Toilet Training

When toddlers learn to use the toilet, they take a large step in becoming an independent being. For some children, this process goes smoothly, for others, it becomes a long-lasting ordeal. Most importantly, your child must be ready for this adventure in order for it to be a successful one.

Background

Toilet training occurs at varying ages in different cultures and has historically differed over time. Many years ago, parents trained children when the parents chose to, regardless of the readiness of the child. Experts today feel that taking a child-oriented approach has better outcomes and success rates.

In the United States, some children are dry during the day by the time they are 24 months old, the majority by 30 months, and almost all by 36 months. Most children obtain control over urinating and stooling at around the same time. However, nighttime control often does not occur until months to even years after daytime control.

On average, it takes children 6 months from the time that toilet training begins until they routinely use the toilet without a reminder from a caregiver. It often takes girls several months less than boys to be toilet trained, and first children often take longer to be trained than younger siblings.

When parents are beginning toilet training, it is important to keep these facts in mind. This is especially true several months into the process, when it seems as if successful toilet training will never be obtained. While it can be frustrating and trying, parents should do their best to keep stress and pressure out of the experience. Each child is ready to be taught to use the toilet at a different time – just because your niece was trained at 28 months and your neighbor’s kid at 27 months doesn’t mean that your child “should” be ready at that point.

How do I know when my child is ready to begin toilet training?

The American Academy of Pediatrics recommends waiting to begin toilet training until the child seems ready to learn, and is developmentally ready to be taught. Instead of basing this on a child’s age, it should be based on whether the child has met certain milestones. Starting the training too early can prolong the process, and mean the child is not yet ready for the experience. However, it is also essential not to wait too long and to miss the period of readiness when the child is interested in learning.

In order for a child to be ready to learn to use the toilet, control of the muscles used to urinate and stool must be obtained. In addition, the child must be able to:

• walk to the potty

• get on and off the potty

• pull clothing on and off

• sit on the toilet

It is also necessary to be able to communicate the need to go to the bathroom, to follow simple commands, and to be dry for at least 2 hours at a time. Signs that a child is ready for toilet training include:

• an interest in using the potty

• wanting to wear underwear

• wanting to be more independent

• stopping what they are doing to hold their diaper when they are urinating or stooling

Before beginning toilet training, parents should make sure that they are ready as well. Parents need to be realistic about how long toilet training takes, and that there are often times when progress seems to halt or even go backwards. Accidents are common, and parents should be prepared to handle them without getting angry or upset.

Importantly, parents should be aware of their own expectations and motivations for wanting to toilet train their child. If training is desired because a daycare center is requiring it, or because a friend is beginning to train her child, the process can be more difficult and last longer since the child may not yet be ready.

Surrounding life circumstances can impact the success of toilet training, and need to be taken into account. For example, if a new baby is arriving soon, a new babysitter is starting, or you are moving into a new home, toilet training should be delayed until things settle down a bit more.

What do I need to start preparing my child for toilet training?

Having the right equipment available can make toilet training easier. That being said, some products work for some children and not for others.

• Potty or over-the-toilet seat?

You have a choice of using a stand-alone potty seat, or a seat that fits over the toilet seat to make the opening smaller.

Some parents like over-the-toilet seats since they encourage kids to go to the toilet right from the start, and don’t require emptying of a potty seat into the toilet. However, some feel that the height makes getting to the seat more difficult, and takes up precious time when trying to get to the toilet quickly. If you decide to use an over-the-toilet seat, you should also get a step stool to make it easier for your child to reach the toilet. Additionally, the step stool provides support to push against when stooling.

Many parents like potty seats since they are easy to get to, are an approachable size, and are portable. Some parents like to place a potty in a commonly used room of the house, such as the playroom, to make getting to the potty even easier. If a potty is used initially, you can transition to an over-the-toilet seat before your child is ready to be on the toilet itself. If you have a son and use a potty seat, look for one that does not have a urine guard, or has a removable guard. While these guards keep things neater, they can also hit into a boy’s penis, causing bumps and scrapes that can make the experience unpleasant.

Whether you choose a potty seat or an over-the-toilet seat, allow your child to help pick it out, and possibly to decorate it so she feels like it belongs to her. Make sure that you have one in each bathroom of the house, and on every level of the house. By having many options, you and your child can get to the potty quickly.

• Underwear

When getting ready to toilet train, buying “big kid” underwear can be an exciting experience for children, especially when the underwear has characters on them. Take your child with you to the store to pick out the underwear, and then keep them in a place in the house where they can frequently be looked at. Knowing that they will get to wear the underwear when they are using the potty can be a strong motivator for kids.

• Training pants

Some parents find training pants helpful, while others find they slow down the toilet training process. Some kids see them as a diaper rather than underwear, and have no problem urinating or stooling in them. For others, pull-ups and training pants can be a useful intermediate step between diapers and underwear, especially during the night.

• Books

Reading books such as Once Upon a Potty and Everybody Poops can help introduce the idea of toilet training to kids. Talking and reading about normal body functions, and seeing how the kids in the books learn to go to the bathroom in the potty can be very helpful to a child getting ready to toilet train. There are also many books which can be useful to parents going through toilet training, such as the American Academy of Pediatrics book Guide to Toilet Training.

How do I toilet train my child?

Learning to use the toilet requires a multi-step process, which can take a while to perfect. Repeatedly going through the steps with your child will reinforce the pattern until it becomes routine.

1) Talking

Right from the start, all caregivers (including babysitters and relatives) should try to use the same names for body parts and waste products. Whether you decide to discuss poop or doody, the topic should be brought up. When you notice your child holding her diaper, or making a face while she stools, point it out. Kids will often start reporting when they have a dirty diaper, which is a good step in becoming aware of bodily functions. When your child begins to tell you that she needs to go to the bathroom, praise her.

Success with toilet training depends on first you, and later your child, recognizing and verbalizing her need to go.

2) Getting to the potty

As mentioned above, you should have a potty or over-the-toilet seat available on every floor of the house. The quicker you are able to get your child to the toilet, the more likely it is that she will urinate or stool in the toilet rather than in her diaper.

3) Getting undressed

Similarly, the easier it is to get out of clothes, the faster it will be to get on the potty. Kids who are toilet training do well with loose fitting elastic waist pants that can be easily pulled down. This is a time to avoid belts, buttons, zippers, and snaps.

4) Sitting on the potty

At the beginning, have your child sit on the potty fully dressed. She can look at a book, or watch family members using the toilet. Sometimes it’s even helpful if she watches another child her age who is toilet trained going to the bathroom. Children will often want to imitate others, which may increase the desire to be toilet trained. If your child doesn’t want to stay on the potty, don’t force her to. If she’s not at all interested in the potty, just wait a few weeks, and try again.

Once your child is comfortable sitting on the potty in clothes, try sitting without pants or a diaper. At this point, you can start emptying stool from a dirty diaper into the potty, saying something such as “Doody goes in the potty.” This will help your child make the connection between eliminating and the potty.

5) Urinating and stooling

Take the child with you to the bathroom so she can watch you go, while you describe what’s happening. Let your child look into the toilet to see the urine and stool. Again, have her watch when you empty her stool from her diaper into the toilet or potty.

If you are able to tell when your child is about to eliminate, get her to the potty quickly. If she happens to go in the potty, praise her. Don’t make too big of a deal of it though, since you don’t want her to feel pressure to always make it to the toilet. If you find that you are missing when she goes, try some scheduled potty time. About 15 to 30 minutes after eating, have her try sitting on the potty for a few minutes. Because of a reflex, people often feel the need to stool a short time after eating. You can also try to put her on the potty 45 minutes or an hour after drinking a large amount of fluids to see if you can catch her urinating. If your child wants to get up, let her, even if she hasn’t gone. Scheduled potty time should only be for a few minutes at a time, and shouldn’t be tried more than a couple of times a day. If the potty time is unsuccessful, continue to encourage your child and tell her, “Good try.”

For boys, it is usually best if they first learn to urinate sitting down rather than standing up. Once they are older and standing is attempted, you can put some cereal pieces in the toilet for them to aim at. You can also try putting a few drops of blue food coloring in the toilet. When they urinate, they’ll be excited to watch the water turn green.

6) Wiping

Even after your child is trained, you will need to help your toddler wipe for a while. Always demonstrate wiping from the front to the back, so that none of the germs from the rectum spread toward the urinary tract.

7) Getting dressed

The same types of clothes that are easy to get off are easy to get on as well – loose fitting, elastic waist pants, or dresses or skirts that can be lifted.

8) Flushing

Kids often find flushing scary, and need some time to get used to it. You can start by letting them flush toilet paper down the toilet, and watching your stool be flushed. When you put your child’s stool in the toilet from the potty or diaper, you can try having her wave “bye-bye” as it is flushed. Once the child is sitting on the toilet to go to the bathroom, make sure the toilet is only flushed after she gets off.

9) Washing hands

Even when your child sits on the potty but doesn’t go, have her wash her hands. By consistently including hand-washing in the toileting routine, it will become something she automatically does, which is important in stopping the spread of germs.

Accidents

It is very common for kids to have accidents while they are toilet training. Parents should never punish children for accidents, nor should they act upset or disappointed. Kids should always feel supported and loved. With an accident, an appropriate response would be something such as, “That’s okay, we’ll try to go in the toilet next time.” The underwear should be changed as soon as possible so the child isn’t uncomfortable.

Additional tips

• When working on nighttime dryness:
• try not to give your child much to drink in the evening
• always have her go to the bathroom right before bedtime, and immediately upon waking up in the morning
• put a waterproof sheet under the fitted bed sheet to protect the mattress in case of accidents
• let your child know she can always call to you for help in the middle of the night
• don’t try to start nighttime training until after daytime control is established – it may take months or even years for nighttime control to be obtained

• Remember that temporary setbacks are common
• If your child has a history of constipation, make sure it is treated before toilet training is attempted

• Consider using a sticker chart for successful trips to the bathroom. If large, expensive rewards are offered, kids can be distracted from toilet training, and may come to expect large rewards whenever they use the bathroom. Instead, a sticker chart can remind your child of the successes so far, with a small treat promised after using the toilet a certain number of times.

 

• If you have any questions or concerns during the toilet training process

• If your child was dry and then starts having accidents. This can be a sign of something else going on, such as a urinary tract infection.

• If your child is not daytime toilet trained by the age of 3 years.

• Nighttime control can take longer to obtain, but if accidents are still occurring at night by age 5 or 6, let your doctor know.

• If at any time, your child has pain with urinating or stooling, blood in the urine or stool, or is drinking or urinating much more than usual. These may be signs of conditions that need treatment, such as infections or diabetes.

 

While toilet training can be a time-consuming and overwhelming experience, in the end, your child will be more independent. As frustrating as the process can be, try to maintain a positive attitude. Your support will be appreciated by your child and the experience may bring you closer together.

More Information

 KidsHealth.org

 DrGreene.com

 Babycenter.com

 

References

 “Bed-wetting.” MayoClinic.com. 7 December 2007, accessed 16 March 2008.

http://www.mayoclinic.com/health/bed-wetting/DS00611

 

“Potty training.” DrGreene.com. 25 January 1996, accessed 18 February 2008.

http://www.drgreene.com/21_745.html

 

Schmitt, Barton. “Toilet training: Getting it right the first time.” Contemporary Pediatrics, March 1 2004.

 

“The ABCs of toilet training.” Babycenter.com. September 2006, accessed 17 February 2008.

http://www.babycenter.com/0_the-abcs-of-toilet-training_4399.bc

 

“Toilet teaching your child.” KidsHealth.org. April 2005, accessed 17 February 2008. http://www.kidshealth.org/parent/emotions/behavior/toilet_teaching.html

 

“Toilet training your child.” FamilyDoctor.org. November 2006, accessed 17 February 2008.

http://familydoctor.org/online/famdocen/home/children/parents/toilet/179.html

 

“When is the right time to start toilet training?” AAP.org. March 2007, accessed 17 February 2008.

http://www.aap.org/publiced/BR_ToiletTrain.htm