How do I know when my child is
ready for toilet training?
The age
at which children are able to successfully complete toilet training varies a
great deal. Girls are often ready a bit earlier than boys, and for most
children the process can begin between ages 2.5 and 4 years, and many children
are able to use the toilet independently by 3.5 to 5 years. A child may
continue to have accidents after being able to use the toilet, especially at
night or during extremely interesting and long activities (for example, going
to the zoo for an hour or two). If forced to choose between going to the toilet
or continuing a preferred activity, children tend to choose the preferred
activity for a while. Eventually, as going to the toilet becomes easier and the
sensation of having an accident becomes more unpleasant, they will start to
communicate more clearly that they need to go to the toilet. Here are some
things that help children be “ready” for toilet training:
- Your child begins to notice when his diaper or clothing has become wet or soiled.
- Your child is able to walk to and from the bathroom without assistance.
- Your child begins to show interest in taking care of himself (for example, wants to try to dress himself, wash his own hands, or try to “go pee in the potty”).
- Your child shows an interest in others using the toilet (it may seem strange to an adult, but a child is likely to become curious about what’s going on and how it works).
- Your child is able to stay dry for more than 2 hours at a time (and has learned how to completely empty his bladder).
- Your child has sufficient balance to remain seated on the toilet for an extended time (for example, at least 2 to 5 minutes).
- Your child is able to follow simple directions from you, such as “sit down”, “stay there”, “stand up”, or “go over there.”
- Your child is able to communicate sufficiently with you to indicate when he needs something. This may be through various means, including words, gestures, facial expressions, or certain postures (the “pee pee dance”).
How do I know when I am ready for
toilet training?
Remember,
toilet training can be a challenging and frustrating experience for parents. It
can be very hard for adults to sympathize or understand why a child doesn’t use
the toilet or indicate when she needs to do so. For your child, using the
toilet is a new and complex skill. There are many steps, including being aware
of the need to use the toilet, removing all necessary clothes, balancing and
sitting on the toilet, knowing when she is done, wiping thoroughly, standing
back up without falling over, putting clothes back on, flushing the toilet, and
then washing hands.
For adults this process is largely automatic because they
have done it so many times; therefore, adults do not think about most of the
steps involved. You have to prepare for your child to forget many steps or ask
for help with some of the steps. You should also plan to encourage and praise
your child for each step she completes successfully! Because it can be so
complicated and frustrating, you need to make sure toilet training is a high
priority for you. You have to be ready to commit a lot of effort and time to
it, and have a plan for how you’re going to deal with your frustration. If your
child is left in the care of others (for example, daycare, relatives,
babysitter…), then you need to make sure they’re ready to help with it as well.
They will need to use the same plan you’re using at home so your child doesn’t
become confused. When you’re ready, everybody is on board, and your child is
ready, then it’s a good time to start toilet training.
How do I prepare for toilet
training?
It can
give you a serious advantage if you know when your child typically goes to the
bathroom. For example, if you know that after eating, your child is likely to
need to pee after about 1 or 2 hours, then you have a window for practicing
using the toilet. When your child is likely to actually need to use the toilet, it is much easier to get him to comply with
using the toilet and he is far more likely to have a successful experience.
Think of it this way, using the toilet is a skill, but it is only “successful”
when your child goes through the motions and actually uses the toilet (peeing
or pooping in the toilet). If your child goes through all of the motions, but
nothing happens, then it is not as good of a practice (it can still be useful,
it simply is not as meaningful to your child). Therefore, though it may seem
strange, it can help to keep track of when your child urinates (pees) or has a
bowel movement (poops). If you do this for about two weeks, then you’ll have a
pretty good idea of when he is most likely to need to use the bathroom.
You may
also begin to notice more of the signs that your child needs to go to the
toilet (for example, he begins to fidget about more, stands up and walks around
a lot, or keeps squatting down). You can also begin to teach your child ways of
communicating to you that it is time to go to the toilet. For example, if you
see your child fidgeting about a lot and sticking his hands down his pants, you
might say, “It looks like you need to go potty, let’s go!” It is important to
make this as positive and enjoyable of an experience as possible, because
you’re asking your child to make a change and you’re asking him to do something
that can be kind of scary. At this point, you should also decide on the words
you are comfortable using to describe using the toilet (for example, “go
potty”, “poop”, and “pee” are common words for this). It helps to use a
different word for urinating (“pee”) and bowel movements (“poop”), though the
term “go potty” is also useful in combination with those. Keep in mind, your
child will use these words in public as well!
Lastly,
it can be helpful to allow your child to observe someone else in the family use
the toilet. Not everyone is comfortable with this or does this, and it is not
critical. However, for some children it helps to see somebody else do it. It
can help them become more comfortable with the idea (“I saw mom do it, so I
know it’s ok”) and also help them see how certain things are done (such as
pulling pants down and sitting, or wiping). Though this step is not essential,
if your child appears to be very reluctant to sit on the toilet or appears to
have a lot of difficulty understanding how to do certain steps, consider
allowing them to observe someone else do it.
How do I start toilet training?
In
addition to some of the things mentioned above for preparing to begin toilet
training, you should also try to setup the bathroom to make toilet training
easier. This might include buying a special child potty seat (usually sits on
top of the regular toilet seat; make
sure it is securely attached) or buying some foot rests for your child
to rest her feet on while using the toilet (this can make your child feel more
securely balanced). You may consider buying special training pants (quickly and
easily removed) and training diapers.
You
should also remove distractions from the bathroom, such as toothbrush,
toothpaste, or other things that might be sitting nearby. On the other hand,
you should also collect a small set of toys or games your child greatly enjoys
that she can use while sitting on the toilet. This will make using the toilet a
more enjoyable experience (“I get to play with some of my favorite toys when
I’m there”). These toys and games should ideally only be available when your child is on the toilet to make her want
to sit on the toilet.
If your
child appears to keep forgetting steps or appears to become anxious about the
process of using the toilet, it may be helpful to prepare a visual checklist of
the steps involved. The checklist can be very simple and features pictures
(recommend trying cartoon pictures first) that show the steps involved:
- Getting clothes out of the way (pulling down pants and diapers/underwear)
- Sitting on the toilet
- Waiting until done (no longer feel the urge to go = “All done!”)
- Getting toilet paper (may help to tell your child how many squares at a time)
- Wiping appropriate areas until done (tell your child how to know when “done”
- Get up from the toilet and pull up clothes
- Flush the toilet
- Wash hand
- All done
What if it doesn’t seem to be
working?
There
are a number of reasons why your child may have difficulty with toilet
training. As mentioned above, consider if your child is actually ready for
toilet training. Starting too early can be very frustrating for both you and
your child. If your child simply isn’t quite ready yet, that’s ok. Review the
signs above for knowing if your child is ready for toilet training. If he is,
then maybe consider some of the suggestions below:
- Because it’s important that your child actually uses the toilet when sitting there, you want to try to get him on the toilet when it’s actually needed. The diary mentioned before can help, but you also might consider increasing the quantity of liquids he’s drinking or offering him foods high in fiber such as prunes. These steps are taken to encourage your child to actually use the toilet when he’s there, so he can then be rewarded and praised for doing it. Think of it this way: it creates more opportunities for him to practice telling you he needs to go and to actually use the toilet.
- Try further modifying the bathroom so that it is more pleasant to be in. Try adjusting the lighting, putting on pleasant music, or providing pleasant scents. For some children, the bathroom can be such a cold, sterile place that it is very uncomfortable to be there, makes them anxious, and therefore makes it difficult to use the toilet.
- Make it easy for your child to quickly get his clothes off and sit on the toilet, so that it reduces the likelihood of accidents and increases his chances of successfully using the toilet.
My child is afraid or unwilling
to sit on the toilet.
It is
fairly common for children to be fearful of sitting on the toilet. Fortunately,
there are some strategies that are often helpful in overcoming this fear. You
will want to get two materials to help overcome fear of the toilet: a timer and
a strong reward. The plan itself is fairly simple. You are going to try to get
your child to sit on the toilet for gradually longer periods of time and
rewarding her each time she does this. It may sound terrible and inadvisable,
but I often recommend getting some kind of small, favorite candy for the child.
Whatever candy she just loves is what we want, and we want her to only get it in association with using
the toilet. I recommend the candy should be no more than a bite worth (for
example, 2-3 M&M’s or Skittles, a Hershey Kiss, etc.). We don’t want her to
ever get “full” on it; it’s important that she continues to want it. It may be
necessary to identify a few different preferred candies and change it up from
time to time.
If she
won’t go into the bathroom at all, then our first step is to get her in there.
Go to the doorway to the bathroom with her and tell her you just want her to
step inside the bathroom for a moment, and that if she does, she’ll get the
reward. After she’s done that a few times, then it’s time to get the timer and
tell her that she just needs to stay in the bathroom (with you) for 5, 10, 15,
or 30 seconds. If you can get her up to 30 seconds, then she can probably begin
working on sitting on the toilet.
With
sitting on the toilet, you once again start with “just sit on the toilet for a
moment” and reward it. Then you start getting her to do it for gradually longer
periods of time. For many children, they’re good to go once they can sit for 30
seconds, but if necessary, try going up to 1 minute or 2 minutes.
The
actual process can take longer than expected. Some children figure out the
reward system and go with it very quickly, resolving their fear of the toilet
within a matter of days. Other children may require longer. A common complaint
from parents is that the child has figured out that sitting on the toilet gets
them candy and they’ll abuse it. The child starts to say that she needs to go
to the toilet even when she doesn’t, and may say it extremely frequently (for
example, 5 or 6 times in a period of 15-30 minutes). That’s alright, though,
because every time the child goes to sit on the toilet, she is overcoming her
fear and before long it is completely gone. Using the timer to require her to
remain seated on the toilet for 2-5 minutes will also reduce the frequency with
which she gets candy (though still allow her to play with whatever toys and
games you’ve setup for “toilet time”). Eventually, she’ll likely be on the
toilet when she actually needs to be there.
My child doesn’t seem to care
about going in the toilet/keeps using the diaper.
Though
parents expect that the child should automatically be uncomfortable when he has
an accident, you should consider how long the child has been using diapers
(typically 2-4 years). Your child is at least able to tolerate the feeling and
knows that it will get changed with a fresh diaper before too long. Using the
diaper is easier than using the toilet (it requires much less effort) and also
allows your child to keep playing with whatever he was doing (which is probably
much more fun than using the toilet). You should
not punish your child for using the diaper, that is likely to cause your
child to associate peeing or pooping with punishment, making your child anxious
as soon as he feels the urge to do that, and may lead to problems with him
holding it in for far longer than he should (and potentially constipation).
So how
do we get your child to actually want to go through all of the effort of using
the toilet and give up playing for a period of time to do it? That’s where
rewards come in again. We have to make it very
appealing for your child to actually use the toilet instead of the diaper. Use
the steps above to encourage your child to actually go and sit on the toilet,
similarly praise your child for telling you he needs to “go potty”, and be as
happy and positive about the whole thing as you can. Your child will learn that
he can get some positive, affectionate attention from you by coming to you and
telling you he needs to go potty. Again, we don’t care if he begins to “abuse”
this by asking to go potty when he doesn’t really need to (Your child wants
more of your attention and affection? That’s not a bad thing at all).
Next we
need to make success (meaning, “actually used the toilet instead of just
sitting on it”) desirable, which entails something called “differential
reinforcement.” Differential reinforcement is where the child is rewarded for
doing behavior B (using the toilet), but receives no reward for doing behavior
A (using the diaper). It sounds simple, but usually takes some practice to get
the hang of it.
After your child is willing to sit on the toilet and stay there
for a while (goal of 2 – 5 minutes), and is able to communicate that he needs
to go to the toilet, then we shift the rewards away from those things and
instead provide the reward only when the child actually does something in the
toilet. Initially, we don’t care about how
much the child does in the toilet, but if he does anything in the toilet,
then he gets the reward. Eventually we want him to completely do all of his
business in the toilet (completely emptying his bladder or completing a bowel
movement). That last part can be a little tricky, but usually isn’t as much of
a problem once you can get him to use the toilet.
The
second component to this plan is for him to be inconvenienced by using the
diaper instead of the toilet. Remember, if he is able to keep playing by using
the diaper, then why is he going to use the toilet? The trick here is to be
able to figure out when he has used his diaper and require him to get it
changed immediately; meaning he doesn’t get to keep playing. This removes one
of the major incentives for using the diaper; now he no longer gets to keep
playing by using the diaper, which means using the toilet is pretty much on an
even playing field with the diaper. If using the diaper isn’t any better than
using the toilet (both require him to stop playing), then the reward he gets
for using the toilet suddenly makes it a more appealing option. When you
implement this kind of plan, you need to keep a few things in mind:
- Consistency is important:
- As much as possible, reward your child for using the toilet.
- As much as possible, require your child to stop playing to get his diaper changed when he uses it instead of the toilet.
- Patience is equally important:
- It takes time for a child to figure out how the system works (“Ah-hah! Toilet = reward, diaper = no playing!”).
- Your child is still practicing a new skill and needs time to become proficient.
- Getting frustrated is likely to make a child worry, which makes the process harder.
- Accidents and setbacks will happen, just keep going with the plan and don’t worry too much about accidents.
If your
child continues to have difficulties even after following this guide, then you
may need to check with your pediatrician or other professionals to see if there
is another reason for the difficulty. A continued difficulty with toilet
training may be an indication of something else (such as a urinary tract
infection, digestive difficulties, anxiety, or other concerns).
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