Teaching a child to use the toilet can be frustrating in any circumstance. Teaching a child with intellectual and developmental delays can make the experience most unpleasant. There has been protocol set forth for teaching Down syndrome children to use the toilet but it has also been suggested that it is helpful for the child to witness a same gender parent or sibling using the toilet in order to see it take place.

The major factor in successful toilet training is the use of a schedule. It is important to watch the child's voiding habits for 2 or 3 days to get an idea of how many times a day he or she urinates and defecates. Most children will eliminate solids at the same time each day so it is important to document this time as well. Once the child's habits are documented, the parent needs to average approximately how often the child uses the bathroom so a training schedule can be put together. It is important to take the child to the bathroom twice as often as the child's average voiding. For example if the child goes once an hour then he should be taken to the bathroom every 30 minutes. It is also important to match up the toileting schedule with the approximate times the child will defecate to make sure he is at the toilet for those times.

It has been suggested that since many children with Down syndrome have difficulties with communication, they should be taught a physical sign for time to go to the potty in addition to the verbal cues. This can be used easily during times when the child needs to be quiet but needs to express the need to go to the bathroom.

It is important to make using the toilet a fun experience. There should be praises and small treats for successful trips to the toilet. The child should never be forced to sit on the toilet and should not be allowed to sit on the toilet longer than 5 to 7 minutes. Normally voiding will take place within that period. It can be helpful to give the child something to drink 15 to 20 minutes before the scheduled voiding time. This can assist with the child's need to go. The parent needs to check the status of the child's underpants several times during the day. It is helpful to get the child involved in this process so he or she can feel the wetness or the dryness. It brings the sense of touch into the process, which can be helpful for the child with Down syndrome. When the child does have an accident, it is important to have the child participate in cleaning up the mess. This includes changing clothes, washing up the body and cleaning up the floor if there is a mess there.

Finally, consistence is the key when toilet training a child with Down syndrome. Once cloth underpants are introduced and diapers are taken away, it is important to never go back to diapers. This tells the child that toilet training is optional and that he or she can choose to stay in diapers. Once this decision is made, it makes going back to training extremely difficult.