Potty Training

Also: Toilet Training

Our thanks to the twopedsinapod blog for much of the information in this handout.

Children typically master potty training between the ages of two and four years. Be patient, not everyone is “typical.”  More important than your child’s age is whether she shows she is developmentally ready to train. These signs include:

  • is generally agreeable/ can follow directions
  • gets a funny expression before passing urine or poop, or runs and hides, then produces a wet or soiled diaper
  • asks to be changed/ pulls on her diaper when it becomes wet/dirty- remains dry during day time for at least two hours
  • NOT because grandparents are pressuring you to start
  • NOT if the child is constipated—the last thing you want to do is to teach withholding to a kid who already withholds
  • NOT if a newborn sibling has just joined the family. A new baby in the house is often a time of REGRESSION, not progression. However, if your toddler begs to use the potty at this time, then by all means, allow him to try.

Make the potty a friendly place. Have a supply of books or a fun, new toy just for potty time to occupy your child while she sits. Make sure her feet are secure on the floor if using a potty chair or on a stool if using the actual toilet. If using the real toilet for training, use a potty training rim on the toilet seat to prevent your child from jack-knifing into the toilet. If your child is afraid of the bathroom, go ahead and put the potty chair in the hall just OUTSIDE of the bathroom.

Have reasonable expectations based on age. A two year old’s attention span is two minutes. Never force your child to sit on the potty. If he doesn’t want to sit, then he isn’t ready to train.

Your can lead a horse to water… reward the child for sitting on the potty, even if she does not “produce.” Reward by giving a high-five, verbal praise, or a small, cheap trinket such as a sticker. Do NOT promise your child a trip to Disney for potty training—large rewards that require delayed gratification do not work. Accept that she may simply enjoy sitting fully clothing on the potty singing at the top of her lungs for a few weeks.

Let your child learn by imitation.  At home, have an open door bathroom policy so she can imitate you and her older siblings. At school, she will imitate her potty-trained classmates.

Initially, kids rarely tell their parents they “have to use the potty.” For these kids, schedule potty visits every 2-3 hours throughout the day. Do potty checks at key times such as first waking up, right before nap and bed. Be sure to spend extra time a half an hour after meals or after a warm bath. Both meals and warmth stimulate poop!

Important note for parents of BOYS: First potty train your son to sit for ALL business. Teach him to gently press his penis downward so pee lands in the toilet and not all over the room. Once your son stands up to urinate, he may become so excited that he may never sit down again. Better to wait until he uses the potty consistently with few accidents before teaching him to stand up. Even after he begins to stands to pee, have him sit on the potty daily to allow him time to poop.

Don’t be surprised if your child trains for pee before poop. In fact, many kids go through a phase when they ask for a diaper to poop in. After all, it’s frightening to see/feel a chunk of your body fall into an abyss.  Dump the poop from the diaper into the potty and practice waving bye-bye.  Have your child poop in a diaper, but in the bathroom, and then while sitting on the toilet as small steps towards stool training.

A note about night time and naps: Potty train for when your child is awake. Your child will spontaneously, without any training, ultimately stay dry at night and during naps. Some kids sleep more soundly than others and some kids are not genetically programmed to stay dry overnight until they are elementary school aged. No amount of daytime training will affect what happens during sleep. Moderate fluids right before bed and keep putting on the diapers at night until you notice that the diapers are dry when your child wakes up. After a week of dry mornings, try your child in underwear overnight. Occasional accidents are normal for years after potty training so you might want to put a water proof liner under your child’s sheets when first graduating to sleep underwear.

Pull-ups: We like sticking to underwear while potty trainers are awake and diapers while asleep.  A reluctant trainer tends to find training pants just absorbent enough that he does not care if he is wet. However, the pants are not absorbent enough to prevent rashes from stool or urine. Explain to your child  “sleep diapers” are perfectly acceptable until their “pee pee learns to wake them up.” Use the pull-ups when your child is older and is mortified by the idea of a diaper or if your family is going on a long car ride and you don’t want to risk urine on a car seat.

Above all: avoid power struggles. If potty training causes tears, tantrums, or confusion STOP TRAINING, put those diapers back on, and try again a few weeks later.

After the training, keep an eye on how often he pees and poops. Older kids get “too busy” to go to the potty. Make sure he is in the habit of emptying his bladder four to six times a day and having a soft bowel movement at least every 1-2 days.

Ultimately… you just have to go with the flow. And remember, everything eventually comes out right in the end.

Potty Training: Take 2

There are many reasons why a child refuses to potty train.  Tops amongst them are chronic constipation (producing hard, painful BMs) and resistance to feeling controlled.

The Stool Withholder

Some children decide to withhold bowel movements during potty training, causing constipation, painful stools and even impaction (where a solid stool is stuck in the rectum, but diarrheal stool leaks around it causing a constant, uncontrollable ooze.)  When this impaction lasts for too long, the rectum and colon become stretched out of shape and lose tone.  Stool builds up and the child loses control over stooling, or refuses to stool due to the painful nature of passing large, hard stools.

The first step in treating stool withholding (or encopresis) is to allow the child to stool in a diaper without reprimand.  You may need to start stool softeners such as Miralax to ease passage of the stool until the rectum regains tone and control (see our article on CONSTIPATION for further instruction.) This can take several weeks to months.

Explain to the child why they need to poop every day.  “Your body makes a poop everyday, and it wants to come out. “  Creativity helps- talk about the poop party that all poops like to go to in the sewer- celebrate when they produce a poop (in the diaper or toilet) that can then be flushed down to the party!

The Resister (and a continuation for the withholder)

The next step is to transfer all responsibility for peeing and pooping onto the child.  This takes the power struggle between parent and child over using the toilet away.  Allow him to pee/poop in a diaper (or ask for a diaper to poop in.)  Don’t remind him to pee or poop (unless you see him trying to withhold stool, and gently remind him of the poop party his poop wants to go to.)  If you use enough miralax daily, stools will eventually become too soft to withhold.

If your child has trained successfully for pee, allow them to wear underwear as a reward, and ask for a diaper to poop in.

Start an incentive program to celebrate a successful pee/poop in the potty.  Introduce a reward chart or jar filled with small toys.  Alternatively, offer a special experience (such as using an iPad for 10 minutes, a special dress up costume, video time, fun experience such as a trip to the ice cream store) for a successful poop.  For an incentive to be effective look to fulfill these 4 conditions:

  1. Your child strongly desires the incentive (ask for their input- “what would help you remember to go poop in the potty?”)
  2. You give the incentive immediately after the child meets the goal. (pees or poops in the potty.)
  3. The goal has to be attainable (if your rule is staying dry all day to earn an incentive, and your child has yet to even pee in the potty, they will give up before ever getting a taste of the reward.)
  4. You, not the child, control the incentive (allow a limited time of access to the privilege, and do not allow its use at any other time.)

Never withhold social reinforcers such as physical attention (hugs) or parent-child activities (reading, playing) as they are essential to your child’s growth and sense of mental well-being.

If your child pees/poops in the diaper, change it in a neutral, quick manner.  Try not to use negative pressure (acting upset, dismayed, angry with the child.)  Simply remind the child that “people don’t walk around in dirty diapers.” If the child refuses to change or be changed, do not allow them to play or participate in any activity until they agree to clean up.  Flush any stool down the toilet to join the poop party.

At the same time, keep a potty close when possible along with a visual reminder of the incentive.  Avoid frequent verbal reminders, as this will often prompt a “refuser” to further resist training.  Pretend that you really don’t care if they pee/poop in their diaper till they are 20 (I promise they won’t!)  Reminders are a form of pressure, and pressure with keep the power struggle going.

If your child is in daycare or preschool, talk with the care providers about continuing the same methods of training within the classroom.

If your child continues to appear very distressed by or resistant to training, consider putting all efforts on hold for a month or two to allow you both to de-stress.