Chances are if you have a toddler, you have changed at least 5,000 diapers so far -- and you likely have another 2,400 more to go. And by now you're probably wondering when your child will ever decide it's time to use the potty. As a pediatrician, I'm asked about potty training all the time. Every parent wants to move past the diaper phase as soon as humanly possible. Unfortunately, we can't check it off our list when it's convenient, such as when there is another baby on the way or when a child is starting preschool.
There are two prevailing schools of thought about the right ways to approach toilet training. One is that children will make it clear when they're willing to be trained; the other is that parents should decide when it's time. Back in the 1920s, Mom and Dad ran the show and used strict, consistent routines to toilet train. In fact, an article published in Parents in 1929 proclaimed that most 8-week-old infants could be potty trained! (If it sounds too good to be true, it is.) The tide turned in the 1960s when the esteemed pediatrician T. Berry Brazelton, M.D., advised that for successful toilet training, a child should be developmentally ready rather than forced.
Based on 20 years of working with families, I side with the Brazelton, child-oriented approach. Being able to use the potty during the day is a developmental milestone, just like learning to walk and talk. (Night training is a whole other story -- see "Night and Day," on the next page.) And as with those other milestones, a child has to be willing. After all, no parent can make a child eat, fall asleep, or poop on the potty! It is much less stressful to wait until a child is prepared.
On average, healthy and typically developing kids will toilet train between ages 2 and 4. Girls usually start earlier than boys do. Are girls smarter? Being a girl myself, I'd like to think so. But a child's IQ has little influence on the age of toilet training -- it's really about body awareness and wanting to be clean. Perhaps boys just don't care as much about that early on. The bottom line: Toilet training is not a race. There are no parenting awards for achieving success early -- just the pure elation of kissing the diaper pail goodbye.
Toilet training takes a weekend. You just have to pick the right weekend! Once your child shows the signs, hang around the house for two days and focus on the process.
Step 1 On Saturday put your child in training pants. These are reusable, specially designed cotton underpants with extra layers of fabric between the legs. (Department and baby-specialty stores usually stock them in the underwear section.) If he has an accident in them, he'll definitely feel wet!
Step 2 If she is not intimidated by the potty, she can practice using it with her training pants off (or use a kid-size toilet-seat insert; both work well).
Step 3 Coax your child to listen to his body and sit on the potty when he knows that pee or poop is coming.
Step 4 Throughout the weekend, direct your child to the bathroom first thing in the morning, before and after naps, after meals, before bedtime, and every two hours if she doesn't already do so herself.
Don't punish your child for accidents, and praise success--that's the best reward. Your child does not need a new toy or a piece of candy every time she uses the bathroom! Bribery rarely works--the desire to be clean is what truly motivates a child to stop playing and go to the bathroom.
If by end of day Sunday your child still leaves puddles on the floor or couldn't care less about having numerous accidents in her training pants, she's not ready. Go back to diapers on Monday (or as soon as you admit defeat) and try again another weekend. She won't transition to the toilet any faster if you keep her in training pants. It only results in more cleanup and frustration for you--and a sense of failure for her.
If she wears training pants for the weekend and regrets having an accident or two, mission accomplished! She can wear them every day and graduate to big-kid underwear once she uses the potty regularly.
Here's my philosophy: It is a privilege to wear underwear, so save the pretty panties and the cool undies until your child uses the potty independently and rarely has accidents.
For nighttime success, your child's bladder size must be large enough to hold the urine produced all night long or his brain must be mature enough to awaken with the urge to go. Those milestones can happen months or years after daytime training. Roughly 15 percent of healthy 5-year-olds are not dry at night, and 10 percent of 6-year-olds still need overnight protection. A medical evaluation is in order only when a 7-year-old child is still incontinent at night. (For more on bedwetting, go to parents.com/bedwetting.) Once he wakes up dry for four weeks straight, try going diaper-free. Until then, you can stick with diapers at night.
Most kids have a few false starts before they are successful. That's okay! I've noticed that the kids who have trouble tend to fall into one of the following categories.
The Absent-Minded Professor
This child is so involved in whatever he's doing that he ignores his body and the urge to go. He doesn't have enough time to get to the bathroom once he gets moving. Result: accidents.
Solution Use a kitchen timer or a watch that goes off hourly as a potty-break reminder. It's your child's responsibility to stop what he is doing and go to the bathroom regularly. Eventually, he will tune in to his body and go on his own.
The Control Freak
Some children would rather sit in a messy diaper and assert their power over the situation than go when and where they're told to go.
Solution Play it cool. Explains Allison Chase, Ph.D., a psychologist specializing in children and families, "It is important to take a step back and avoid getting in a power struggle. Learning to disengage is an essential parenting skill." Take away the diapers and put your child in charge of her pee and poop. She can also share the responsibility of cleaning up accidents. Use a kitchen timer or a watch as a potty reminder. The process is much easier when no one's fighting about it.
A child who had just one painful experience with constipation may never want to poop again. Every time he has the urge to go, he may attempt to hold it in instead of letting it come out. This becomes a vicious cycle and a self-fulfilling prophecy because holding poop in only makes it that much firmer, which means it's all the more painful when it comes out later.
Solution Set up a plan with your child's doctor. Docs usually recommend a gentle laxative for several days or even weeks to clean out the backed-up stool. A high-fiber diet is also critical for long-term success. A withholder needs to have a consistent pattern of soft, comfortable poops before potty training begins.
The Terrified Toileter
Some kids have real anxiety about the toilet. They may worry they'll fall in. Or the flushing sound may scare them. Or they may even fear a "toilet monster."
Solution Ask what she's afraid of. "Acknowledge the fear, no matter how outrageous it seems," advises Dr. Chase. Then try a gradual approach to the potty. Start by telling her that it's okay to wear diapers but that she needs to poop and pee in the bathroom. Next, let her wear training diapers while sitting on the toilet. (Since they have stretchy material on the sides, she can slide them up and down like underwear.) Once she does that willingly, go ahead and cut a hole in the center of the training diaper (a more comfortable next step for some kids than sitting on the toilet with a bare bottom). Ta-da! Her pee and poop end up in the potty and she realizes she will not fall in with them. For a kid with flushing fears, save that part for later.
Originally published in the October 2014 issue of Parents magazine.