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The first person with Down syndrome that I ever knew was my sister, who is now 42 years old. She inspired me to a career in working with children who have special needs, so over the course of decades, I have successfully toilet trained many children.

The first step is to get her out of pullups or diapers and into regular underpants. Why? The pullups and diapers do such a good job of absorbing the urine that the child never really experiences being wet. It is really difficult to teach toilet training if the child never realizes that she is wet. So you start by saying, “Guess what? You’re a big girl now, and you get to wear big girl underpants!” Make it sound like the beginning of a great adventure. Take her shopping and let her pick out the underpants that she finds most attractive. Get at least 10 pairs, because you always need some clean and dry ones – don’t put her back in pullups or diapers in the day time. (You may want to use them at night at first, since night time bladder control is more difficult.)

At home, have her put on her new underpants and tell her how great she looks and what a big girl she is. If possible, have her wear clothes that are easy to get on and off – sweat pants with an elasticized waist are ideal. Take her into the bathroom and have her sit on the potty, and tell her, “This is where you need to go when you wear big girl pants.” Then you need to start a schedule of taking her to the bathroom at regular intervals. You might start with taking her every hour and having her sit on the toilet for 2 minutes. A lot of kids like to have a chart that they can see, so you can draw a star for every time she sits on the toilet, even if she doesn’t urinate. When she does pee in the toilet, give her all sorts of praise and attention – “Hooray for Sara! You peed in the potty! You’re a big girl now! Great job!” Then put a sticker on the chart – that shows that just sitting on the toilet is great (a star) but actually using the toilet is fantastic (a sticker.)

She will no doubt have a few accidents, and when she does, you calmly say, “Oops, pee goes in the toilet, not in your Princess underpants.” You don’t get upset or angry, but you do have her take responsibility for helping to clean up and change herself. Just stick with the schedule, adjusting the time intervals if you need to. She will not like the feeling of being wet, nor the hassle of cleaning up, and that will help motivate her to use the toilet.

It’s very unlikely that she will be toilet trained completely in the first couple of weeks, so don’t get discouraged. Keep praising her for trying, and give her stickers or other small rewards when she does use the toilet. I promise you, this works with virtually every child – just keep it positive and keep on trying. She will get it sooner or later, and the inconvenience of extra laundry and a few messes will be far outweighed by her increased independence.