The Azrin and Foxx Toilet Training in Less Than a Day Method
Training begins at about 20 months of age. Assess bladder control, physical development and ability to follow instructions to see if child has developed sufficiently to acquire toilet training skills. A child is ready to be trained if he or she:
- has bladder control, that is, the child urinates all at one time (not constant dribbling), stays dry for several hours and appears to know when he or she is about to urinate, e.g., facial expression or posture changes];
- is physically ready, i.e., picks up objects easily and walks without assistance; and
- can follow 10 instructions: point to nose, eyes, mouth, hair, sit on a chair, stand up, walk with parent to another room, imitate simple tasks, fetch a particular object, and place one object inside another.
- Teach the child to assist in own dressing and undressing, especially raising and lowering pants.
- Allow the child to watch others toilet and explain the steps they are following.
- Teach the toileting words to be used during training.
- Teach the child to cooperate when given instructions; do not allow an instruction of which the child is capable to go unfulfilled; do not allow temper tantrums to discourage progress.
Training supplies and setup
- Conduct training in one room.
- Eliminate or minimize all interruptions and distractions, e.g., toys.
- Have a ready supply of child's favorite drinks, snacks, and treats.
- Use a potty chair designed so a child can easily remove the pot from the chair and replace it.
- Have a doll that wets to demonstrate to the child the urination process.
- Make up a list of the persons and characters (real or fictional) the child admires to use to praise the child and indicate how pleased they will be to hear of the child's success.
- Have at least eight pairs of training pants large enough for the child to easily lower and raise.
- Have child wear a short T-shirt that will not interfere with lowering and raising training pants. Teach child to grasp pants in the middle of the back, palm facing backward, and mid-front for easier lowering and raising.
Provide immediate, varied (juices, edibles, treats, hugs, etc.), positive reinforcement at every instance of correct toileting skill, e.g., approaching potty, grasping pants, sitting on potty, etc. Do not reinforce non-toileting acts. Tell the child how happy [name significant other] will be that the child is learning to use the potty and to keep pants dry.
Accidents: Verbal reprimand, omit reinforcement, have child change wet pants to dry ones by him or herself, conduct 10 rapid "positive practice" sessions as follows:
- Use the doll that wets to imitate the processes of toileting and teach specific actions. Manually guide child through the proper actions, then let the child guide the doll through the process.
- When the doll urinates in the potty, teach the child to remove the pot, empty it into the toilet, flush and return the pot to the chair. Once this is learned, begin training child.
- Teach the child to check and identify dry pants from wet pants. Reward/praise dry pants. Perform checks every 3 to 5 minutes and keep track using a training reminder sheet.
- Give child as much to drink as desired to create a strong, frequent desire to toilet (at least 8oz/hr). Use as a positive reinforcement.
- Instruct child to walk to the potty, lower pants, sit down quietly for several minutes, stand up, and raise pants. Watch to see if urination begins and praise/ reward immediately.
- After urination takes place, the have child wipe him or herself, and empty and replace pot as in 2 above.
- Increased number of trials: give prompted potty trials every 15 minutes in the beginning, decrease frequency as child acquires skill.
- Conduct "dry pants" checks every 5 minutes, have child do it as well.
- At first, have child sit on the potty about 10 minutes; after two to three successful urinations into the potty and much praise, the child will begin to understand and prompting and sit time can be reduced.
- Gradually change from directing child to "go potty" to asking child if he or she has to "go potty" to general questions such as "Where do you go potty?" and "Are your pants dry?". Once child goes potty after a general question, only comment on dry pants.
- As child acquires skills and performs actions correctly, give approval only at the end of an action rather than during it. Eventually reduce to praising only dry pants.
- For next several days, do dry pants checks at meals, naps, bedtimes, etc., and praise each time pants are dry. If there is an accident, reprimand the child, have the child change by him or herself, and perform more practice sessions. No reminders to toilet are given.