Potty Training 101

According to Mueser and Liptay, readiness usually occurs some time between 18 and 30 months of age. However, Adams asserts, "No one can tell you when your child is ready -- it is really between you and your child. When your child is showing you signs when he is ready, that is when you need to start working on it." Adams continues, "There are all kinds of books, videos and tapes that you can use, but mostly it is watching your child, listening to your child."

Mueser and Liptay recommend getting a small potty chair that the child can get on and off of without help. Remove the deflector designed to keep a little boy's urine in the pot -- a wet floor is preferable to an injured penis. You can teach the boys to hold down their penises and leaning forward when urinating, or teach them to stand up. The pot should be easy to remove, empty and clean. Leach notes that gimmicky potties, such as those that play a tune, may amuse the child or you for a short time, but the child will soon learn that a thrown toy produces the tune just as readily as urination or bowel movement does.

Rolls of toilet paper can be great fun. Mueser and Liptay state that the roll will last longer if kept our of reach of the child's potty. They suggest that you give the child a handful of toilet tissue before the child sits down. For bowel movements a flushable, disposable wipe is easier to use. Remember to teach girls to wipe from front to back to prevent infections.

Leach states that when your child is aware of producing urine or feces it is time to introduce him or her to a potty. She suggests that you show your child the potty and tell him or her that it is for putting urine and feces in (using whatever terms your family has decided upon). Put it in the corner of the playroom, child's room or the nearest, most convenient bathroom where the child can become familiar with it. At first the child might sit a doll or teddy bear on it. Eventually the child will want to sit on it him- or herself. Leach notes, "Don't insist on taking off the child's diaper yet."

Leach states that you may also want to introduce the toilet to your child as well. The toilet may be a scary thing to some children, while others may associate it with the place where you go. Your child may like the idea of urinating where you do, but will need a toilet seat and a firm stool or box for climbing onto and off of the toilet. Some children enjoy flushing the toilet, while others may become afraid with flushing, whether it is the noise, or the fear of being flushed away themselves. If the child is afraid of flushing you may just have to wait to flush the toilet until the child is out of the bathroom.

After the child is comfortable with the equipment of toilet learning, it is time to watch the child for potty readiness. Mueser and Liptay warn, "If you don't teach your child when these signs of readiness are noted, he or she might lose interest in bothering with toilet learning, and training won't be nearly as easy as it might have been when enthusiasm and eagerness were ready to work for you."

Iris recalls that her son Conor was just past his second birthday, when he walked into her bedroom one day with a handful of diapers and said "These go in trash". Iris states, "He never wore diapers again!"

Some of these signs given by The American Academy of Pediatrics, Leach, and Mueser and Liptay include:
1. When a child becomes aware that he or she is about to produce urine or a bowel movement. Before this most children are able to tell you that they are in the process of going (or have gone).
2. When he or she regularly wakes up dry in the morning or after a nap, and stays dry for two or more hours between diaper changes when awake.
3. The diaper is not always wet when checked, which indicates that his or her bladder is able to store urine.
4. The child asks to be changed or attempts to change his or her own diaper.
5. When the child asks to use the toilet or shows interest in the process.
6. When the child shows an interest in imitating other family members or friends in the bathroom.
7. The child's bowel movements occur on a fairly predictable schedule.
8. The child can and will follow instructions.
9. Through words, facial expressions, or a change in activity, the child shows you that he or she knows when his or her bladder is full or when she or he is about to have a bowel movement.

According to the American Academy of Pediatrics, once your child is ready to begin the process of toilet learning, things should proceed smoothly as long as you maintain a relaxed, unpressured attitude. Praise your child for his or her successes, while not even mentioning the mistakes along the way. Punishing the child when he or she has an "accident" will only add an unnecessary element of stress, which is bound to hinder your child's progress.

Adams notes that potty training can be a bond between you and your child. Adams states, "If you are a stay at home mom, it is great because you can be with your child. If you have a daycare situation for your child, you need a caring provider who is going to work with that child, because everyone around the child will need to work with the child" for the child to succeed. Adams notes, "The most important thing is you need to take the time to be with the child."

The best approach is to be easygoing and relaxed. Mueser and Liptay state, "If you make clear what your child is supposed to do, and provide encouragement and support, chances are the child will learn to use the toilet quite readily." However, they continue, "If you make a big deal or a battle out of toilet training, you'll increase the likelihood of a long term problem."

Leach states it this way, "If you try to insist on cooperation before your child is emotionally ready, you will be trying to impose your will on the toddler's in an area where you cannot win. You cannot make him or her use that potty; attempts to force training invite the child to experience successful defiance."

The American Academy of Pediatrics suggests that the best way to introduce your toddler to the concept of using the toilet is to let him or her watch other family members of the same sex. Leach concurs, "Make sure that the child sees family and friends using the toilet. Imitation can be a great help."

The recommendation from the American Academy of Pediatrics is to begin with bowel training first. Urination usually occurs with the bowel movement so at first it is difficult to separate the two. Boys usually learn to empty their bladders in the sitting position but gradually transfer to the standing one, particularly after watching the "older boys" do it that way. However, some children will insist on having bowel movements in diapers even when fully bladder trained.

Leach notes that many children who are introduced to the idea in a casual way and at the right time will bowel train themselves completely within a couple of weeks. "Don't try to force the child to sit on the potty even if you can see that he is about to have a bowel movement," states Leach. "Toddlers are extremely contra-suggestive. Since toilet training can only succeed through his voluntary cooperation, battles will mean certain failure," concludes Leach.

The American Academy of Pediatrics gives these steps as suggestions for how to proceed with bowel training:
1. For the first few weeks let the child sit on the potty fully clothed while you explain to him about the toilet, what it is for, and when to use it.
2. After the child is sitting on it willingly, let him or her try it with the diaper off. Show the child how to plant his or her feet firmly on the floor (which is important during bowel movements). Make it part of the routine, gradually increasing from once to several times per day.
3. When the child is comfortable with sitting on the potty, try changing a soiled diaper while seated and dumping the contents into the pot, to show what the chair's purpose is.
4. To encourage using the potty, allow your child to play near the chair without a diaper on, and remind him to use the potty when he or she needs to. While the child is bound to forget or miss at first, do not show your disappointment, but instead wait for a success and reward him or her with excitement and praise.

If you know that your child is likely to produce a bowel movement right after breakfast, or upon waking from a nap, Leach suggests delaying putting on the diaper so that using the potty can be quick and easy. Make sure that the potty is in the usual place and casually suggest that the child might like to sit on the potty so that the feces (or whatever term you decide to use) will go in there. If the child says, "no," do not push it, states Leach. If he or she is ambiguous or enthusiastic, Leach recommends proceeding to the potty, and staying there while the child accomplishes the bowel movement and then be calmly congratulatory.

Leach states that parents shouldn't make using the potty a moral issue, calling your child "good" for using it or "naughty" for not doing so. Using the potty instead of a diaper is just a new skill which the child is learning. Feces in the potty deserves a quiet word about how "grown up" he or she is getting, and feces in the diaper (or on the floor) should be met with a quiet suggestion that next time he or she might choose to put them in the potty.

While bowel control is usually easier than bladder control and accidents are rare after the toddler years, sometimes they can occur in an older child. Leach states that sudden attacks of diarrhea can lead to lack of control. However, when a child who has been using the potty or toilet begins to prefer making bowel movements in his or her pants or on the floor, then this can be a sign of emotional disturbance. A child who insists on having movements not in the potty or toilet is usually making an unconscious protest either against your pressure to become clean or against your general power over him or her, notes Leach.

Refusal to move his or her bowels (withholding) is also usually a form of protest, reports Leach. The child who withholds his or her feces may appear to have diarrhea rather than constipation, as liquid feces will leak around the blockage of withheld feces. Both soiling and withholding should be dealt with as soon as the problem is discovered. Your child's doctor can help you and your child find ways to cope and resolve the stresses surrounding defecation, suggests Leach.

Bladder training may take more time to complete in some cases than bowel training. Leach notes that children urinate so many times during the day that many failures are inevitable, especially when they are preoccupied or absorbed in play, and do not notice their need in time. Adams states, "When a child has an accident, that's okay, and it is good to let the child know that it is okay." However, one of the most important thing is to be aware of the child's activities and be sensitive to his or her need to use the potty. "You can't put a child off, when their bladder is full, it is full," states Adams.

"We put Rose in underpants before she was fully trained, and it did take a few days for her to get into the rhythm," states CK, the mother of two sons (7 and 6) and a 3 year old daughter. "Have patience (you'll need it), as well as a sense of humor," suggests CK.

Jennifer, a mother of 2, recalls one of the most humorous incidents in her daughter's training experiences which occurred when visiting relatives which had a potty-training Barbie, complete with toilet. Jennifer's daughter Brenna was playing in the living room in only a diaper, and she spotted it. Jennifer remembers, "She took the toilet, ran into the backyard, set it on the ground, whipped off her diaper, and peed into it! Actually the thing wasn't more than 2" tall, so she really peed in and all over it. We were trying so hard to be congratulatory about the whole thing without dying of laughter. She was quite proud of herself!"

According to the American Academy of Pediatrics, most children take longer to complete nap- and nighttime training. Leach notes that at first they still cannot wake themselves to urinate so they continue to wet themselves during naps and nighttime. The American Academy of Pediatrics suggests that parents encourage their toddler to use the potty immediately before going to bed and as soon as he or she wakes up. A plastic sheet under the cloth one will minimize the cleanup of accidents. Reassure your toddler that all children have accidents and praise the child when he or she wakes up dry. Using training pants rather than diapers at nap time and bedtime may also help. If the child wakes up during the middle of the night and needs to use the toilet assure your child that he or she can go alone to the bathroom or call you for help.

Mueser and Liptay states that when your child wakes up dry, the potty chair should be the next stop. If the child doesn't want to, don't force. But, according to Leach, you may decide to delay diapering and suggest that he or she sits on the potty. If at first the child refuses or sits momentarily but gets up without doing anything, do not make any comment, but leave the child bare-bottomed and encourage him or her to sit on the potty (kept near at hand) when he or she feels the need. If your child succeeds, be congratulatory, however, if the child makes a puddle instead, mop it up without comment and dress the child as usual. Each experience of feeling and seeing him- or herself urinate will help the child make the connection between the feeling and what happens next.

The American Academy of Pediatrics states that when the child is using the potty regularly, you may decide to switch over from diapers to training pants or underwear during the day. At this point boys may be able to urinate into an adult toilet and both girls and boys may be able to use adult toilets with training seats. Leach states that after several successes, you may wish to take your child out of diapers when he or she is at home and awake, putting on the diapers for outings, naps and nighttime. Realize that this is "the puddly" stage, being sympathetic when they occur. CK recalls that for a while her daughter Rose would only pee on the floor in the bathroom. "She got the room right, but not the exact location," jokes CK.

If the weather is warm, you may wish to leave your child naked (or bare-bottomed) in the yard. Mueser and Liptay recommend that parents should act pleased at the successes but not make a big fuss over the inevitable failures. You can say, "Next time try to put the urine (or whatever term you use) in the little toilet over there."

Rewards or incentives will sometimes help in motivating the child to use the toilet or potty. Adams notes, "We had a jar of gummy bears and with some children that works, and some children it doesn't work." Lisa the mother of 4 year old Spencer in an attempt to motivate her son to toilet train recalls saying, "When you can wear underwear all day and use the potty then we get to go to Disney World." However, Spencer (who loves Disney World) who just wasn't ready to give up the diapers responded, "I don't want to go to Disney".

Some children respond well if the parent or caregiver just sits with the child. "Don't push the children," Adams states, "Don't make it stressful. Sometimes it takes just a pat on the back or a great big hug to tell them how proud you are of them."

Leach suggests that initially diapers should be worn for outings, naps and nighttime to help the child avoid failures. When your child becomes reliable at home in the daytime, you may decide to try eliminating diapers when going on outings. If you decide to give them up during the daytime, do not alternate as this can cause confusion. The child may not be able to remember whether he or she is wearing a diaper when faced with the urge to urinate.

Adams states, "I made sure that when we went out shopping, I took them to the restroom so that they knew where they were -- it put the child at ease. Children may not know there is a bathroom, and they need to have the security of knowing that if they have to go they can go." Leach notes that most three and four year olds prefer a parent to go with them into a strange bathroom, especially one in a public place. No one objects with a very little boy accompanying his mother into the "Ladies' Room," however, fathers and daughters produce a more difficult situation due to the open urinals in the "Men's Room".

As a daycare provider, Adams recognizes how important it is for children to know where the bathrooms are, and sometimes the daycare provider doesn't realize how important this is. Many times children starting a new daycare situation will have accidents, and it can be as simple as the daycare provider has not taken the time to show them where the bathroom is.

It is not uncommon, according to the American Academy of Pediatrics, for children to still occasionally wet the bed at night when daytime toilet training has been completed. This may happen as often as two to three times per week early in the training period and gradually become less and less until it is gone at around the age of 5. However, one out of every 10 children over the age of 5 continues to wet the bed. Boys make up two thirds of this group, and there is often a family history of bed-wetting. A much smaller number of children over the age of 5 have daytime wetting problems. If nap- or nighttime wetting is still a consistent problem one year after daytime training is complete, you may wish to discuss the situation with your pediatrician.

Leach reports that many children still need diapers at night well past their third birthday and the urination that takes place while the child is asleep is not within his or her control. Don't insist on taking off the nighttime diaper if your child insists on wearing them. When you do decide together to abandon the nighttime and naptime diaper, do encase the mattress in a plastic sheet or covering. Show the child the mattress cover and explain that because it is there it does not matter if he or she wets while asleep. Distinguish between trying to keep the child's bed dry and keeping him- or herself dry. Leach notes that restricting evening drinking may actually increase nighttime wetting, as a child who goes to sleep thinking thirstily of water is more likely to wet the bed. Avoid praise or blame. Leach suggests that instead explain that people's bladders grow up along with the rest of them and that eventually your child's will be grown up enough to hold all the urine all night.

According to the American Academy of Pediatrics, the best way to deal with incontinence is to treat it as something natural and unimportant. Don't put your child back in diapers, and don't scold or punish him. Leach states that if bedwetting starts suddenly after months of being dry, your child may be reacting to stress, which might be relieved by talking about it and pampering the child a little. Sometimes children will "revert" due to various stressors in their lives such as the arrival of a new sibling, traveling, or moving.

If the child is wet because of a continuous dribble of urine, there might be a physical problem. If incontinence does occur both day and night (after being fully trained) it is indicative of bladder or kidney problems. The American Academy of Pediatrics gives the following list of possible causes for incontinence:
1. Slow development of awakening when the bladder is full.
2. Urinary Tract Infection
3. Urethral irritation from bubble bath or detergents in bath water.
4. Physical abnormalities.
5. Constipation (which can cause extra pressure on the bladder from the rectum).
6. Diabetes mellitus
7. Emotional distress (especially if wetting begins suddenly after six months of total dry nights).

Adams notes that for some children toilet learning may take a couple of days, and for some it may take quite a bit of time, "Every friend and every relative has an opinion -- but it is individual," states Adams. "With most children suddenly it clicks -- you can almost see when it clicks."

CK notes, "Sometimes they show an interest, then back off for a while. David (her middle child) made signs as if he were going to train when he was 1 month shy of 3 years old. So we went through the whole shebang, only to have him withdraw his interest." However, CK recalls, "Within a few months, though, he was back at the potty, and six months after his initial interest, was completely trained."

As the parent or caregiver, your goal is to make this entire process as positive, natural, and nonthreatening as possible so the child is not afraid to make the effort on his or her own. Adams notes that toilet learning is not only an accomplishment for the child, it is also a big thing for the parent when they get through potty training. "You feel like you jumped over the first big hurdle," states Adams. "They think `Hey, I can do this!'"