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Getting Started on the Potty

Most parents are thrilled at the prospect of never having to change another dirty diaper, but some dread toilet training. But rather than view toilet training as a critical issue, suggests Mark Wolraich, MD, FAAP, professor of pediatrics at Vanderbilt University, parents should treat it like any other aspect of a child's development -- as a fascinating process that children go through. A parent's job, Wolraich notes, is to simply guide the natural process along by providing the child with opportunities to use the toilet and by encouraging her when she does.

Why are children today training later than they were when we were children? For one thing, says Dr. Wolraich, pediatricians and child development experts are concerned that previous generations of parents were putting too much pressure on their children to train early. Children were often being punished for not learning to use the toilet.

Another reason behind the delayed toilet training stems from disposable diapers, which are:

  • More absorbent than cloth diapers and less uncomfortable for a child when soiled or wet
  • More convenient for parents who want to get away from the laundering of cloth diapers

Taking cues from your child will make the process of toilet training go more smoothly for everyone. Not every sign of readiness needs to be there, but if you notice a few, your child may be ready and willing to start using the potty. If, after a few attempts, your child still resists, it's wise to back off. Praise her independence in other areas, such as feeding or dressing herself, and try again in a few weeks or months.

For some children, it might be best to wait if they're about to experience, or have experienced, a major disruption in their life, such as the birth of a new sibling, a move to a new home, or a divorce or death in the family. Such situations may disrupt the learning process and may even cause temporary setbacks.

Experts suggest that parents look for signs of physical, emotional, and cognitive readiness before attempting to toilet train. Most signs begin to emerge between 18 and 24 months of age, though this may vary. Here are some cues to look for:

  • Your child stays dry for at least two hours during the day and is dry after naps, which indicates that she's able to remain dry for an extended period of time.
  • He's able to follow simple instructions, such as a request to sit down or remove his clothing.
  • She shows an interest in wearing underwear.
  • He's able to walk to and from the bathroom, sit still on his own for at least a few minutes, and even undress by himself.
  • She cries, fusses, or shows other signs of obvious discomfort when her diaper is soiled.
  • He has predictable bowel movements on a regular basis.
  • She expresses an interest in using the toilet or potty seat.
  • He indicates through facial expression, posture, or language that he's ready to use the toilet.

Once you're ready to start, take your child into the bathroom with you, and talk about what you're doing. If possible, have your child go to the bathroom with the same-gender parent, so he (or she) can see and learn the proper mechanics of toileting.

After your child understands what she's supposed to do on the toilet, follow up with these strategies:

1. Provide your child with her own potty chair so she's low to the ground and her feet touch the floor. Some children have a fear of falling in the toilet or of just hearing it flush, notes Maria Luisa Escolar, MD, a developmental pediatrician at the Center for the Study of Development and Learning at the University of North Carolina. Although a potty chair is generally placed in the bathroom, you could also put it in the playroom or child's bedroom, where she'll become comfortable with its presence over time.

2. Place your child on the potty seat at the same time each day so this becomes a regular part of his daily routine. You may want to try this first thing in the morning, says Dr. Escolar, but other times of the day may work better for your child. Leave him there for a few minutes and see if he goes; then take him off, even if he hasn't.

3. Ask your child regularly if she has to go to the bathroom, and encourage her to tell you if she does. Adopt a consistent lingo for words associated with toilet training. Whether you say "poop" and "pee" or "urinate" and "defecate," choose words that are not offensive or embarrassing or that describe toileting functions in a negative way.

4. When your child does go in the potty, be sure to reward him. Hugs, praise, or small rewards (like placing stickers on a calendar to mark his achievement) all help to reinforce the behavior. Don't use food as a reward.

5. If your child fails to go in the potty, don't scold or punish her. And if she's had an accident, simply clean up and encourage her to keep trying. Then move on to another activity without making a fuss.

6. Once your child has been successful at toileting a few times, consider dressing her in underwear so that she becomes keenly aware of being wet or dry. Some parents prefer to put their kids in disposable training pants until they're fully trained. But, Dr. Wolraich warns, training pants are still absorbent enough that they may delay the process.

7. Continue toilet training even if you go on outings. Take along a potty seat, if possible, and remember to ask your child if she has to go to the bathroom. Take an extra pair of clean underwear, too, in case of an accident.

8. When your child has learned to use the toilet consistently during the day, you may be able to take her out of diapers at night. Avoid giving her too many fluids before bedtime, and make sure she uses the toilet so that she's less likely to wet her bed.

Above all else, remain calm and matter-of-fact about the entire process. Keep in mind that accidents will happen, and when they do, avoid making a fuss or criticizing your child.

The key to successful toilet training is patience. According to Dr. Wolraich, children are toilet trained when they consistently, of their own volition, ask to use the toilet. The time it takes to complete the process varies enormously, though Dr. Escolar says parents may continue to guide their children for two to three months.

Even then, occasional accidents may happen and some children may regress and stop using the toilet. Your child will likely have her share of accidents, especially at night. Bed-wetting, or enuresis, is normal and affects about 40 percent of all children under age 3. Until this age, a child's bladder may not be fully developed. Your child also may be unable to recognize the urge to go, wake up, and use the toilet.

Children under stress may have difficulty mastering new skills and rely on the old way of doing things. If a child does regress, Dr. Wolraich recommends that parents not get overly concerned. Try to pinpoint the cause of your child's anxiety, and take steps to eliminate the stress. Don't punish your child, Dr. Wolraich suggests, just start working with him again.

Additional reporting by Winifred Yu

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.