Potty "Learning" Primer

Probably one of the most asked about topics I encounter during toddler well-child examinations relates to potty training. Whether it's recognizing the signs that your child is ready, to which method is the best, to how to actually do it; potty training causes many parents anxiety and undue stress.

Potty training is a momentous milestone in your child's development and as parents, we want it to be a positive one (hooray, no more diapers!). This is precisely the reason why I'm going to take time this month and next month to discuss everything you ever wanted to know about potty training. This month I'll go over the basics and next month I'll dive deeper into common problems that arise after your child has been toilet trained. It is my hope that through these posts, it'll be a positive experience, not only for your child, but you as well.

First, and probably most important, is we have to change the way we talk about potty training. The term “potty training” is a misnomer. Here at ABC Pediatrics, we like to think of it more like “potty learning.” Our children are our little apprentices. Like it or not, they learn by watching, listening and the example we set for them. For example, if you don't get excited about vegetables and eat them regularly, would you expect your child do the same? It's the same way with learning to use the potty. Your child needs to see and hear you talk about using the potty before she can be able to do so herself. Think of this like hands-on learning. For the sake of being more simple, I will use the term potty training, but please, think of it more as active potty learning.

So how will you know your child is ready? Well, that answer is two-fold. Most children are physiologically ready, that is, their digestive and urinary systems are developed enough that they can hold their urine and stool long enough to make it to a toilet, between 18 and 30 months. That being said, this doesn’t mean that your child is psychologically ready. In other words, at 18 months or 2.5 years of age, your child may not have the mental capacity or desire to be potty trained. Some signs your child may be ready to initiate potty training include: your child begins to demonstrate independence by saying “no,” your child is able to walk and sit down, your child imitates your behavior, your child expresses interest in using the toilet (i.e. wants to flush the toilet, watches you use the bathroom, etc.), your child can tell you when she is peeing or pooping and then begins to tell you that she needs to pee or poop before she is actually doing it, and, finally, your child has the motor skills to pull her clothes up and down or on and off. Physical, emotional, and cognitive readiness happens at different ages for all children, so don't rush it. Just pay attention to these clues that your child may be ready to start the process.

There are a plethora of different potty training methods out there and it can be difficult as a parent in deciding which one to implement. Ultimately, the two most common methods in a study conducted by the Agency for Healthcare Research and Quality were the child-oriented approach and the Azrin and Foxx “Toilet Training in Less Than a Day” method, and, both have been found to be effective. The American Academy of Pediatrics (AAP) recommends using a child-oriented approach as it seems to be the most agreeable and reasonable one for most families. This method has parents slowly introduce the potty chair and begin educating their child as soon as she starts showing interest in using the potty. This touches upon what I was discussing earlier regarding how our children learn by watching us. For example, expressing to her when you feel like you have to go the bathroom, letting your child follow you into the bathroom and showing her what you're doing while you're going to the bathroom, have her sit on the potty when you sit on the potty, demonstrating proper wiping technique and subsequently flushing the toilet and then showing her how to wash her hands properly are all ways to begin potty education. Now, if you're like me, the few minutes I use the restroom each day may be the only time I have to myself in a given day. Or, you could be like some fathers I know out there, who are calling the bathroom their new “man cave.” All joking aside, you don't have to take your child on every trip to the bathroom and you'll be surprised how these simple steps spark a whole new interest for your toddler. The biggest take-home point to this child-oriented method is to not push too hard. The key is slow and gentle encouragement.

Another common and effective method for potty training that parents have asked me about is the Azrin and Foxx method which uses behavior modification to potty train. Simply put, you pick a day where you don't have to go anywhere, free from other distractions, and you can devote all of your attention to your child, preferably a block of 4 to 6 hours. You then give your child plenty of fluids and snacks and have her sit on the potty regularly with the idea this will help her need to go to bathroom more frequently. Rewards are then given for using the potty and not soiling her underwear and redirection and education if there's an accident. The key to this method is positive reinforcement with successful use of the potty. There is no punishment with accidents. While this method may work for some families, it is not something I typically suggest because it's a very intensive process. That being said, with proper preparation beforehand, it can be very effective (see here).

I'd like to leave you with some final tips. Know that with any type of learning, it is a dynamic process and it will likely take some time to master. Setbacks are likely, but with practice, things should improve. Don't be discouraged and remember to stay positive and encourage your child. Once you begin talking about using the potty, bring your child with you to have her pick out a potty. Picking it out herself may give her more motivation to start using it. Also, bringing your child to pick out her underwear can be helpful. I will often recommend parents displaying the underwear in an out-of-reach place as incentive. Your child will likely be excited to put her favorite Disney character or superhero underwear on and will likely not want to dirty them by going to the bathroom in them. Pull-ups are generally unhelpful and should be used sparingly, if at all. They sometimes become a crutch and you don't want the use of a pull-up to give her permission to just pee or poop in the pull-up instead of using the potty. Finally, pick up some of these books from your local library or purchase them for your own library (see here, here and here). They are great introductions for your child and super cute reads. As always, don't hesitate to contact us here at ABC Pediatrics if you have any specific questions or concerns. We'd love to help in any way we can. Happy learning!

Information presented adapted from:
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American Academy of Pediatrics. Toilet training guidelines: Parents -- the Role of the Parents in Toilet Training.
http://pediatrics.aappublications.org/content/pediatrics/103/Supplement_3/1362.full.pdf

American Academy of Pediatrics. How to Tell When Your Child is Ready. https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/How-to-Tell-When-Your-Child-is-Ready.aspx

American Academy of Pediatrics. Toilet Training 101.
http://www.aappublications.org/content/28/5/16

Schmitt, Barton D. Toilet Training: Getting it Right the First Time.
http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics/news/clinical/pediatrics/toilet-training-getting-it-right-first-time#1