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Entries in potty training (3)


Troubleshooting for the Stubborn Potty Trainer

Some children (often those who are described as “spirited” or “strong willed”) resist using the potty when parents initially attempt to potty train. For these kids, you will need some different tactics. Some ideas to keep in mind for these kids: 1. they need to feel in control. 2. you can create the rules, but if you pressure or even encourage too much this often provokes rebellion, 3. they still need encouragement but just a few words here and there about how you know they can do it. 

Here are some step by step instructions for a strategy to help potty train stubborn toddlers.
1. If you are currently trying to potty train and they are refusing to use the potty (crying, fussing, tantruming when you suggest sitting on the potty) then STOP. Do not ask them to use the potty. Do not mention anything having to do with diapers or potty etc. for at least 2-3 weeks. Potty training can NOT be a power struggle.
2. Be casual/low pressure. When you start back after a couple of weeks, act very casual about potty training and talk in positive language. Example: “I know you are growing up and big kids can put their pee-pee and poopers in the potty. I don’t know when you’ll be ready to do that but I know you will do it when you are ready! 
3. Get them sitting on the potty regularly. Do not ask them if they want to use the potty. Very matter of factly explain that there is a new reward (candy, toy, stickers, etc) that they get whenever they SIT on the potty. Without any emotion. Example “Oh, guess what, we have M&Ms now for anyone who sits on the potty.” Then, every 1-2 hours throughout the day ask them if they want to try to earn an M&M? If they say yes! Say okay, sitting on the potty earns M&Ms. If they say no. DROP IT for a few days. If candy or stickers etc aren’t motivating, try a new reward several days later. If they start getting upset when you suggest earning a certain prize then DROP any mention of trying to earn a prize for at least 1-2 weeks again. Note: Ipad/iphones are great rewards IF they are allowed limited access to these devices so that playing with them is a big incentive. So ask if they want to earn some iPad time. Then casually explain they only get to play with the iPad while they sit on the potty. If they aren’t interested in the iPad search the App store for a new game that would appeal to them and casually show them there’s something new on the iPad to try to get them interested. PLEASE NOTE: I suggest sitting in the bathroom with your toddler while they are on the potty holding your ipad/iphone to prevent any accidental drops into the toilet!!! This may mean a lot of time sitting in the bathroom waiting on your child to potty. I generally limit "potty attempts" to 10-15 minutes and then say "we can try again in a little bit but we need to plug in the ipad to give it more battery now." since some kids would sit on the potty all day long! 
4. Change the goal from sitting to peeing/pooping on the potty. Once they are happily sitting on the potty to earn their reward 6-8 times per day for several days. Very casually tell them the rule is now that they get the reward (candy/sticker/iPad) if something comes OUT when they are sitting on the potty (Pee-pee or poopers in the potty = reward). If they sit on the potty but nothing comes out, stay positive. Example “That was a great try! I bet something will come out the next time.”
5. Introduce underwear and change the goal again. Once they are regularly sitting and peeing or pooping on the potty then tell them it’s time to wear underwear like (insert older friend or cousin’s name they think is cool). Do not make a big deal about this as sometimes that can trigger the power struggle in a strong willed kid. When you’ve put them in underwear change the goal again to “You can earn the reward (candy/sticker/iPad) at lunch time if you’ve had no messes this morning.” Then again before dinner if they’ve had no accidents all afternoon. 
6. Expect accidents and remain calm. When they have an accident, stay calm and casually say “Oh no, you didn’t quite make it to the potty today. I know you can do it next time! Remember pee-pee goes in the potty.” Then drop it. Do not lecture. Do not plead. Just tell them they need to help clean it up (this is frustrating and makes a bigger mess but is important that they don’t get to play while you clean. Give them a paper towel or wipe and have them “help” you. If they refuse to help. Tell them they have to at least stay and learn how to clean (aka watch you). Then help them get changed into new dry underwear and clothes and again give encouragement “I know you can keep your pants dry this time and earn that reward before dinner/tomorrow etc.”
7. More encouragement. When they successfully pee or poop in the potty tell them you are proud of what a big kid they are and how they are learning to do something new. 
8. Stay close to home. Minimize time away from home for 2-3 days once they are in underwear to make it easier for them to always have access to the potty. 
9. Expect setbacks: Most kids take a few days to stop having very frequent accidents, then start doing a bit better, but then have setbacks where they have more accidents again. Do not stress. Just very casually say “Today you are having a hard time with the potty. I know you can do better this afternoon/tomorrow” and remember to have them clean with you or “help” you (watch) you clean up the accidents. Keep a bag with 1-2 pairs of extra pants and underwear and socks in your car at all times. If your child has an accident when you’re out somewhere fun (the playground, park, children’s museum etc. tell them you have to leave to get cleaned up. If possible, clean them up in the car and then leave to go home to “wash the wet clothes” instead of resuming the enjoyable activity. This can be a big motivator in the future.

Potty Training in Action: Step by Step Guide to a Child Oriented Apporach

Okay, now is go time! Either you've carefully prepped your child and noted the signs of readiness as discussed in my earlier blog post Getting Down and Dirty: Potty Training Part 1 or, perhaps, you are one of those lukcy parents whose child is self-motivated and has excitedly proclaimed they are ready to use the potty.  Whatever has led up to this moment, now your potty training adventure is about to begin.

The general approach most pediatricians recommend these days for toilet training a child between 2-3 years of age is based on the work of Dr. Terry Brazelton, a well respected pediatrician and expert in child development who first developed this "Child Oriented Approach to Potty Training" in the 1960s.

Dr. Brazelton suggests waiting until your child shows some signs of readiness (staying dry for at least 2 hours during the day or after naps, child can follow simple instructions, child can walk to the potty and at least partially undress, child shows interest in potty). Once you've noted these signs, you're ready for the stepwise appraoch:

  • Step 1: Sit your child on the potty fully clothed (to read a book for example) for several minutes 2-3 times per day for several days to get them comfortable with the idea.  Use a stool to help them feel secure while sitting on a regular sized potty or introduce a small, portable potty (or both).
  • Step 2: Encourage your child to sit (bare bottomed) on the potty at regular times (upon awakening in the morning and after nap, after meals, before bath) but with no pressure to perform.  Also start emptying your child's dirty diapers into the potty to reinforce that the potty is where we dispose of poop.
  • Step 3: BREAKTHROUGH! this happens at random when, by chance, your child either urinates or stools in the potty at one of the regular sitting times.  Parents are instructed to praise their child and reward them for this accomplishment.

If at any point you encounter resistance, parents are instructed to back off and wait until their child shows interest.  For the majority of self-motivated children this approach will eventually work, but it may take several months (3-12). 

A slight variation in Brazelton's approach includes the parent encouraing "practice runs" at key times throughout the day.

  • Make sure your child is wearing minimal, easy-to-remove clothing. If it’s warm enough, consider going pantsless.
  • Watch your child for signs that he needs to urinate or stool (grunting, making faces, squirming, pulling at the diaper, etc).
  • When he is about to void, remove his diaper or underwear and place him on the potty. Encourage him to use the potty (for example, say “try to go pee-pee in the potty"). If he does, reward him with praise, affection, and special treats (stickers or a snack). If he doesn’t void, allow him to stay on the potty for up to five minutes. If nothing happens by that time, end the practice run. But don’t force the child to sit. If he’s restless, let him off the potty with an encouraging word (“good try").
  • Troubleshooting: If you have trouble telling when your child needs to pee, Schmidt suggests that you hold practice runs about 45 minutes after your child has finished a large drink, or after two hours without urinating. If you have trouble detecting when they will stool, stage a practice run after a large meal or after 24 hours without a bowel movement.

Important tips to keep in mind while potty training:

Stay positive! Praise your child for any attempt (even if they are not successful and nothing comes out).

Expect accidents.  When your child has an accident, change her as soon as possible. You want your child to get accustomed to wearing only clean, dry pants. Encourage your child to keep trying to use the potty. Avoid a show of negative emotions. Be patient, affectionate and upbeat.  Keep encouraging them "That's okay, we can clean you up.  I know you'll be able to keep your underwear dry soon.  You're getting bigger each day."

Teach Toileting Hygiene. When you're potty training, it's important to include a lesson on keeping clean. Instruct both girls and boys how to wipe front to back, to flush, and to wash their hands with soap and water afterward. You can buy sparkly or colorful kid-friendly soap as an incentive to get kids excited about washing. Make sure your child is washing long enough by asking him to sing the Alphabet Song while he cleans up.

Please keep in mind that for more sensitive, anxious or more strong willed children potty training can be more difficult.  Look for my next post on Toilet Training Troubleshooting coming soon.


Getting Down and Dirty: Potty Training (Part 1)

I love children.  I love being a parent.  But potty training is my least favorite part of parenting, so far.  It’s not particularly enjoyable even for the kids who potty train quickly.  But in some cases, like with our first child (a strong willed boy who was not at all interested in using the celebrated potty) parents have to try many, many different approaches until we finally figure out what it takes to motivate our little ones to become toilet trained.  Now, I’ll pass along what I’ve learned (both professionally as a pediatrician and some personal lessons I learned along the way that may help other families).  First, I’ll give you an overview of the general approach to potty training and then give some specific tips for younger kids and older kids.

When to potty train?

According to the American Academy of Pediatrics, there is no right age to toilet train a child. Readiness to begin toilet training depends on the individual child.  In the United States, experts typically recommend toilet training between 18 months and 3 years.  One research study found that the average age for completing toileting in girls is around 2.5 years (about 32 months) and in boys is closer to 3 years (about 35 months).  I think there is a wide range of ages when a child can successfully potty train and while some children may be able to do so at 18 months, others can not. 

It's best to start the potty training process during a stable period of your child’s life. If there are stressors happening at home (moving to a new home, a new baby, starting a new school or meeting a new caretaker) then it’s best to wait until your child adjusts.

As an aside, some parents are interested in "infant potty training" which is a different approach.  This is not wrong but involves a different strategy and involves trying to read your child's signs (scrunched face when preparinig to stool for example) and then repeatedly placing them on the toilet.  You can read more about this concept here. Many other cultures use this method but traditionally in the United States we recommend child led potty training which is what I will be discussing here.

Signs of Toilet Training Readiness

1. Periods of dryness: If your child’s diaper is dry for more than 2 hours at a time or dry after naps, they may be ready.

2. Interest in the toilet: Some children may simply verbalize their desire to use the toilet.  Others become very distressed when their diaper is wet or dirty (this is the perfect time to show them the solution to feeling wet or messy - the toilet!!)

3. Ability to walk to the potty and undress (for traditional potty training for children over 18 months).  It's helpful to avoid overalls or tight pants or belts that will make it difficult for a child to remove themselves.

Most children show some interest and then have set backs (more accidents or refusal). The most important thing if trying to potty train early is to STOP if you meet signs of resistance so as to avoid power struggles that can lead to major toileting resistance and refusal.

Setting the Stage:

First, I recommend introducing the idea of using the potty by modeling for them (let Junior come and watch you use the toilet and explaint that he or she will too as they get older).  Reading books about potty training is also very helpful for explaining what is involved.  A few of my favorites are Once Upon a Potty (comes in a girl version and a boy version), Potty Time, and Potty Superhero.  Also, there's a great Daniel Tiger episode about potty training (episode 111).

Secondly, I recommend taking your child shopping with you for all the "big kid" supplies for potty training. Make this into a special outing and tell him or her that you are so excited to watch them growing up into such a big kid.  

- A small potty seat or seat reducer inserts for the regular toilet seat (etiher removable or these that you can install to raise or lower with your regular toilet seat). If you are going to have a child sit on an adult sized toilet, make sure to get a stool that they can place their feet on (it's easier to push out stool if you can brace your feet on the floor or a stool).

- Big kid underwear (try to find a design that your child loves, perhaps a favorite carachter from book or movies, dinosaurs, etc).

- Kid friendly soap (love the foaming soap)

I also keep a package of wipes, lots of disposable trash bags, a roll of paper towels, and some Lysol cleaner in a nearby cabinet for easy clean up for near misses or accidents that are sure to occur.

Stay Tuned for Potty Training in Action (Part 2) and Troubleshooting for Potty Training Stubborn Toddlers (Part 3).