The Royal Throne Set-Up — Feet Flat, Knees High

Your child learns to set themselves up on the toilet like a king or queen on a throne — feet supported, knees up, body relaxed, no rushing — which is the position that lets the bladder and bowel empty properly.

  1. Do the dangle test. On a dining chair, have your child sit with feet dangling and notice how their tummy and legs feel. Then slide a stool under their feet. “Which one feels steadier?” That is the difference you are about to fix in the bathroom.
  2. Build the throne. In the bathroom, set a sturdy step stool in front of the toilet and, if the seat is big, add a child seat insert. Your child adjusts the stool until their feet are flat and their knees are a little higher than their hips.
  3. Learn the pose. Bottom well back on the seat, knees apart, lean forward a little with elbows resting on knees, tummy soft. Practise once fully clothed with the lid down so it is just a pose.
  4. Add slow blowing. Give your child bubbles, a pinwheel or a party blower, or have them pretend to blow up a balloon — five long, slow blows. Blowing out gently helps the tummy muscles push while the bottom relaxes, with no straining.
  5. Use it at toilet time. From now on, the stool goes in place before sitting. Boys sit like this for a poo. Nobody leaps up the second they finish — count slowly to ten first to check everything is out.

Variation: Make a “throne check” drawing together — a stick figure with flat feet, high knees and leaning forward — and tape it where your child can see it from the seat. Away from home, practise the back-up plan — hold the seat edges for balance and lean forward.

Requirements

  • Space: Your bathroom, plus a dining chair for the dangle test
  • Surface: Non-slip bathroom floor
  • Materials: A sturdy non-slip step stool (or a solid box); optional: child toilet seat insert, bubbles, pinwheel or party blower
  • Participants: 1 adult + 1 child
  • Supervision: Moderate for the set-up and first tries; after that the child manages it alone

Rationale & Objective

A five-year-old on an adult toilet usually has dangling feet and is gripping to stay on — which tenses exactly the muscles that need to let go. ERIC and Bladder & Bowel UK both advise the same position for children: feet flat and firmly supported on a stool, knees higher than hips, leaning forward, relaxed. The International Children’s Continence Society includes instruction on voiding posture and regular, unhurried toilet habits in standard urotherapy, the first-line approach for children’s bladder and bowel problems, and NICE guidance on childhood constipation recommends scheduled toileting and support for a regular bowel habit as part of management. Good posture supports complete emptying, which in turn reduces damp underwear, constipation and the urgent dashes that cause accidents — all of which stand between a child and the “no daytime accidents” marker of independence. Slow blowing is a widely used ERIC tip that helps a child bear down gently without straining. Teaching the child to set up the stool themselves makes this an independent habit rather than something done to them, and the OT Practice Framework names maintaining a toileting position as a component of the toileting occupation.

Progress Indicators

  • Early: perches on the front of the seat with feet dangling and hands gripping; gets up the moment anything happens; wriggles and rushes
  • Developing: uses the stool when an adult puts it in place; holds the pose with reminders; sits long enough for a slow count to ten
  • Proficient: positions the stool and sits in the throne pose without being asked; relaxes and takes the time needed; boys choose to sit for a poo
  • Advanced: adapts on toilets away from home by sitting well back, holding the seat edges and leaning forward; can explain why supported feet help; notices and says when they have not finished

Safety Notes

  • Use a stool with a non-slip base and top, on a dry floor — stepping up and turning round is where slips happen
  • Check that a seat insert fits your toilet firmly and does not shift when your child leans forward
  • Keep sitting relaxed and short — a few unhurried minutes, never a long enforced sit, and never as a consequence for an accident
  • Do not ask your child to push hard or strain; the slow blowing is there to replace straining
  • See your doctor if your child has hard or painful stools, goes fewer than three times a week, has soiling or streaks in underwear, pain when weeing, or new daytime wetting — these need treatment, not just a better position

Hints

  • Playfulness: it is a throne, so treat it like one — the royal footstool must be in position before Their Majesty sits. Bubbles in the bathroom are a treat most children do not get anywhere else
  • Sustain interest: rotate the blowing toy (bubbles one week, pinwheel the next, then “blow out pretend birthday candles”); let your child decorate the stool with stickers
  • Common mistake: hurrying — “Quick, we’re late, just go.” A rushed child half-empties and needs to go again twenty minutes later. Build two extra minutes into leaving the house
  • Limited space: in a small bathroom use a low, slim stool that tucks beside the toilet; with no stool at all, a firm stack of old books taped together or an upturned sturdy box does the job
  • Cross-domain: slow breathing for calming (self-regulation); noticing how the body feels in two positions (body awareness); setting up and putting away own equipment (personal responsibility)
  • Progression: adult sets up the stool and coaches the pose → child sets up with a reminder → child sets up unprompted → child uses the pose on unfamiliar toilets without a stool → child takes unhurried time without being told

Sources

  • ERIC, The Children’s Bowel & Bladder Charity — advice on toilet sitting position (feet flat and supported, knees above hips) and blowing games
  • Bladder & Bowel UK — guidance on moving from potty to toilet and correct toilet position for children
  • Austin, P.F. et al. (2016), “The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children’s Continence Society,” Neurourology and Urodynamics — urotherapy and voiding posture
  • NICE Clinical Guideline CG99 (2010) — Constipation in children and young people: diagnosis and management
  • AOTA Occupational Therapy Practice Framework, 4th ed. (2020) — toileting and toilet hygiene, including maintaining toileting position
  • AAP HealthyChildren.org — guidance on constipation and toilet habits in children