My household has recently been in a long-standing battle of wills. It is not a rare occurrence to see and hear my son yelling and crying at me one minute, followed by cheering, smiling, and high-fiving me the next. Most parents of toddlers will know what I mean when I say, “Man, I am ready for potty training to be done.” Up to this point, I would say, without a doubt, that toilet training has been one of the most frustrating times for me as a parent. It also can be one of the most difficult developmental phases that both children and parents experience together because pressures for the child to conform to parental and social expectations occur at the same time with a child’s growing need for independence. Because of this, we as pediatricians recommend that parents avoid pushing their child into toilet training, and suggest instead that the process begin only when the child is developmentally ready or shows signs of readiness. Trust me, this can save hours of frustration for everyone in the family, and sometimes a day or two (or even a month or two) of “taking a break” from toilet training can be enough time for a switch to flip in your child and have him/her make great strides.
Learning independent toileting is a gradual process that is driven by the child’s motivation and interest. Initially, the parents should explain what needs to be done, perhaps by demonstration (I know, kinda weird), but then it is the child’s willingness that will determine when to attempt the next steps. Remember that during this process the child’s self esteem is delicate. The parents should encourage, reinforce, and praise the child for each accomplishment of toilet training. Positive reinforcement should always be used. As difficult as it may seem, negative reinforcement like yelling, belittling, and taking things away from your child for having an accident should never be used. In my house, we have over-the-top celebrations after the deed is done, followed by a race to the sticker chart. Our son gets one sticker for “number 1” and two stickers for “number 2.” Ten stickers equal a small prize. This is the plan that has had the most success with our son up to this point, but it may not be the best for your toddler, so I encourage you to try different things and find something that works best for him/her.
There are three variant forces in child development that need to be in place in order for toilet training to progress: physiologic maturation (eg, ability to sit, walk, dress and undress); external feedback (ie, understands and responds to instruction); and internal feedback (eg, self-esteem and motivation, desire to imitate and identify with mentors, self-determination and independence). More specifically (because most of us out there are not sure when these things occur), at about 18 months, children may show signs of readiness; at 24 months, a step-by-step approach for teaching the child his/her role in the process should be initiated; at 30 to 36 months, most children will have achieved daytime continence; and finally, at 36 to 48 months, most children will have completed nighttime training. That being said, these ages are not set in stone. Every child is different, and even the sex of the child can be a factor in when the child is potty trained (ON AVERAGE, girls usually are potty trained by about 36 months of age, and boys, usually a little later, by about 38 months of age (add your own “typical guy” comment here)). Remember, these ages are averages, so there is a very wide range.
Another thing to remember, which can be very hard to do, is to not compare your child’s success or failure with his/her siblings or other children his/her age. This may push your child in to toilet training sooner than he/she is ready and could add unnecessary stress and strain (pun intended). Some parents might wrongfully equate toilet training success with intelligence or attribute the child’s lack of interest in toilet training to the child’s character (ie, the child may be perceived as stubborn, lazy, uncooperative, hostile, or perhaps jealous of a new sibling). When parent–child relationships are strained, both parent and child may need a break from toilet training to focus on enjoyable activities together and establish a stronger mutual trust and cooperation.
Okay, so you think your child is ready to potty train, but how the heck do you get the whole process started? First, get a potty chair. Many kids feel more secure on potty chair than a toilet because their feet are securely on the ground, and they are not afraid of falling off. Have your child get comfortable with the chair by observing it, touching it and sitting on it fully clothed. Never force them to sit on it, and let them leave the potty chair when they want. Tell them that it is “your special chair.” Place the chair in a convenient place where your child can get to it when he/she wants (the playroom, outside during the summer, wherever the child is playing). It does not necessarily need to stay in the bathroom. Once your child is comfortable sitting on the chair fully clothed, have them sit there without clothes. You can also try putting stool from a diaper into the potty chair so your child can see where it should go. It also can help if you sit on a toilet and “demonstrate” for your child.
Setbacks during the toilet learning process (eg, the child starts to withhold stools or insists on wearing diapers after learning to use the toilet) tend to occur or escalate if the child is pushed too hard or too fast, or if a significant, stressful family event (eg, new sibling, new home, or new child care provider) transpires. Regression is a normal part of the toilet training process, does not constitute failure, and should be viewed as a temporary step back to a more comfortable place. During toilet training, children can be very sensitive (both psychologically and physically), and even one episode of having a hard or painful bowel movement can lead to withholding (which can lead to a downward spiral of harder, more painful stools, which leads to more withholding) Withholding behavior often can be improved by an adequate intake of dietary fiber (fiber content = child’s age + 5 g per day) and decreasing excessive milk intake. Sometimes, however, it may necessitate adding a stool softener. Certain elements of toilet learning can prompt fears, such as flushing or the disappearance of feces or urine, and may even discourage further development in toileting. Allowing the child to flush a piece of toilet paper or joining the child in saying “bye-bye” to excrement may alleviate some of the anxiety a child might feel as it disappears. Another setback can occur when the child is with different caregivers throughout the day, and expectations are different with each person. Make sure to coordinate your toilet training plans with others who may be with your child during the day (caregivers, grandparents, day care staff members). It is important that they know how you want your child to be trained so that the child receives the same message during the day when you are not present as during evenings and weekends when you are.
I know that potty training can be a long and frustrating process, but stay positive and consistent. It will happen, and when it does, the rewards will be great. Good luck!