Health Education

Potty Training

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Bring up “potty training” at a gathering of parents and you will hear lots of strong opinions of do’s and don’ts. This reflects both the individuality of children and the many techniques for success. Most American children achieve control of bladder and bowel function between 24 and 48 months of age. Approximately 25% are trained at 24 months, 85% at 30 months and 98% at 36 months. Girls tend to be slightly younger than boys.

How do I know when my child is ready to be potty trained?

First, it is important to decide if you as the parent are ready. Training takes time and effort. In general, it is best to avoid training immediately after the birth of a sib, a move, or other big family event (unless your child demands to). Decide what terminology you will use. Is it pee and poop, sissy and dudy, no. 1 & no. 2, or urinate and defecate?Allow your child to watch you or older sibs using the bathroom (as if you have a choice!). Potty chairs or seats may be helpful. If you plan to use the kind that fits inside the regular seat, you will also need a stool for the feet to rest on.

Once you decide you are ready, look for these signs of readiness in your child. Not all of them need to be in place:

  • Your child stays dry at least 2 hours at a time during the day or is dry after naps.
  • Bowel movements become regular and predictable.
  • Facial expressions, posture, or words reveal that your child is about to urinate or have a bowel movement.
  • Your child can follow simple instructions.
  • Your child can walk to and from the bathroom and help undress.
  • Your child seems uncomfortable with soiled diapers and wants to be changed.
  • Your child asks to use the toilet or potty chair.
  • Your child asks to wear big-boy/girl underwear.

How do I start the potty training process?

Although clearly child initiated, you have a large part in guiding the process. Initially, expose your child to the potty-chair. Have it in the bathroom with you. During this time, he should be allowed to watch you use the toilet. Next encourage him to sit on the potty fully dressed, perhaps while you go. Then have him sit at routine times such as before a bath. At some point it will happen, usually it is urine before stool. By all means express your pride and happiness. During this time, you can dump the urine or poop into the toilet to demonstrate its eagerly awaited rightful place.

Once you have had a success or two and you child seems enthusiastic, it is time to start leading him to the potty several times a day and encourage, but not force an attempt to go. Make it pleasant. Have some toys or books there reserved for potty time. When your child spontaneously wants to try, be sure to give praise. In the beginning, it is important to try and follow a toileting routine; you can’t rely on asking them if they need to go. For example, go upon awakening, before naps, before leaving the house, after snacks, and at bedtime. The older the child, the less you will have to initiate these toileting breaks. Older children have more of an internal decision to make about going. They essentially decide when they are ready.

Positive reinforcement can be of great help; however the reward must be immediate. Clapping and jumping may be all that is needed for some children while others need more tangible rewards like stickers or a small toy. For an older child, an effective method is to find a prize that your child wants but is not allowed to have (a matchbox car or doll). Keep it visible but only allow your child the prize when they can get four or five stickers on a chart – it does not matter how long it takes them to acquire the stickers. Once you know that your child is physically able to use the toilet, the trick is to figure out what will motivate them to use the potty. Everyone can be motivated, remember they are not going to get married in diapers!

When a child begins to urinate spontaneously, switch to thick training pants. When success becomes more frequent, it is okay to switch to underwear. Beware, the cute underwear are a real novelty; be prepared to purchase 12 pair or you are likely to be doing laundry twice a day. When children are ready, it takes about two weeks. However, the shift from parent reminder to the child letting you know they need to go is gradual.

Stool can often come many months after training for urine. Once your child is potty trained for urine, buy a big (not expensive) item and place it on the dining room table. Your child may talk about if for months and then suddenly make the transition.

Things were going well but now my child refuses, now what?

Stickers and small toys no longer work. The initial excitement is over and now it’s more trouble than it’s worth. It’s time to back off. This is tough. You may be encouraging too much. Tell your child that you would prefer that she use the toilet, but that you will provide diapers. Have your child stool or urinate in the bathroom (even with a diaper) and then have them help with the cleanup. Do not have her lie down to be cleaned. This reinforces her wanting to act like a baby. She should stand up and help clean herself.

What do I do I my child asks for a diaper to stool?

Again, provide the diaper, but have him go in the bathroom. Then involve him in the cleanup. Put the stool in the toilet.

Should we use pull ups?

Pull ups are confusing for many children, why is it okay to urinate in these underwear and not those? Resist the urge to put your child in underwear if they are not potty trained; it will only create more work for you. The pull up may be useful for the older child who only wears pull ups at night (night potty training may take much longer, especially for deep sleepers).

Should boys stand or sit?

Whatever is most comfortable is fine. Try the old “Aim for the cheerio in the toilet” trick.

What about bedwetting?

Night time dryness follows daytime dryness by months to years, so be patient. 80% of children are wet at age 3, 40% at age 4, 25% at age 5 and 20% at age 6.

What if my child is just not interested?

“Everyone else’s child is trained, but he could care less. We’ve tried to be nice. We’ve yelled at him. Nothing works.” This is definitely a time to back off. This is one fight you are bound to lose. Generally, this child is already more than three when this conversation arises. This is a whole new level of development. The best strategy is to throw in the towel for a couple of months, then when he is ready, be totally supportive because by this time, it’s his issue to work out. Sometimes there is a bigger problem that he is playing out by remaining a baby or by controlling the situation such as a new sibling or marital problems. If this is the case, you may need help from a professional such as a behavioral specialist. Schedule an appointment to discuss with us first.

These are the basics of toilet training. Remember, be patient. It will happen. Children don’t graduate from high school wearing diapers. Try reading the following books with your toddlers:

  • No More Diapers by J.G. Brooks
  • Your New Potty by Joanna Cole
  • Once Upon a Potty by Alona Frankel
  • All By Myself by Anna Grossnickle
  • Going to the Potty by Fred Rogers
  • KoKo Bear’s New Potty by Vicki Lansk