Pediatrician Gives Potty Training Tips

By: Deborah Simpkins

DURHAM , NC - Many parents who are anxious to have their 2-year olds out of diapers become frustrated with potty training. However, toilet training can be a positive learning experience for parents and children, provided the process is begun when the child, not the parents, is ready.

"Parents are highly motivated to toilet train because they want their children to grow up - maybe there's a new sibling on the way, maybe they don't like changing diapers, or maybe they are getting pressure from grandparents to toilet train" said Barbara Howard, M.D., a pediatrician and behavior and development expert at Duke Children's Hospital.

"What parents need to realize is that children cannot control these body functions until they are neurological and cognitively mature, which usually happen between ages 2 and 2 1/2 but can occur earlier or later" she said.

Howard had developed a standard list of skills that parents can check to determine whether their child is ready. "Sign of Readiness" include:

  • an understanding of what the toilet if for;

  • language or signs (such as pointing) to indicate the need to use the toilet;

  • motor skills to get oneself to the toilet and on it;

  • the ability to stay dry for at least two hours after a diaper change;

  • fine motor skills to get clothing off and on;

  • and an interest in modeling or pleasing parents.

"The relationship between the child and the parents is important because toilet training can set the tone for communication with the family," Howard said. "Toilet training involves gender identity, privacy and ideas about who's in charge of the child's body and life. If carried out in a coercive way, toilet training can set off negative reactions that may affect a child's mental health"

Howard suggest parents begin "toilet learning" from the moment the child is born. "Parents should be talking about these normal body functions and labeling different body parts and conditions of voiding - such as by saying 'You're wet' to an infant. Parents should also adopt simple words for these functions, such as pee and poop."

When the child is 10 months or older, parent should encourage modeling by allowing the child to watch a parent or sibling in the bathroom. "Often children will train themselves later by modeling an older sibling's behavior," Howard said.

As the child approaches 2, parents should begin to look for the readiness signs and a pattern in the child's voiding habits. Howard suggests training for bowel movements first because they are easier to anticipate.

"Begin by explaining what the toilet is for," she said. "One way to do that is to take the dirty diaper to a potty chair and explain, "This is where we want your poop to go", without letting them see it transferred into the big toilet.

"A potty chair is helpful because it is not scary; it is low enough for the child to use himself, he won't feel he can fall in, and there's no big pool of water to be frightened about. It also gives the child a sense of ownership."

The next step, Howard said, is to watch for signs that the child needs to use the bathroom. "When you recognize the pattern of a child's bowel movements, take him to the bathroom to sit on the potty chair, fully clothed at first so there will be no temperature shock. Sit with him in a non-coercive way, perhaps reading or singing with him.

"Never strap a child in because the child will feel punished and develop a negative association with using the potty chair," Howard said. "The overall goal is for the child to have this be his accomplishment."

When the child produces, she said, offer lots of praise. Some children may follow with producing urine on their own. If not, Howard said, parent can take the child to the potty every hour or hour and half. The probability of success during this process can be increased by offering the child a lot to drink.

Howard also has a list of trick to make the toilet learning easier:

  • switch to the big toilet when the child indicated he is ready and place books or steps to make it accessible;
  • consider switching from diapers, which allow the child comfort during wetness, to training pants, which make accidents more noticeable, thus motivating the child to use the potty.

"The new pull-on paper pants might also make it too convenient for a child to keep wetting his pants," Howard said. "I think they are most useful at night because night-time wetting typically continues well past the age of day-time control. Ten percent of children still wet the bed at age 5."

Parents should remember that accidents will happen, usually in times of stress or excitement or when the child has had little sleep. "Parents should stay cool and not treat the accident as an emergency. It's perfectly OK to act disappointed because we do want the child to get the message that we prefer another way.

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