How Can I Help My Autistic Child Move from Pull-Ups to Underwear?

Many autistic children resist transitioning from pull ups or diapers to underwear but with a bit of preparation you can help ensure success.

Quick Summary

• Many autistic children resist wearing underwear due to sensory issues, routine changes, or interoception differences.

• Transitioning out of pull-ups takes time, patience, and a personalized approach.

• Try short wear periods, soft fabrics, layered underwear, and social stories.

• Use timers and routines to gradually increase underwear time without pressure.

• A visual home plan and reward system can support daily practice and success.

Table of Contents

1. Why Some Autistic Kids Resist Underwear

2. Helpful Statistics on Autism and Toilet Training

3. 10 Practical Tips for the Pull-Up to Underwear Transition

4. Sample Home Plan: 4-Day Underwear Practice

5. Extra Tips for Success

6. Related Resources & Freebies

What should I do if my child refuses to wear underwear?

Why Some Autistic Kids Resist Underwear

If your autistic child refuses to wear underwear, you’re not alone—and it’s not stubbornness.

There are a few common reasons this happens:

1. Sensory Sensitivities

Many autistic children find typical underwear uncomfortable. Seams, waistbands, tags, and fabric textures can feel itchy or painful.

2. Interoception Challenges

Your child may not yet recognize the feeling of needing to pee or poop, which can make wearing underwear feel unsafe or unpredictable.

3. Comfort with Routine

Pull-ups feel familiar. Changing to underwear can disrupt a routine your child depends on.

4. Motor or Communication Delays

Underwear may be harder to manage physically—or your child may not know how to explain what feels wrong.

Nearly 50% of autistic children aged 4–5 are not yet fully potty trained.

Helpful Statistics on Autism and Toilet Training

🧻 According to studies:

• Nearly 50% of autistic children aged 4–5 are not yet fully potty trained.

• Toilet training tends to be delayed by 1–2 years compared to neurotypical peers.

• Resistance to underwear is often linked to broader developmental, sensory, and emotional factors—not a lack of readiness.

(Source: CDC, Autism Speaks, ResearchGate articles on toileting delays in ASD)

10 Practical Tips for the Pull-Up to Underwear Transition

1. Start Small

   Wear underwear for 5–10 minutes during calm times at home. Set a visual timer so your child knows exactly how long they’ll be wearing it. This helps build predictability and avoids getting “stuck” in one phase too long.

   
   

2. Try Different Styles

   Seamless, soft cotton, or boy-short styles might feel better. Let your child explore different options and give feedback—even if it’s nonverbal.

   
   

3. Layer Over Pull-Ups

   Add underwear on top of the pull-up at first to introduce the feel while maintaining a sense of safety.

   
   

4. Offer Choices

   Let your child pick their favorite characters, colors, or even decorate plain underwear with fabric markers or iron-on patches.

   
   

5. Use a Social Skill Story That Explains and Normalizes the Change

   Some autistic children benefit from stories that walk them through new routines.

   
   

   Try a social skill story that explains what underwear is, why some kids start wearing it, and how it’s okay to feel nervous, excited, or unsure. These stories help reduce anxiety

   

   and make the experience more familiar. 👉Purchase story here

   
   

6. Practice at Low-Stress Times

   Don’t start new routines before a stressful event or when you’re in a rush. Calm, quiet moments at home are best.

   
   

7. Celebrate Small Wins

   Use a sticker chart, high-five, or simple verbal praise like “You wore underwear! That was brave!” to build positive momentum.

   
   

8. Try Again Later if Needed

   If your child resists, it’s okay to step back. Revisit a preferred pair of underwear or shorten the time again.

   
   

9. Keep a Calm Routine

   The more structured and calm the routine is, the more your child will know what to expect. Use a timer, a song, or a visual schedule to signal when it’s time to change.

   
   

10. Track Progress Visually

    A daily tracker helps you celebrate how long your child wore underwear—even if it’s just

    

    Click here to grab your free Underwear Chart!

    5 minutes.

    👉 You can download our free, child-friendly Underwear Sticker Chart to make progress fun and visual for your child! It includes space for daily stickers and a built-in reward line.

    Click here to grab your free Underwear Sticker Chart!

Sample Home Plan: 4-Day Underwear Practice

Day	Morning	Afternoon	Evening
1	Underwear for 5–10 min during quiet play	Pull-up rest of day	Underwear over pull-up before bath
2	Try softest style; reward wearing underwear	Watch a short video or read social story	Ask child to help pick tomorrow’s pair
3	Set a timer for longer session (10–15 min)	Introduce visual chart	Sticker chart or calm praise
4	Increase underwear time in two short sessions	Choose preferred fabric again	Celebrate with a reward of choice

Tip: If your child resists, return to a previous step and try again slowly.

Extra Tips for Success

• 💬 Normalize the Change: “Some kids take time to switch from pull-ups. That’s okay.”

• 🧺 Wash Before Wearing: Many kids find new clothes itchy— washing may help.

• 👃 Scent-Free Options: Avoid perfumed detergents if your child is scent-sensitive.

• 📷 Use a Visual Tracker: A simple check-off sheet or sticker chart can build motivation. [Use our free one here → Click here]

Related Resources & Freebies

🩲 Free Download: Potty Training Mini Coloring Book Social Story🧼 Blog: How to Use Social Stories for Toilet Training📚 Product: Editable Social Story: Transitioning from Pull-Ups to Underwear for Autism

Download a free potty training social story.