Clinical Reference Systems: Pediatric Advisor 10.0
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DESCRIPTION

Your child is toilet trained when, without any reminders, your child walks to the potty, undresses, urinates or has a bowel movement, and pulls up his pants. Some children will learn to control their bladders first; others will start with bowel control. Both kinds of control can be worked on simultaneously. Bladder control through the night normally happens several years later than daytime control. The gradual type of toilet training discussed here can usually be completed in 2 weeks to 2 months.

TOILET TRAINING READINESS

Don't begin training until your child is clearly ready. Readiness doesn't just happen; it involves concepts and skills you can begin teaching your child at 12 months of age. Reading some of the special toilet learning books to your child can help. Most children can be made ready for toilet training by 24 months of age, many by 18 months. By the time your child is 3 years old, she will probably have trained herself. The following signs indicate that your child is ready:

• Your child understands what "pee," "poop," "dry," "wet," "clean," "messy," and "potty" mean. (Teach him these words.)
• Your child understands what the potty is for. (Teach this by having your child watch parents, older siblings, and children near his age use the toilet correctly.)
• Your child prefers dry, clean diapers. (Change your child frequently to encourage this preference.)
• Your child likes to be changed. (As soon as she is able to walk, teach her to come to you immediately whenever she is wet or dirty. Praise her for coming to you for a change.)
• Your child understands the connection between dry pants and using the potty.
• Your child can recognize the feeling of a full bladder and the urge to have a bowel movement; that is, he paces, jumps up and down, holds his genitals, pulls at his pants, squats down, or tells you. (Help him understand what these signals mean: "The poop (or pee) wants to come out. It needs your help." Try to teach your child to come to you at these times.
• Your child has the ability to briefly postpone urinating or having a bowel movement. She may go off by herself and come back wet or soiled, or she may wake up from naps dry.

METHOD FOR TOILET TRAINING

The way to train your child is to offer encouragement and praise, be patient, and make the process fun. Avoid any pressure or punishment. Your child must feel in control of the process.

1. Buy supplies:
   • Potty chair (floor-level type). If his feet can reach the floor while he sits on the potty, your child has leverage for pushing and a sense of security. He also can get on and off whenever he wants to.
   • Favorite treats (such as fruit slices, crackers, and cookies) for rewards.
   • Stickers or stars for rewards.

2. Make the potty chair one of your child's favorite possessions.

   Several weeks before you plan on beginning toilet training, take your child with you to buy a potty chair. Make it clear that this is your child's own special chair. Have your child help you put her name on it. Allow your child to decorate it or even paint it a different color. Then have your child sit on it fully clothed until she is comfortable with using it as a chair. Have your child use it while watching TV, eating snacks, playing games, or looking at books. Keep it in the room in which your child usually plays. Only after your child clearly has good feelings toward the potty chair (after at least 1 week), proceed to actual toilet training.

3. Encourage practice runs on the potty.

   Do a practice run whenever your child gives a signal that looks promising, such as a certain facial expression, grunting, holding the genital area, pulling at his pants, pacing, squatting, squirming, or passing gas. Other good times are after naps or 20 minutes after meals. Say encouragingly, "The poop (or pee) wants to come out. Let's use the potty." Encourage your child to walk to the potty and sit there with his diapers or pants off. Your child can then be told, "Try to go pee-pee in the potty." If your child is reluctant to cooperate, he can be encouraged to sit on the potty by doing something fun; for example, you might read a story.

   If your child wants to get up after 1 minute of encouragement, let him get up. Never force your child to sit there. Never physically hold your child there or strap him in. Even if your child seems to be enjoying it, end each session after 5 minutes unless something is happening.

4. Praise or reward your child for cooperation or any success.

   All cooperation with these practice sessions should be praised. For example, you might say, "You are sitting on the potty just like Mommy," or "You're trying real hard to put the pee-pee in the potty."

   If your child urinates into the potty, she can be rewarded with treats or stickers, as well as praise and hugs. While a sense of accomplishment is enough for some children, others need treats to stay focused. Big rewards (like going to the ice cream store) should be reserved for when your child walks over to the potty on her own and uses it or asks to go there with you and then uses it.

   Once your child uses the potty by herself two or more times, you can stop the practice runs. For the following week, continue to praise your child frequently for dryness and using the potty. (Note: Practice runs and reminders should not be necessary for more than 1 or 2 months.)

5. Change your child after accidents.

   Change your child as soon as it's convenient, but respond sympathetically. Say something like, "You wanted to go pee-pee in the potty, but you went pee-pee in your pants. I know that makes you sad. You like to be dry. You'll get better at this." If you feel a need to be critical, keep it to mild verbal disapproval and use it rarely (for example, "Big boys don't go pee-pee in their pants," or mention the name of another child whom he likes and who is trained); then change your child into a dry diaper or training pants in as pleasant and nonangry a way as possible. Avoid physical punishment, yelling, or scolding. Pressure or force can make a 2-year-old child completely uncooperative. Do not keep your child in wet or messy pants for punishment.

6. Introduce training pants after your child starts using the potty.

   Switch from diapers to training pants after your child is cooperative about sitting on the potty chair and passes about half of her urine and bowel movements there. She definitely needs training pants if she comes to you to help her take off her diaper so she can use the potty. Take your child with you to buy the underwear and make it a reward for her success. Buy loose-fitting ones that she can easily lower and pull up by herself. Once you start using training pants, use diapers only for naps and nighttime.

READ THE GUIDELINES ON TOILET TRAINING RESISTANCE IF:

• Your child won't sit on the potty or toilet.
• Your 2-year-old child is negative about toilet training.
• Your child holds back bowel movements.
• You begin to use force or punishment.
• Your child is over 3 years old and not daytime toilet trained.
• The approach described here isn't working after 2 months.

RECOMMENDED READING

Joanna Cole, The Parents' Book of Toilet Teaching (New York: Ballantine Books, 1983).

Vicki Lansky, Koko Bear's New Potty (New York: Bantam Books, 1986).

Katie Van Pelt: Potty Training Your Baby (New York: Avery, 1996.)

Alison Mack, Toilet Learning (Boston: Little, Brown, 1983).