In the United States, many parents begin potty training between the ages of two and three, but it’s possible to train at a much younger age. Across the globe, toilet training often begins in the first year of life, frequently as early as three to six months. The process of toilet training a non-verbal, non-mobile child is called “elimination communication.” In truth, elimination communication has more to do with training caregivers than children. After learning to recognize cues (facial expressions, squirming, farting, etc.), parents transport their babies to an appropriate receptacle to receive the waste. Because elimination communication requires so much parental vigilance (and cleaning!), I’m not a fan of the process; but hey, if you’ve got the time and patience, go for it. The less money spent on diapers, and the less solid waste being dumped in landfills, the better!
The bottom line with toilet training is that children become trained when parents decide they’re ready. Potty training can be time consuming and messy, so parents must be invested in the process. A common misconception is the idea that parents should wait until a child is ready to begin training, but this isn’t the case at all. Let me repeat this. There is NO need to wait until the child is ready, especially because you might find yourself waiting much longer that you expected. In my experience, parents who defer to the wishes of tiny dictators often run into potty problems. Two and three-year-olds can be incredibly stubborn and controlling. They love the word “No!” and use it liberally. Before you know it, that demanding two-year-old has turned four, and no one wants to be changing a four-year-old’s diaper.
When is the best time to potty train? At around 18 months of age, most children are walking, communicating (at the very least non-verbally), interested in pleasing their parents, and highly susceptible to bribery. In my opinion, this is a fantastic time to begin training. Keep in mind that all kids develop at their own pace. Children with cognitive disabilities may take longer to train, and those who are walking/talking at a young age may train earlier. The good news is that almost all children can be successfully trained by employing the right strategies—a combination of positive and negative reinforcement that will motivate the child.
Before diving into the specifics of potty training, I’d like to share a few amusing anecdotes about my own children, who taught me almost everything I needed to know about toilet training. Not long after my oldest turned two, she threw a diaper at me (literally) and proclaimed, “No more diapers! I want underwear!” Princess Anna had spoken, so I shrugged my shoulders, bought some underpants, and that was that. The kid was fully trained in a weekend, through no work of my own. Moral of the story? If a child is motivated, potty training is a piece of cake.
When my middle child was 18-months-old, I was spending a fortune on daycare and decided it would be nice to spend less money on diapers. Our family began actively training, which turned out to be a fair amount of work with lots of reminders and celebratory singing, but within two months we were done.
If a child can be fully trained at 20 months, I reasoned, why not start younger? With daughter number three, we opted to conduct an experiment and began training at 15 months. While this required even more commitment and frequent encouragement (not to mention more laundry), the experiment was successful. By 17 months we were done. Perhaps if we’d had a fourth child, we would’ve attempted the process at an even younger age, but we never got that far—our next child was a puppy, and Chewy took the longest to train of everyone.
Step-by-step guide to potty training:
One. Parents should decide they’re “ready” to train their child. This is critical. Potty training doesn’t work without full parental commitment. To prepare for this project, develop a celebratory song (for example, “Sally made a pee-pee, a pee-pee on the potty, yay—Sally, yay—Sally,” or something along those lines). You can also choreograph a simple dance to go along with your song. I’m serious. Children sense the energy (or lack thereof) that parents bring to their potty training routines.
Two. Take your child into the bathroom with you. Demonstrate how big people use the potty. If you have a moment when your child isn’t wearing a diaper and happens to pee in front of you (in the tub, for example), point out the exciting event which has just occurred. With enthusiasm, you can say something like, “Look at that, you went pee pee, hooray! Big girls put pee pee in the potty, and you can, too!”
Three. When your child poops in a diaper, transfer the poop to the potty. Together, you can flush the poop and happily wave, “Bye-bye, poopy!”
Four. Buy underwear. Instead of a diaper bag, carry around an “extra clothing” bag, including socks and possibly shoes (pee pee accidents often soak the feet below the ankles).
Five. Buy a plastic ring to fit over the big potty. This allows little behinds to fit comfortably on a regular toilet. Starting with an adult toilet minimizes clean-up duties and the need for transitioning later. However, if your child isn’t comfortable sitting on a big potty, feel free to buy a small plastic potty you can place in the living room, or wherever. Have your child practice sitting on different potties. Offer lots of praise when she does.
What if your child doesn’t want to sit on any potty? When it comes to small children, urinating into a potty is like eating vegetables—you can’t make them do it. For potty training to be successful, children must want to do it. Ideally, toilet training should be a fun adventure that a family embarks upon together, rather than a battle.
When I began training my middle child, our fun adventure quickly turned into a fight because she wasn’t inclined to sit on any potty, big or small. I theorized that the potty was too scary. On a journey to Walmart, I discovered the answer to our problem—a “musical” potty for less than 20 dollars! Whenever someone tinkled into this potty, it played a pretty song. My daughter and I practiced sprinkling tap water into the potty and listening to the song. Eventually she decided it would be fun to pee in the potty, and voila, she was trained! Sometimes you have to get creative.
Six. Dress your child in underwear while he’s awake, but still use diapers for naps and nighttime (your child can also wear nothing from the waist down, or just a T-shirt over underpants).
Dryness during sleep is a separate milestone related to bladder muscle maturity and has nothing to do with daytime dryness. Children who are fully potty trained may take several years, or even 10 years (or more) to achieve full nighttime dryness. Trust me, it isn’t worth using underwear at nighttime if your child generally wakes up wet; you’re going to be stuck doing lots of laundry, and your child won’t achieve dryness any sooner.
Furthermore, if your child is wearing diapers or pull-ups during the daytime, potty training is almost impossible. Diapers are so absorbent that children don’t realize when they’ve had an accident. While wearing a diaper or pull-up, there is no motivation to pee in the potty. If you want to successfully potty train, putting away the diapers and pullups during awake hours is essential.
Seven. Watch the clock. Encourage your child to pee on the potty every one to two hours. If you encounter resistance to sitting on the potty, try using positive reinforcement (otherwise known as bribery, see below).
Eight. Allow your child to have some accidents. Try not to get mad or frustrated when these occur. The process of having accidents (and feeling them) is what motivates children to pee in the potty. When your child has an accident, encourage her to take responsibility by cleaning up any mess on the floor and then putting her clothing into the washing machine. Acting a little disappointed is okay. You can say something like, “Next time, let’s try to put it in the potty.”
If your child has an accident and couldn’t care less about getting wet, you may need to come up with creative strategies to motivate her.
Nine. When your child successfully uses the potty, break out your potty song and perform it with the pee-pee dance. Your kids will love it! The more celebratory the experience, the better. The first time a child uses the potty is a truly wonderful moment, so live it up! Dancing and singing may be the cheapest (and most effective) form of positive reinforcement. Small children love to watch their parents acting like happy idiots.
Trouble shooting potty problems
One. What if your child remains potty averse, despite plenty of encouragement? It’s time to try bribery! Feel free to offer the timeless classic, M & M’s, for peeing in the potty (but not for just sitting on the potty). If candy doesn’t work, consider offering stickers, or a “treasure box” from which a small prize may be chosen. Be sure to give the prize only after the child pees in the potty. If small incentives aren’t doing the trick, up the ante, at least initially. Buy something your child has been wanting, like a remote-control car or some fancy arts and crafts. Place a big bow around the item and leave it sitting in the bathroom. Give the present to your child only after she successfully uses the potty. From that point forward offer smaller incentives.
Two. What if your child pees like a champ on the potty but refuses to poop on the potty? Children who won’t do number two are frequently suffering from chronic constipation. Because it hurts to poop, they purposefully withhold their stool, leading to an accumulation of stool in the colon and rectum. When they eventually pass stool, it hurts more, and the vicious cycle is perpetuated. In my experience, the only way to break the cycle of chronic constipation and/or BM refusal is to use a stool softener over a period of months. This is not a problem that can be fixed overnight. A dilated rectum takes weeks to shrink to a normal size. Furthermore, constipated children must be convinced that passing a bowel movement is neither scary nor painful. The best way to change their opinion is by keeping the stool soft for a long period of time.
If you’re at the point of needing a stool softener, try Miralax, otherwise known as glycolax. The medication is tasteless, odorless, and can be dissolved in a small amount of any fluid. Despite some controversy on the internet, Miralax is both safe and effective. For a two-year-old, you can start by using one teaspoon twice daily. Remember that the powder should be titrated to effect, with the goal of achieving one to two soft stools daily. If your child is skipping days between bowel movements, you will need to increase the dose of medication. If the stool is too soft, then decrease the dose. Contact your pediatrician if you’re struggling to achieve the right dose.
Three. What should you do if your child refuses to poop on the potty because she’s being difficult, not because she’s constipated? The best way to answer this question is with an entertaining anecdote.
When a child I know well, “Laura,” was four-years-old, she was stubbornly refusing to poop on the potty, just as she’d been refusing to do since the age of two. During a family vacation to Disney World, Laura was having a great time swimming at an outdoor pool near our hotel. At some point she informed her father that she needed to poop. Though her dad escorted her to the bathroom several times, Laura kept returning to the pool without any potty success. Eventually she was overwhelmed by the urge to poop. Stool suddenly filled the bottom of her little white bikini. Instead of being sympathetic and letting her down easy, her dad began yelling.
“That is disgusting, Laura! You should be ashamed. You’re going to have to walk back to the hotel, and everyone is going to see poop running down your legs! How embarrassing!”
Rather than cleaning her up, Dad accompanied Laura on a 15-minute walk of shame, right back to the hotel room, just as he’d threatened. Kudos to Dad—this was a brilliant strategy. From that moment forward, Laura never, ever pooped in her pants again. Take-home lesson for parents: sometimes negative reinforcement can go a long way toward motivating a stubborn child.
Frequently in my practice, parents ask me what to do about stubborn three-year-olds who refuse to poop on the potty. If the children are constipated I recommend Miralax, but I also reinforce the idea that it’s okay to demand that a child poop on the potty. By age three, almost everyone has full control of their bowel movements. In fact, bowel control occurs well before bladder control. Most three-year-olds are perfectly capable of pooping in the right place. For children who are being difficult about training, I recommend that parents place them in underwear and explain their expectations. If a child has an accident and soils his underpants, then he should be the one to wash out the poop. This can be done by placing the child, holding the stinky underpants, in the bathtub. Washing poop out of your own underwear is a great motivator for pooping in the right place thereafter. Importantly, stubborn children who aren’t constipated can also benefit from treatment with Miralax. The medicine increases the urge to go, making children less likely to withhold their stool and develop constipation.
Four. What if your child is refusing to pee in the right place? When one of my daughters had been fully potty trained for a few months, she suddenly began urinating on the floor, mainly to cause trouble. At that time in her life, she loved watching Dora the Explorer on television. Using her interests as leverage, I threatened, “If you pee on the floor again, then I’m unplugging the TV and you can’t watch Dora.”
About five minutes later I was forced to follow through on my threat (note that follow through is incredibly important for any kind of reinforcement, positive or negative!). Happily, this was the last time she ever urinated in the wrong place. When potty training a stubborn child, the key is figuring out what specific combination of positive and negative reinforcement will motivate the child. As a wise person once said, “you catch more bees with honey.” I heartily agree! Try to use positive reinforcement whenever possible.
Five. What if your child has cognitive delays, and developmental issues are making it particularly difficult potty train? Hang in there and don’t give up! Multiple studies of developmentally disabled adults and children have shown that almost anyone can be potty trained by employing the right strategies. The process of potty training a child with disabilities may require a greater investment of patience, time, and creativity on the part of the caregiver; but the strategies employed are the same as those used when training a typically developing child.
Dr. Allison Beitel's Pedi Blog 