. 

645
00:39:22,000 --> 00:39:25,960
Buy the very cheap one because 
it's just single use, so the 

646
00:39:25,960 --> 00:39:28,640
comfort level is no longer 
important because he wear it for

647
00:39:28,640 --> 00:39:31,040
a very few minutes or 10 minutes
or more. 

648
00:39:31,360 --> 00:39:34,360
So only night time we still buy 
back the very expensive one. 

649
00:39:34,600 --> 00:39:38,080
But the daytime one, we have two
kind of diapers now, so which we

650
00:39:38,080 --> 00:39:41,280
just look at the price and buy 
the night 1 is still the same 

651
00:39:41,280 --> 00:39:46,000
breath. 
So it does help this it keep the

652
00:39:46,000 --> 00:39:50,640
diapers cost about half lower by
half because the actual usage 

653
00:39:50,640 --> 00:39:53,040
during daytime is more than the 
night, night is one or two, 

654
00:39:53,040 --> 00:39:57,040
yeah, so different something we 
do. 

655
00:39:57,800 --> 00:40:01,240
And and it's important to find 
this. 

656
00:40:02,400 --> 00:40:08,480
A little humor in these little 
quirky things are when with our 

657
00:40:08,480 --> 00:40:13,520
kids I said was so quirky so 
funny just unique It's important

658
00:40:13,520 --> 00:40:18,120
to have a laugh over it as well 
Yeah don't it's just this is one

659
00:40:18,120 --> 00:40:21,920
of the things that you know when
to OK everybody just stand down 

660
00:40:21,920 --> 00:40:25,600
you know and take a zoom out 
view of of things and. 

661
00:40:28,200 --> 00:40:32,080
We also laugh at the fact that 
he actually his usual pool spot.

662
00:40:32,520 --> 00:40:34,800
He's next to where he sleep. 
Is he? 

663
00:40:35,240 --> 00:40:37,240
Oh, so he must feel very 
comfortable there. 

664
00:40:37,240 --> 00:40:38,160
So. 
He likes that. 

665
00:40:38,280 --> 00:40:40,800
Yeah, yeah, he's happy place, 
yeah. 

666
00:40:41,120 --> 00:40:45,880
That's why we try to lock the 
door because to, to adopt, it's 

667
00:40:45,880 --> 00:40:48,280
not hygienic. 
We lock the door, but then we 

668
00:40:48,280 --> 00:40:51,880
realize it's his comfort spot, 
so we don't want to take that 

669
00:40:51,880 --> 00:40:54,360
away from him. 
So what we can do is we allow 

670
00:40:54,360 --> 00:40:58,120
him to do that. 
Another tip before I forget that

671
00:40:58,120 --> 00:41:00,320
when he still needs his diaper 
is clever already. 

672
00:41:00,320 --> 00:41:02,200
He knows already he can ask for 
that diaper. 

673
00:41:02,880 --> 00:41:05,480
Buy increasingly smaller size 
diaper. 

674
00:41:06,200 --> 00:41:09,000
Smaller, yeah. 
So like one day say getting 

675
00:41:09,000 --> 00:41:13,960
smaller, soon cannot soon cannot
fit, already soon cannot fit. 

676
00:41:14,080 --> 00:41:17,360
So over a few weeks, maybe 1-2 
months getting smaller. 

677
00:41:17,360 --> 00:41:19,960
So I think next week cannot fit 
already. 

678
00:41:20,520 --> 00:41:25,240
So again step by step by step, 
correct and it's step wise. 

679
00:41:25,480 --> 00:41:29,200
And so you are preparing him 
physique very tangible Ma 

680
00:41:29,200 --> 00:41:34,240
minimum smaller Ma the size is 
smaller you compare cannot fit 

681
00:41:34,720 --> 00:41:37,640
then he will physically he will 
have it's a cube. 

682
00:41:37,640 --> 00:41:39,320
That ready? 
Get the mind. 

683
00:41:39,360 --> 00:41:42,200
To be ready, get smaller and 
smaller in size I. 

684
00:41:42,640 --> 00:41:45,400
Hope you are now then. 
You feel so sad in skin so fast.

685
00:41:46,040 --> 00:41:49,800
Everything. 
I hope he won't use the 

686
00:41:49,880 --> 00:41:53,320
underwear because. 
That is a comfort. 

687
00:41:53,320 --> 00:41:57,320
For him, I don't think so. 
I don't think so because he has 

688
00:41:57,560 --> 00:42:01,000
he's able to tell you he's able 
to differentiate. 

689
00:42:01,160 --> 00:42:03,560
Yeah. 
So every day you put on his 

690
00:42:03,560 --> 00:42:07,040
diaper to put getting smaller. 
I like the idea. 

691
00:42:08,600 --> 00:42:10,080
So cannot wear this. 
So cannot. 

692
00:42:10,080 --> 00:42:13,200
So the soon eventually cannot 
wear. 

693
00:42:16,720 --> 00:42:20,080
Yeah, but like me, I always tell
myself shirt is getting tighter 

694
00:42:20,080 --> 00:42:23,840
so I buy a bigger size. 
OK I'm OK so need to reverse 

695
00:42:23,840 --> 00:42:27,440
one. 
So. 

696
00:42:28,080 --> 00:42:32,960
I feel like it's very important 
for parents to have a good 

697
00:42:32,960 --> 00:42:38,320
support system indeed, like like
my son's journey, the therapist 

698
00:42:38,320 --> 00:42:40,960
and teacher is incredibly 
important for this whole toilet 

699
00:42:40,960 --> 00:42:43,000
training. 
Yes, yes, and. 

700
00:42:43,080 --> 00:42:45,440
Extended family use to. 
Help we have very good luck to, 

701
00:42:45,480 --> 00:42:49,440
you know, know all these great 
people who are here and we only 

702
00:42:49,440 --> 00:42:54,080
know them because we took the we
had the chance to see doctor and

703
00:42:54,080 --> 00:42:55,960
then Dr. tell us you need to do 
this. 

704
00:42:56,160 --> 00:43:00,000
Then only you know it all 
started from taking the doing 

705
00:43:00,000 --> 00:43:04,040
what we feel is able to do and 
the right first step. 

706
00:43:04,640 --> 00:43:08,560
Because I see many parents, they
are worrying about a lot of 

707
00:43:08,560 --> 00:43:12,120
things, which is normal. 
But when we over worry a lot of 

708
00:43:12,120 --> 00:43:15,280
thing, we fail to identify what 
is the best next step. 

709
00:43:15,560 --> 00:43:18,280
And it's always the next step 
that leads to the next, next 

710
00:43:18,280 --> 00:43:20,560
step. 
So we just need to start from 

711
00:43:20,560 --> 00:43:21,960
the first step. 
Yeah, right. 

712
00:43:21,960 --> 00:43:26,800
So a favorite mantra of mine is 
you can only see as far as your 

713
00:43:26,800 --> 00:43:30,080
headlights. 
If you're driving a car in a 

714
00:43:30,080 --> 00:43:34,200
dark part of the road with no 
lights, you can only see as far 

715
00:43:34,200 --> 00:43:38,160
as your headlights show you. 
But if you know where you want 

716
00:43:38,160 --> 00:43:39,920
to go, you just need to get 
there. 

717
00:43:39,920 --> 00:43:42,800
And then the next step, the next
step and somehow you will find 

718
00:43:42,800 --> 00:43:46,680
your way to your destination. 
So you don't need to know the 

719
00:43:46,680 --> 00:43:50,600
route, you just need to know 
where you hope to reach and then

720
00:43:50,680 --> 00:43:55,640
take it one step at a time 
because there will always be 

721
00:43:55,800 --> 00:43:59,720
headlights, there will always be
people to guide you, support you

722
00:44:00,160 --> 00:44:03,800
if you reach out. 
Yes, if we don't isolate 

723
00:44:03,960 --> 00:44:06,320
ourselves, we will not be left 
alone. 

724
00:44:06,840 --> 00:44:12,280
Yeah, and I think this is also 
why we decided to spend our 

725
00:44:12,280 --> 00:44:16,560
energy and time to create a 
podcast called Adapting 

726
00:44:16,560 --> 00:44:19,400
Together. 
Our goal is always just to have 

727
00:44:19,400 --> 00:44:25,160
something to empower and inspire
and support parents and 

728
00:44:25,160 --> 00:44:27,360
caregiver. 
And of course, it's not going to

729
00:44:27,360 --> 00:44:29,800
be possible. 
It's just three of us alone. 

730
00:44:29,960 --> 00:44:34,120
We also need people who have 
experience working with children

731
00:44:34,120 --> 00:44:37,400
across the spectrum, which is 
why we work very hard. 

732
00:44:37,400 --> 00:44:40,240
Carmen have been working very 
hard to invite different, 

733
00:44:40,240 --> 00:44:43,760
different expert to, to come and
share across different topics. 

734
00:44:44,080 --> 00:44:47,880
And then we all are challenging 
ourselves and learning ourselves

735
00:44:47,880 --> 00:44:50,760
everyday. 
So what we just asked and we 

736
00:44:50,760 --> 00:44:54,160
hope is that you find all this 
has been helpful. 

737
00:44:54,440 --> 00:44:57,560
And just now Doctor mentioned 
about dieting and whatnot. 

738
00:44:57,840 --> 00:45:00,880
And just a small preview, I 
think about two episodes from 

739
00:45:00,880 --> 00:45:04,960
now, we will talk about an 
episode which cover the topic of

740
00:45:04,960 --> 00:45:08,520
feeding and dieting contents. 
Yeah. 

741
00:45:08,800 --> 00:45:11,440
So do come back and follow the 
podcast. 

742
00:45:11,440 --> 00:45:14,720
And of course, always I would 
like to just invite you to share

743
00:45:14,720 --> 00:45:18,240
with people who might need it. 
Yeah, because Constipation, if 

744
00:45:18,240 --> 00:45:20,440
you detect it early, is very 
helpful. 

745
00:45:20,680 --> 00:45:23,560
But if we leave it a bit later, 
then it will become complicated 

746
00:45:23,560 --> 00:45:25,720
for everyone, which is 
avoidable. 

747
00:45:25,720 --> 00:45:26,480
Yeah. 
OK. 

748
00:45:26,680 --> 00:45:30,120
So with that, I think thank you,
Doctor Cindy, for spending your 

749
00:45:30,120 --> 00:45:32,800
time. 
And yeah, thank you, everyone. 

750
00:45:32,800 --> 00:45:33,720
Bye. 
Bye.