Potty Training

Most children show signs of readiness to begin using the toilet as toddlers, usually between 18 months and 3 years of age.

These signs include staying dry for at least 2 hours at a time, having regular bowel movements, being able to follow simple instructions, being uncomfortable with dirty diapers and wanting them to be changed, asking to use the potty chair, or asking to wear regular underwear. You should also be able to tell when your child is about to urinate or have a bowel movement by his facial expressions, posture or by what he says. If your child has begun to tell you about having a dirty diaper you should praise him for telling you and encourage him to tell you in advance next time.

You should choose a potty chair once your child has shown that he is ready to begin toilet training. You can have him decorate it with stickers and sit on it with his clothes on to watch TV, etc. to help him get used to it. Whenever your child shows signs of needing to urinate or have a bowel movement you should ask him if he wants to use the potty or take him to the chair and explain to him what you want him to do.

Only keep him seated for a few minutes at a time, don't insist and prepared to delay training if he shows resistance. Until he is going in the potty, you can try to empty his dirty diapers into his potty chair to help demonstrate what you want him to do.

Things to avoid when toilet training your child are beginning during a stressful time or period of change in the family (moving, new baby, etc.), pushing your child too fast, and punishing mistakes (treat accidents and mistakes lightly). Be sure to go at your child's pace and show strong encouragement and praise when he is successful.

Potty Training Readiness

As children approach 2 years of age, parents frequently start thinking about toilet training. What is the "right" age? Depending on whom you ask, the "right" age may range from as young as 6 months to 3 years. While age can be used as a determining factor, there are several others to address. The most important factors are not necessarily age, but rather physiologic, physical and psychological readiness.

Before a child can be "toilet trained", she must have attained a certain amount of physiologically readiness, namely "bladder readiness". In infancy, babies frequently are unable to hold large amounts of urine in their bladder and void small amounts. As a child grows older, her bladder becomes more mature, and is able over time to hold larger amounts of urine between voids. This comes hand in hand then with the additional ability to be able to increase the interval between voids. When you notice that your child is dry at longer intervals (i.e. dry after a nap or for at least 2 hours) and is voiding large amounts at a time, then that is a sign that your child may be physiologically ready for toilet training.

Another component, which overlaps with psychological readiness, is the ability of your child to recognize that she is voiding (i.e. if your child does not recognize when she is voiding, toilet training is virtually impossible). Some children start showing some signs of "bladder readiness" around 2 years of age. Most will attain it by three years of age.

Another component of readiness is physical readiness. This includes the ability to walk well (to and from the bathroom), to be able to pull pants up and down, and the ability to get on and off the toilet/potty chair fairly independently. While this may seem like a "given", think about grandmas who claim their children were toilet trained at 6 months or a year of age. Some kids are not even walking at a year, how could they be toilet trained?

The last component is probably the most important: psychological readiness. Or what I like to call willingness! If a child is not bothered by a wet or dirty diaper, if she is uninterested or unwilling to sit on the potty, believe me, you are not going to get very far. As the saying goes, you can place a toddler on a potty, but you can't make her pee. Toddlers quickly learn that they can control their bodily functions.

Once your child is showing all these components of toilet training readiness, most experts recommend waiting at least three months before you start toilet training to ensure that all is set. This is a good time to "set the stage" for toilet training as well (letting her observe others using the toilet, introducing books or videos on the subject, starting to talk about them using the potty soon).

Last but not least, look at yourself and your family situation. In order for toilet training to be as painless and smooth as possible, make sure that you AND your child are ready. Some kids toilet train quite easily, while for others it becomes what seems like a long drawn out battle. If you are incredibly busy at work, moving to a new house or a new baby is due soon, it's ok to wait a few months to let things settle down. This is probably one of the biggest steps for your child and it's worth it to wait.

Just remember, all good things come with time. Or as my then 3 and a half year old son said "You have to be patient, and then the pee will come".

Starting Potty Training

You've been waiting for the signals. Your child seems to recognize when she is peeing or pooping. And, miraculously, your child is actually telling you from time to time! ("I peed!" or "I pooped!"). She is dry after naps and occasionally upon awakening in the morning.

Now is the time to set the stage if you haven't done so already. Discussing using the toilet, reading about it, and even watching videos is just as important as the process itself. The more your child understands, the more successful toilet training will be.

Discussions of using the toilet are just that. If you haven't done so already, let your child see you and other family members using the toilet (modeling). Let your child know that when she is ready, she can do the same thing. If she has a little friend that is about the same age that is using the toilet, that can also be mentioned (nothing like some peer pressure!). If you notice that she is peeing or pooping, remark on it: "Are you peeing?"...especially if she is in the tub or naked and both of you are observing this act. Follow the observational comment with something positive, like "Let me know when you are ready to try peeing/pooping in the potty!" or "Next time we can try peeing in the potty if you like". Ongoing observational remarks and comments of "when you are ready" let the child know that there is no pressure to start, and that the choice is hers.

Books and videos are wonderful adjuncts to the discussions you have with your child. They help reinforce the ideas you have discussed. And, they see other "kids" or "characters" undergoing the same process, which will help your child understand the whole process.

If you haven't done so already, now is a good time to get the potty "ready" (i.e. purchase a potty chair or child sized potty seat that fits over toilet seat) and to buy some underwear or pull-ups.

Some things to consider regarding your potty "set up" is that there are several potty chairs out there. You needn't spend a fortune on one, but:

make sure that it is sturdy. The last thing you want is for it to collapse while your child is sitting on it!
make sure the "pot" part (where the pee and poop end up) of the chair is secure and empties easily for easy cleaning and minimal spilling.

It is also a nice idea, if your child is interested, to have your child help pick the potty chair. If there is something about the potty chair your child does not like (and believe me, you never know what a 2-3 year old might find fault in!), she may be resistant to using it........and that's the last thing you need!

Most children do start out with a potty chair, but if your child is older (around 3 years of age or older) or has an older sibling, she may prefer to use the "real" toilet first. In this case, a child-sized seat which fits over the toilet would be most helpful. Stability of the seat is probably the most when picking a potty seat. Find one that has the least amount of "wiggle" and does not feel like its going to collapse under the weight of the child. Make sure also, that there aren't any parts that may pinch the child. If your child doesn't feel secure on the potty seat, she may not feel comfortable enough to pee or poop in it.

The next consideration is pull-ups vs. underwear vs. training pants.

Things to keep in mind:

Pull-ups are very convenient and useful when first starting out. They are great for bedtime and naps. However, some children learn quickly that it is just like a diaper, and start using it as such. Similarly, some children may not care if they have peed/pooped in their pull-up because it is as absorbent as a diaper, and hence a wet/dirty pull-up does not motivate the child to use the potty. I would recommend pull-ups when the child is showing a lot of interest but not much consistency. It is nice to use the pull-up when they are running to the bathroom frequently (as diaper tabs generally start to wear out after awhile) with or without success. Not only are the pull-ups easier when using the potty, but they are "different" from diapers and the child will feel more "grown-up". Once your child gets the hang of it, transitioning to underwear would be the next step.
There is not too much difference between training pants vs. underwear. Training pants do have a layer that is meant to absorb more urine than regular underwear, but I have found that there is still a puddle on the floor after an accident regardless of the type of underwear. However, a little help may be better than none. The advantage that underwear has over pull-ups, is that the child definitely feels when she is wet/dirty which can help encourage/motivate a child to use the potty. Also, cleaning up after an accident takes longer and hence may serve as a deterrent to further accidents.

**A word of caution: some children may find toilet training discouraging or humiliating if they have too many accidents in underwear. So it is a good idea for the child to have some "successes" either in diapers or pull-ups before you put underwear on.**

With these thoughts in mind, we are getting closer and closer to independent toileting. Making sure your child is both physically and psychologically ready, and setting the stage are two of the most important steps in toileting success

Starting Potty Training II

OK! We're ready to start toilet training!

By the time you've finished with the preparation (discussions, videos, books), purchasing the potty chair and underwear/pull-ups, most children will have started making some associations between peeing/pooping and the potty. For some it may be peeing in his/her diaper, announcing that she needs to pee and running to the potty after the fact. For others, it may be actual successes on the potty. And yet, for others it may be the mere recognition of peeing in his/her diaper. This is the time to start watching your child's body signals closely.

Most children will have a tell tale stance, facial expression ("the look"), or routine (running to another room) when having a bowel movement. When you notice that your child is about to have a bowel movement (especially helpful if there is a particular time of day your child does it) this is the time to say "Shall we go sit on the potty?" If willing, take your child to the potty. Sometimes reading books will help your child relax while sitting on the potty. However, this may also end up being a "reading fest" so I would try to limit the book reading to only what's necessary. Additionally, some children may want "privacy" and helping them sit on the potty and then leaving (letting them know that when they are done they should let you know) may prove the most successful.

Recognizing when your child is urinating is a bit harder. Some children, especially as they get older and are voiding less frequently, will stop momentarily to pee. Some will even squat. Frequently watching their fluid intake is more helpful. If your child has had a large amount of fluid, taking him/her to the potty 30 minutes to an hour after drinking will maximize success, and help your child recognize the connection between bladder fullness and peeing.

Every child is different, and some children will be "bowel" trained before being "bladder" trained and vice versa. Whichever may be first, keep in mind that it is usually one before the other and not both simultaneously. Additionally, day-time dryness almost always comes before night-time dryness and may precede it by several months.

Now that the process has started, here are some additional things to keep in mind:

Patience! Patience! Patience!

Toilet training is a big process. Some experts feel that it is the first and biggest developmental step your child will take. The process generally takes several weeks to several months to complete.

Two steps forward, one step back.

Don't be discouraged if you have a few good days followed by a few bad. Again, it's a process that's going to take time. Also keep in mind that when your child is tired or upset this is the most common time for accidents or setbacks to occur.

Know when to back off

If you are pushing too hard, your child may "push" back with more accidents and/or resistance. Take the control out of the issue and step back. It is ok to take a few days or even few weeks "off" . Your child will recognize the power struggle is gone and relax and respond to it.

A final word: As hard as it may be to admit or realize, toilet training is truly in the control of your child. All you can do is be supportive and encouraging and set the stage for success. Keep in mind that your child will probably be toilet trained when she is ready, NOT necessarily when you are ready. If you are experiencing major difficulties, it may be time to sit back, re-examine the situation and ask yourself if your child is truly ready (see article on readiness). If you are meeting up with a lot of resistance in a child that is ready, it is time to examine those issues.

Potty Training Resistance

While most children show signs of physical readiness to begin using the toilet as toddlers, usually between 18 months and 3 years of age, not all children have the intellectual and/or psychological readiness to be potty trained at this age.

Signs of physical readiness can include your being able to tell when your child is about to urinate or have a bowel movement by his facial expressions, posture or by what he says, staying dry for at least 2 hours at a time, and having regular bowel movements.

Signs of intellectual and psychological readiness include being able to follow simple instructions and being cooperative, being uncomfortable with dirty diapers and wanting them to be changed, recognizing when he has a full bladder or needs to have a bowel movement, being able to tell you when he needs to urinate or have a bowel movement, asking to use the potty chair, or asking to wear regular underwear.

Things to avoid when toilet training your child, and help prevent resistance, are beginning during a stressful time or period of change in the family (moving, new baby, etc.), pushing your child too fast, and punishing mistakes (treat accidents and mistakes lightly). Be sure to go at your child's pace and show strong encouragement and praise when he is successful.

Even after he begins to use the potty, it is normal to have accidents and for him to regress or relapse at times and refuse to use the potty. The process of being fully potty trained, with your child recognizing when he has to go to the potty, physically goes to the bathroom and pulls down his pants, urinates or has a bowel movement in the potty, and dresses himself, can take time, often up to three to six months for most children. Having accidents or occasionally refusing to use the potty is normal and not considered resistance.

While it is recommended that you don't insist that he sits on the potty and you should be prepared to delay training if he shows resistance, at some point if his resistance to using the potty persists, especially after he is 3 -3 1/2 years old, then you should consider him resistant to potty training and you will need to change your methods.

Early on in the training, especially if your child is less than 3 - 3 1/2 years old, resistance should be treated by just discontinuing training for a few weeks or a month and then trying again. At this age (18 months to 3 years), resistance is usually because your child just isn't ready to begin training.

Potty training resistance usually occurs because your child has had a bad experience at some point during potty training, especially if he was started before he was intellectually or psycholgoically ready. Other times, especially with strong willed or stubborn children, it may have nothing to do with your technique or timing, and you may have done nothing wrong.

Reasons for developing a resistance to potty training can include:

being scared to sit on the potty chair
flushing the toilet may have scared him from wanting to sit on the toilet
being pushed too early or fast before he was ready
severe punishment for not using the potty or being forced to sit on the potty
inconsistant training, especially among different caregivers
he may have had a painful bowel movement from being constipated. If this is the case, treat his constipation and wait until he is having regular, soft bowel movements before you begin training again.
or he may just be stubborn and is involved in a power struggle with his parents and is using his control over where he has a bowel movement
he may enjoy the negative attention he gets from not using the potty or from having accidents
although rare, there are medical conditions that can make it difficult for your child to hold in or delay urinating or having a bowel movement. Discuss with your Pediatrician if there are any medical reasons why you may be having a hard time teaching your child to use potty, especially if he seems to have other delays in his development.

At this point, if your child is totally resistant to being potty trained, then it is best to just make him responsible for when he wants to use the toilet. This includes not punishing him for mistakes and not reminding him to use the potty. If he seems fearful, you can try and discuss calmly what it is about using the potty that scares him.

While you may get a lot of negative feedback from friends or family members about not being more aggressive with getting your child potty trained, you should be firm and let them know that you are working on it and remind them that not all children potty train at the same time.

In addition, it can be helpful if you:

establish a reward or incentive for using the potty. This should include lots of praise and attention when he uses the potty. It can also include a star or reward chart on which you child can place stickers whenever he uses the potty. After a certain number of days that he has stickers, then he can get a reward, such as toy, etc.
have your child be involved in changing himself when he wets or soils himself. This can include getting a new diaper, taking the dirty diaper off, cleaning himself (although he will probably need help after bowel movements), and throwing the dirty diaper away.
At some point you can change him into regular underware. You can talk about it beforehand and maybe have a ceremony where he throws away the left over diapers or you may just decide not to buy any new ones. Now, when he does wet or soil himself, you can have him help to clean out his underware in the sink or bathtub. You may even have him put them in the washing machine and wait with you while they are getting washed and dried. He should then dress himself. This method is not for everyone, but is usually very effective. You can also have him clean up after himself if he wet or soiled the floor.
Limit him to having BMs in the bathroom. This isn't always possible, but is easy if he always asks for a diaper just to have a bowel movement. Next, have him sit on the potty to have a bowel movement, even if he continues to wear his diaper. Then work on getting his diaper off by opening it and eventually taking it off. During this process, you should give lots of praise and rewards during each step.
If he is having a hard time learning to use the potty, but isn't necessarily resistant to the idea, then developing a regular daily routine of sitting on the potty for five or ten minutes every few hours may be helpful.
Most importantly, avoid physical punishment for not using the potty, even in an older child. It can be appropriate to verbally let him know that you disapprove of his not using the potty, but this should not get to the point of yelling, shaming or nagging.

Potty Training Problems

You are in the midst of toilet training. Things appear to be going relatively well. Your child appears to understand when she needs to use the potty, and is using it with some regularity. However, there's just one thing...

Problem #1: Your child is toilet trained at daycare/preschool but refuses to use the toilet at home.

This can be particularly frustrating for parents, as you know that your child can do it, but is just refusing to do it at home. Interestingly, I have found that this tends to occur in younger children (closer to 2 years of age), hence it may be more of a maturational issue.

Things to keep in mind:

Your child may be feeling little to no pressure at school/daycare to use the potty as it may be merely “part of the routine” (all the children go to the bathroom at the same time so your child is not singled out).
Copying what other kids do (or better yet, the older kids) is terrific incentive for a child, as opposed to parental pressure.
As frustrating as it may be, kids will sometimes do things for teachers they won’t do for parents (i.e. they know which buttons they can push in whom!).

So what's a parent to do? Here are some things to try:

Depending on your child’s age, level of language ability, and developmental level (i.e. a child closer to 3 years of age or older), it may be worthwhile trying to discuss this with your child. Keep it neutral and without pressure (“That’s so wonderful you are using the potty at school, your potty is here waiting when you are ready to use it at home”).
Discussions with daycare providers/teachers may also shed light on the problem (What is their routine? what do they say or do with the children?).
But most importantly, in this situation, especially if your child is closer to the age of two years, mere patience and backing off will frequently do the trick. Your child has taken a big step in using the potty at daycare. For whatever reason, s/he may not be ready to use the potty at home. You know s/he is capable, it’s just a mindset to get over. If there is no pressure on your part, your child will come around eventually.

Problem #2: Your child is completely urine trained. However, she continues to refuse to use the potty for bowel movements and specifically requests a diaper when she needs to have a bowel movement.

This problem is not all that unusual, and it may be attributed to either a fear of having a bowel movement in the toilet, the security of a diaper, or a coordination issue.

Things to try:

Again, being patient and backing off may be your best bet, especially if your child is on the younger side (less than three years of age).
If ongoing for several months, now may be the time to take some parental initiative. As per Dr. Iannelli’s article (Toilet Training Resistance), now may be the time to have the child go to the bathroom for bowel movements, gradually have the child sit on the potty with a diaper on, and eventually take it off to have a bowel movement. For those children who the diaper seems to lend much security, some experts even recommend cutting a hole in the diaper and allowing the child to wear the diaper on the potty, but having the BM go into the toilet.
If you notice that your child always stands to have a bowel movement, posture may be more the issue than the security of the diaper. Focus on having your child stand (or whatever transitional stance s/he needs)over the potty and then gradually go to sitting. In one particular example, a mother told me that she let her child be naked from waist down and allowed him to run back and forth to the bathroom, essentially allowing him to experiment with different stances, until he was able to have a bowel movement sitting on the potty. She found that once he was successful sitting on the potty, he was able to do it subsequently.

Problem #3: You know that your child can use the potty, but she is being very erratic and staying motivated seems to be the problem.

Here is a situation where you may want to consider offering rewards for using the potty.

On the pro side:

Experts and parents alike have found rewards to be helpful.
It is frequently the incentive your child needs to get started (or to stay motivated).

On the down side:

Other experts discourage use of rewards for behavior, as they feel that the child should be motivated from within to use the potty.
Some children may not clearly understand and want a reward when unearned. This may cause more trouble than it’s worth.
Candy, a very powerful and frequently used motivator, is the worst reward. Not only is it problematic with dental care, but it may also interfere with meals; and it is not uncommon to have a child peeing a drop of urine every 5 minutes for a candy treat.
Certain children may prove stubborn (or should I say resilient) enough and prolong the reward system for months.
Some children no matter what you try, will not be enticed by stickers, small toys or other rewards.

Conclusions:

Rewards do work for some, but not all children.
Keep rewards tangible and simple (i.e. 10 stickers to get a small prize may be too many for some children).
If a child does not understand or is easily frustrated by the reward system you create, it’s best to not use it.
For the sake of your child’s teeth and dietary habits, don’t use candy!
Know when to end it. When mastery is achieved, it’s time to stop the rewards. Frequently kids lose interest as their mastery of toilet training occurs and you may have no trouble. Others may hang on. Sometimes in a very stubborn child one can trade the reward chart/system for one “final toy”.

Final words on toilet training (as it is onward to Sibling issues for my next series of articles): Patience and Perspective! I know I sound like a broken record, but it is true, your child will not be in diapers forever, and patience is a necessary component on the parent’s part. Also, it’s good to keep perspective when you hit a stumbling point: this is just a small snag and your child will be toilet trained.