It’s Potty Time!

Patience, patience, patience- the ultimate virtue to possess when training your toddler to master the toilet. The developmental task will be accomplished when both parent and child are ready and willing to put forth the effort. Children are not physically or mentally ready to potty until they are 24 months old, and some research suggests that 27 months is even more appropriate. Parents are ready when they are able to devote the time and energy necessary for encouragement on a daily basis for at least three months. The toddler is ready when he or she can signal that the diaper is wet or soiled, or when your child is able to say that he or she would like to go to the potty.

Toilet training proceeds optimally when parents appreciate the child’s need for autonomy and mastery. If this process begins before the child is ready, tension may be created between the parent and the child. By respecting the child’s autonomy and pride in potty mastery, parents can make training an occasion for growth rather than for frustration and conflict.

How do I know when my child is ready?
Some of the behaviors that may indicate that your child is ready to be toilet trained may be:
(All of these signals do not have to be present, but the more behaviors your toddler possesses, the more efficient potty training will be

• has regular, soft bowel movements, at somewhat predictable times
• can pull his pants up and down
• imitates other’s bathroom habits (likes to watch you go to the bathroom, wants to wear underwear/panties)
• makes a physical demonstration when he’s having a bowel movement (grunting, squatting, telling you, or he hides)
• has words for stool and urine
• can follow simple one step command
• can feel that he has to go and can may be tell you before it happens
• likes to be in a clean diaper
• periods of dryness of at least 3-4 hours –this shows that the bladder muscles that hold urine in and store it are developed
• doesn’t have negative feeling about the potty if you suggest he may want to use it
• understands the value of putting things where they belong-toys, etc
• demonstrates a desire for independence
• can walk and sit down
• asking to wear “big boy/big girl underwear”
• able to “sit down and play quietly for 5 minutes”
  

How can I begin preparation for training?
First of all, is this a period of stress in the house? Any major changes going on in the house? (moving, new baby, parent returning to work) Ideally, it should be at least 4-6 weeks from the stressful time to begin the process.

Decide carefully what words you will use to describe specific body parts, urine, bowel movements. Friends, caregivers, teachers, family members will all hear these words, so be discriminating. Proper and not “family” terms will not embarrass or confuse your child while in the company of others. Do not use words such as “dirty” or “naughty” to describe any aspect of toileting. Ensure that bowel movements and urine are discussed in frank and straightforward terms. If your child wishes to play with her “creations”- immediately say, “this is not something to be played with” and distract her with completing the process.

Choosing a potty chair is the first step and placing it in a familiar place –in the toy room. To increase familiarity in the early stages, you may encourage your child to decorate the potty to “make it his own”- stickers, etc. Later, your child may want to sit on it with his clothes on. If she shows signs of needing to urinate or have a bowel movement, ask if she wants to sit on the potty. Do not insist that your child use the potty, and only keep her seated there for a short time. Read a story or sing a song. Sometimes sitting a favorite toy, doll, or stuffed animal on the potty may ease comfort. If you encounter resistance, delaying training is optimum. Do not push your child rapidly, be lavish with praise and think about an “instant gratification” small reward for each time he is successful. Practice sessions once or twice a day for about 2 weeks may be necessary for the learned behavior to “sink in” with your toddler.

How do I actually train my toddler?
Each stage may last a week or longer.

Stage One:
• Keep a daily log of urine and BM’s just like you did during the newborn period- so you may identify a pattern
• Put the potty in the bathroom and casually talk about what it is and why it is there- ( it may be helpful to place it in your child’s toy area first!)- give your child the control- let him ask questions about it rather than you initiating the dialogue.
• Have your toddler sit on the potty several times a day with my clothes on- this will get your toddler in to the routine without too much stress. Provide a special activity for use on the potty- i.e. Magna Doodle, chalkboard drawing, Etch a Sketch, a favorite book,etc. Distraction in an activity will prevent boredom and decrease anxiety.

Stage Two:
• Encourage me to sit on the potty several times a day with my diaper and pants off!- If the activity is too tense- i.e. skin against porcelain- revert back to the activities discussed in week one.
• Consult your output log from week one and try to coordinate these times for practice on the potty. Bath time is always a good time too- the running water and the “air to the area” may just produce a success! Lots of flamboyant praise and an instant reward (read a favorite book, fruit snack perhaps, or an M & M?)

Stage Three
• For a set amount of time (at least 30 minutes) each day- leave my diaper and pants off. This will help your toddler coordinate the idea that urine and feces come from their body! Expect an accident!! When you take the diaper off, explain that big boys and girls go “poop and pee” in the potty and show your toddler where the potty is. Explain that you will help and that now we can play. If your toddler sits on the potty at all regardless of success or not- praise, praise, praise!!! Consider a reward even in the absence of a success. If your toddler has an accident, simply say, “Uh oh – you had an accident, let’s clean it up, maybe next time we will get your poop/pee in to the potty!” Stay in this week of training until your child has had at least 10 successes.

Stage Four (or Five or Six and beyond)
• Try wearing training pants/panties/underwear all the time instead of a diaper. Sometimes, “pull ups” can delay training- just like diapers only different- they may be confusing for some toddlers.
• As time passes- try transferring some of the toileting functions to your toddler- pushing pants and underwear down, getting on the toilet, wiping, flushing, washing hands, etc.

What if I am “encountering resistance”?
Resistance as defined by the parent may be extreme refusal to talk about, sit on, or be in the same room as the potty. Resistance may also take the form of demanding diapers at all times regardless of place or time. Even after he/she begins to use the potty, it is normal to have accidents and to regress at times. The process sometimes may take from 3-6 months for most children. Having accidents or occasionally refusing to use the potty is expected and not considered resistance.

If your child is less than 3 years old and resistance is encountered- then discontinue training for a few weeks or a month and then try again. It may just be that your child is not ready for training. The approach taken by parents and caregivers in toilet training plays an important role in the process. Overly harsh or rigid measures (i.e. “I have to have my toddler trained before preschool starts in 1 month and she won’t even go near the potty!”) produce fear, anxiety and occasional hostile feelings on the part of the child. A battle may then ensue that will delay the process. On the other hand, some research suggests that “extremely permissive” approaches may not produce conflict, but may delay successful complete toileting as well. This may be the parent who “just puts a pull up on at night” even if the child rarely has an accident- plan for the success, and don’t be afraid to change some sheets! Accidents happen! A “middle of the road” approach between the overly restrictive and demanding approach and the indifferent approach is best tolerated by children and is most likely to lead to successful attainment of autonomous toilet training control. Parental patience, gentle encouragement, and support are attributes most likely to facilitate toilet training success.

If your child is 3-3 ½ years old and resistant to training, he/she may be a little more difficult to train and a parent may have to change methods. Wait a week at least to start again. Possibly a daily routine of sitting on the potty for five or ten minutes every few hours may be helpful if he/she is willing. Praise any effort they make at toilet training! These efforts can be as simple as talking about the potty, telling you before stooling even if it is in a diaper, etc. Call the office if you are not making any progress.

What are some reasons that cause a child to be resistant to potty training?

• starting too early- before your child is physically, intellectually, or psychologically ready (check out the readiness list and back off for a month if your child is not ready)
• being scared to sit on the potty –flushing, the way it feels, etc
• punishment or being forced to sit on the potty
• inconsistent training- especially across caregivers
• a painful bowel movement- especially from being constipated- check with our office- the constipation will need to be treated and you will need to wait until he is having regular soft bowel movements for awhile before training is reinitiated
• stubbornness??
• he may enjoy the negative attention he is receiving from having accidents or from not using the potty
• a medical condition-especially if your child has other delays in development – also consult your pediatrician

What do I do if my child was trained, then started having accidents again?
Start with a call to our office, sometimes this may mean that your child has a urinary tract infection or some other illness that must be investigated or treated. Sometimes, the accidents may be a direct result of a change in the toddler’s environment.. i.e. going from crib to a bed, starting a new class or day care, a recent move, or a new baby in the house. The toddler’s mentality may be “back to the familiar-the diapers” or “back in control-the diapers”, for this environmental change. Try to find ways that your toddler is showing independence and praise and reward those little signs of independence. Show care to not make him feel bad or ashamed for the recent setback. Make your toddler feel relaxed and empower him by telling him that he is old enough to be in control of learning to use the toilet- then don’t mention it for awhile.

Other Helpful Suggestions
Never underestimate the power of a sibling’s earlier mastery of the toilet. Big brother/sister will be anxious to show off his/her skills. Encourage your older child to model for your younger child and to provide needed encouragement.

During training, if your child has an accident, involve him/her in the changing process in a matter of fact way- encourage him to help you get a new diaper or new set of underwear, assist in cleaning himself, etc.

Let him/her pick out some big boy/big girl underwear at the store- he will be proud to show off his new “Spiderman” underwear! Limit the BM’s to the bathroom- if he/she likes to hide, show him the room where the BM should be happening and he may want to go there on his own the next time.
As always, avoid punishment, especially physical.

Books for Inspiration:
"Everyone Poops"- Taro Gomi
"My Potty Reward Stickers"- Tracy Foote
"Once Upon a Potty for Boys/ Girls" from HarperFestival
"A Potty for Me-lift the Flap"- Little Simon
"Mommy! I Have to Go Potty!" Parenting Press