Paediatric Pelvic Health, Sensory Processing and Toileting Readiness with Quiara Smith
Paediatric pelvic health is so much more than wees, poos and toilet charts.
In this episode, Caitlin sits down for the second time with Quiara Smith, a paediatric pelvic health occupational therapist, to unpack the layered world of toileting, constipation, stool withholding, sensory processing and teen pelvic pain.
Quiara shares why the 24–30 month window tends to be a more developmentally and physiologically supportive time for toilet learning, and why rushing the process can contribute to the rise in toddlers presenting with withholding, toileting refusal and anxiety that she is seeing in clinic.
They explore how toileting is a whole-child skill — one that draws on sensory processing, nervous system regulation, interoception, environment, confidence and readiness — and why a toilet chart alone often isn't enough.
The conversation also turns to teen pelvic pain, particularly in high-achieving adolescent girls presenting with tampon pain, constipation, bladder holding at school and difficulty down-regulating their nervous system. Quiara explains how she approaches assessment with teens without internal examination, using education, consent-based external assessment, SEMG biofeedback and functional strategies.
Quiara also shares the thinking behind her sensory screening checklist for clinicians working with children with toileting difficulties, and gives an early glimpse into her use of red light and blue light therapy as an adjunct in paediatric pelvic health.
In this episode:
Why many children are not ready for toilet learning before 24 months
Stool withholding, constipation and toileting refusal in toddlers
The role of sensory processing and interoception in continence
Teen pelvic pain, tampon pain and school-based bladder and bowel habits
Consent-based assessment in paediatric pelvic health
Biofeedback with children and teens
Setting realistic expectations with families
Emerging use of red light therapy in paediatric pelvic health