Nappies can be a real bind, but the prospect of potty training is pretty daunting too. Clinical psychologist and play therapist Dr Jo-Marie Bothma takes an in-depth look at techniques you can use to potty train your toddler.
A few years ago, when I was in the middle of potty training my son, I took him to a public restroom in a big shopping mall. It was a busy Saturday, with many people waiting their turn. After we were both finished, we walked out to wash our hands and he loudly said: “Did you poop, Mom”? Pretty embarrassing.
I tried to move him along, but he insisted on knowing. It was what he was always asked. I had a few smiling at me, and some reassuring nods from other moms, and it reminded me again how at some point in time we are all in the middle of figuring out how best to help out children become ‘potty-wise’.
A few surprising facts
In general, scientists have done very little research on potty training. So even with many articles on potty training in the popular media, very few scientific studies have actually addressed this issue of how best to potty train a child.
Associate professor and paediatrician Dr Timothy Schum, from the Medical College in Wisconsin, explains that most of what parents read in the lay literature is not backed up by scientific evidence. In fact, some advice can even be harmful.
In an attempt to refrain from adding more articles on this topic without sound scientific back-up, let’s have a look at what peer-reviewed research has said over the last few years and then navigate around those facts for solid advice and tips.
The right age to start
Although I have heard of parents announcing that their 20-month-old successfully stays dry during the day, that is most definitely not the norm, and should not make any other parent feel like a failure in any way. Also, just because your child’s playschool has a goal of potty training all two- to three-year-olds, does not mean that all of them will be ready to train at the same time.
What paediatric science does tell us without any uncertainty, is that children should only start potty training when they are ready to do so. A review of the available literature during the past 50 years reveals a steady increase in age of attainment of daytime bowel and bladder continence from approximately 24 months in the 1950s, to 36-39 months in the late 1990s. The main reasons seem to be the luxury of good quality nappies, as well as different parenting practices. Current literature suggests that the average age when parents can expect little girls to stay dry during the day is only at around 32 months. Little boys can be expected to stay dry during the day at around 35 months. Remember that these are mere averages, and some toddlers do achieve success a little earlier and some a little later.
Dr Barbara Howard, a toilet training expert and paediatrician from Duke Children’s Hospital in North Carolina states that parents need to realise that children cannot control these body functions until they are neurologically and cognitively mature. Chronological age is therefore not the only determinant of a child’s readiness to potty train. Mental, neurological and cognitive age would be better predictors.
Research has furthermore identified several readiness skills (see the table below) that children need to master before they are in fact ready to start training. These skills form the foundation for successful potty training, and when parents can tick off this list, it would be correct to assume that their child is now ready to start learning how to become pottywise.
|Global readiness skills||Specific readiness skills|
So, based on research it is not so much the ‘right age’ that determines when parents or schools should expect to start training, but more whether children have mastered the necessary readiness skills. Once toddlers are ready, they can also learn to accomplish middle and late potty training skills. See below.
|Middle potty training skills||Late potty training skills|
Ten right things to do during potty training
- A healthy and loving relationship between the toddler and parent (or teacher) is important, because potty training can set the tone for communication with the family. Some children can use elimination as a way to communicate unhappiness and stress. Some use the potty training phase to manipulate others. If parents or schools carry out this training in a coercive way it can set off negative reactions that may affect a child’s mental health. Toilet training is particularly ripe for power struggles because it is so tied up with toddlers wanting to have control over their own bodies. It is therefore important to approach toilet training matter-of-factly and without a lot of emotion. So, if you are starting to see power struggles developing over potty training, it might help to take the pressure off and stop any training for a little while until your child shows signs of readiness again. Begin potty training from the moment the child is born. Talk to an infant during their nappy change by saying: ‘You are wet’ or ‘Let me make you comfortable and change your nappy, you made a poo’.
- Aim to make nappy changing times fun and pleasurable. Sing a song while changing your baby’s nappy and be sure to end it off with a cuddle and a kiss before going on to the next activity. Try to not pull faces or show disgust at soiled nappies as they grow older. Older babies might indicate or ask their parents to change their nappies. Always reply very positively and reassuringly and say something like: “Sure, my darling. Let’s go and clean your bum so that you can feel better. ”Most babies follow their parents everywhere once they start walking around. Let them join you in the bathroom. Often children train themselves later by modelling an older sibling or parent. It is also witnessed in schools. Toddlers tend to train earlier because they see the older children in their class using the toilet and they want to join after a while.
- Once your toddler shows readiness skills, move him or her out of nappies into training pants or cloth underwear. One effective way to know that neurological maturity is taking place is to ask your little one to urinate in the water during bath time. Be patient during the first attempts. It will take some time. Once they have managed to urinate on instruction a few times during bath time, you can try to remove their clothes and put them on the toilet while you run the bath and ask them to wee in the toilet so long, while you are getting the bath ready. This is not intimidating and usually works very effectively to take off any pressure. Success during attempts like this should give parents an indication whether their children are ready for potty training.
- Some parents use potty chairs, which is less intimidating. Others prefer making use of the adult-size toilet and add smaller inner seats or little steps and handles to make it more accommodating. Do whatever suits your family and toddler’s needs and preferences. Schools usually have toddler sized toilets installed in bathrooms.
- The next step would be to take your child to the bathroom every one to two hours or so during the day. It sometimes works well if you offer them something to drink and then take them to the toilet within minutes of doing so. Apart from regularly taking your child, you should also take them the moment you recognise their need to go. Parents know their children and can often anticipate when they are about to have a bowel movement. Sit with your child in a non-coercive way and sing songs, read books or tell stories. Best practice would be to sit flat next to them on the bathroom floor and appear relaxed and in no rush. Give them at least five minutes before getting them dressed again. If they have not managed to produce some evidence during that time, chances are slim that they have a need. Do not look disappointed and definitely do not be angry about a no-result-activity. Act very matter-of-fact and say something like: “Seems like there is nothing that wants to come out now – let’s get dressed.” Do not be surprised if they wet their underwear a few minutes after leaving the bathroom. That is normal.
- Choose when you start with potty training cleverly! Do not start with this process if, for instance, you are going through a particularly stressful time at work, moving house or are about to deliver the trainee’s sibling. Patience is the key and any frustration experienced by your child will be taken personally and can make a child feel insecure and sabotage your potty training attempts.
- Make a big hoo-ha every time your child succeeds during those first few days or weeks. Do the Macarena if you must, pull silly faces, phone a friend, call the other siblings to come and have a look or take a picture of the evidence and send it off to daddy as proof (yes, I know – what parents will not do nowadays!). You should make a big thing out of those first successes, because they are a pretty big deal.
- However, once you are sure that your little one does, in fact, have some control over this potty training business, stop making such a big fuss. Anger or disappointment when it is not going well or overwhelming joy when it is, gives some children the knowledge that this is something you badly want for them to do. Refusing to do so can then become a powerful way for your child to feel in control.
- Star charts can be used to visually show them how many successes will lead to a bigger hoo-ha, such as a nice treat somewhere or a small present. Again, these kinds of rewards may encourage progress in the short run and could be valuable ice breakers. The concern, however, is that for some children the pressure of success in the form of rewards creates anxiety or feelings of failure when they have potty accidents.
- The other risk is that the continued use of reward charts can lead certain children to expect rewards for almost anything. If parents do not attach such a huge amount of meaning to potty training, most children are more likely to follow their own internal desire to reach this important milestone. The bottom line, therefore is to aim for a healthy balance of excitement and mundanity during this time.
- Dress your child in comfortable clothes that can easily be pulled down. This is one of the reasons summer is often chosen as the ideal potty training season.
- Consider switching from pull-up nappies during the daytime, which allow the child comfort during wetness, to cloth underwear, which makes accidents more noticeable, thus motivating the child to use the potty.
- Start by letting little boys sit down while urinating. At first, it is hard to control starting and stopping while standing.
- You can consider getting some props to help. They can come in the form of potty training story books, a potty training dolly and even a brightly coloured ball for aiming in the middle of the toilet. If it can make things more fun, use it.
- If your child resists using the potty or toilet or is just not getting the hang of it within a few weeks, take a break. Chances are he or she is not ready yet.
The big no-no’s during potty training
Never shame a child during this process for either not managing it or for having an accident. Be prepared that there will be little wet pools in your house for a while. Stay cool and do not treat the accident as some sort of an emergency. Say something such as: “Oops, you did not see this one coming. Let’s quickly clean up and get you dry underwear.”
This is part of the training, and will happen more in times of stress or excitement or when the child has had little sleep. Luckily pull-up nappies make it easier now and can be used when you are out and about. The overall goal is for a child to experience potty training as an accomplishment. Your child should never be made to feel like there is something wrong with them for not managing the task.
Night-time control usually comes much later than daytime control. Complete night-time control may not happen until your child is four or five years old, or even older. Even when children are toilet trained, they may have some normal accidents (when excited or playing a lot), or setbacks due to illness or emotional situations.
Potty training can be a challenge, but with the help of prizes, siblings, and a few good songs, it can be easier (and funnier). Like most other developmental phases or milestones, this too shall pass.