Toileting Difficulties in Children: Understanding an Overactive Core

Toilet training can be stressful for both children and parents. If your child is experiencing ongoing accidents, difficulty sitting on the toilet, or seems unable to “let go,” there may be more going on than meets the eye.

From an occupational therapy perspective, one underlying factor we sometimes see is an overactive core.

Let’s break down what this means and how it can impact your child’s toileting success.

Why Is Toileting Difficult for Some Children?
Toileting is not just a learned habit. It is a complex developmental skill that requires:

• Body awareness

• Gross and fine motor coordination

• The ability to relax core and pelvic muscles at the right time

For some children, their bodies are working overtime throughout the day. This can make toileting feel uncomfortable, confusing, or even overwhelming.

What Is an Overactive Core?

The core includes the muscles of the abdomen, lower back, and pelvis. These muscles help us sit upright, move efficiently, and maintain stability.

However, when these muscles are constantly switched on, meaning tight or braced, it becomes very difficult for a child to:

• Relax while sitting on the toilet

• Fully empty their bladder or bowels

• Tune into their body’s internal signals

In simple terms, if the body cannot relax, toileting becomes significantly harder.

Signs Your Child May Have an Overactive Core

You may notice your child:

• Appears stiff or tense in their body

• Has difficulty sitting still or relaxing

• Avoids sitting on the toilet

• Experiences frequent accidents despite toilet training

• Seems unaware of when they need to go

• Uses excessive effort, such as straining, holding, or rushing

These signs are often mistaken for behavioural challenges, when in fact they may reflect underlying physical and sensory differences.

How Occupational Therapy Can Help

At ChiroKinetix 4 Kids, we take a whole-child approach rather than focusing solely on toileting behaviour.

Occupational therapy supports toileting by addressing:

Body Awareness (Interoception)
Helping children recognise and respond to internal body signals.

Muscle Regulation
Teaching children how to appropriately activate and relax their core and pelvic muscles.

Sensory Processing
Supporting children who may feel overwhelmed by or disconnected from body sensations.

Toileting Routines
Establishing predictable, low-stress routines that build confidence and consistency.

Most importantly, these skills are developed through play-based, engaging activities that feel safe and achievable for the child.

Simple Strategies You Can Try at Home

Here are some practical, OT-guided strategies to support your child:

1. Heavy Work Activities

These activities help regulate the nervous system and reduce overall muscle tension:

• Pushing a laundry basket

• Carrying groceries

• Climbing or crawling games

2. Relaxation-Based Movements

Encourage the body to switch off and down-regulate:

• Child’s pose

• Gentle rocking

• Blowing bubbles or using a straw, even while sitting on the toilet

3. Correct Toilet Positioning

Positioning plays a significant role in successful toileting:

• Feet flat on a stool

• Knees slightly higher than hips

• Leaning forward with elbows resting on knees

This posture supports natural relaxation of the pelvic floor.

4. Build Awareness Through Routine

• Use consistent toilet times, not only in response to accidents

• Talk through body cues such as “your tummy feels full”

• Use visual supports if needed

When to Seek Support

If your child is experiencing frequent accidents, avoiding the toilet, becoming distressed, or not progressing despite consistent strategies, it may be time to seek professional support.

Early intervention with a paediatric occupational therapist can make a significant difference, particularly before children transition into school or more social environments.

Final Thoughts

Toileting is not simply about training. It reflects the connection between the brain and the body. For children with an overactive core, the challenge is not just recognising when to go, but learning how to let go.

With the right support, strategies, and understanding, children can build confidence and independence in their toileting journey.

Need Support?

At ChiroKinetix 4 Kids, our paediatric occupational therapists provide individualised, evidence-informed support for children experiencing toileting difficulties.

If you have concerns about your child’s toileting, we are here to help.