Toilet Training
Primary Care Pediatrics
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Parents often ask, "What is the best age to start toilet training?" Toilet training is a skill all children learn and master at different times. There is no "best age" for all children to begin toilet training.
Some children are ready to begin toilet training at 18 months. Others are not ready until 3 years of age or older. Some things that might slow down a child's readiness for toilet training are: childhood illnesses, family crisis, language delays, a new baby in the family or fear of the toilet.
The best time to start toilet training is when your child can do all of these things:
- Stands and walks by himself
- Stays dry in a diaper
- Recognizes the urge to have a bowel movement or to urinate and can delay the urge
- Gives a "cue" when he feels the need to "go potty." The parent or caregiver must be able to understand that cue
- Can follow basic directions
Gaining Your Child's Cooperation
- It is helpful to look at toilet training as a time of learning for your child. Like learning new words or learning to stack blocks, it takes time for the child to master what he or she has learned. The best way to gain cooperation is to praise him when he is successful and be kind and understanding when he is not.
- Harsh words and spanking should never be used when the child fails because that may make him feel ashamed. It will not help and will only cause delay in the training.
- Let your child have choices, such as picking out his own potty
- Consider using a child’s book or a video about toilet training.
Learning the Words
Before you can begin toilet training, there have to be words or cues to use. Choose the word you want to use then start teaching your child to use it. For example, each time your child has a bowel movement (BM) in the diaper, you might say, "Sammy's going poo-poo” or whatever word you use.
Repeat the same word each time you change his diaper. Soon the toddler will start to say a word that sounds like BM to himself and to you. After he is able to say the word and knows what it means, he may be able to tell you he wants to go to the bathroom.
Cues Your Child May Be Ready for Toilet Training
Many people who have had children feel they are "experts" in toilet training. Some will advise you to start earlier. Since all children are different in the way they grow and develop, you should follow your child's "cues" for readiness and start the training when your child is ready; do not force him into potty training. If your child keeps wetting his pants, becomes frustrated or does not seem ready, stop the toilet training and try again in a few months. Usually, children become completely toilet trained between the ages of 2 and 3½. If your child is toilet trained before he is 2, he may "backslide" and start wetting his pants again before he is totally trained.
Some children prefer to give signals, or cues, when they need to "potty" instead of using words. These are some examples of cues:
- Bowel movements become regular and predictable
- Child stays dry for longer than 2 hours or does not wet his diaper during naps
- Brings you a clean diaper when his is soiled or wet and wants to be changed
- Takes off a soiled or wet diaper himself
- Pulls at your clothes to let you know his diaper needs to be changed
- Talks about using the potty and wearing "grown-up" underwear
Choosing the Right Potty Chair
Many types of potty-chairs are available. The chair should be low enough for your child to place his feet firmly on the floor (Picture 1). The chair should have a back support and arm rests so that your child will feel secure and not be afraid of falling.
Learning to Use the Potty
- Take your child to the potty each time he tells you he wants to go or signals he is ready. Taking him to his potty while you use the toilet can help him get used to the routine. Stay with him each time if he seems afraid you might leave him. Gradually, he will be content to stay alone.
- Dress your child in loose-fitting pants and training pants.
- Since your child is beginning to want his independence, let him help. You might begin by having your child tear off the toilet paper. Later, he may want to stand and pull up his own pants.
- Consider having regular sitting times to make it more of a routine.
- The training will be easier if you remember "accidents" may happen and you stay calm when they do. When you feel your child wants to sit on the regular toilet, let him try it once in a while, but stay with him. This will help avoid the fear of strange toilets when you are away from home without a potty chair.
- Do not flush the toilet while your child is sitting on it. Toddlers don’t know their body is larger than the drain hole and may be afraid they will fall in. If your child uses a regular toilet, put a footstool in front of the toilet so the child can put his feet on it. This makes having bowel movements easier.
Habits of Cleanliness
- Teach your child to wash her hands each time after using the potty (Picture 2).
- Empty the potty into the toilet after each use. Wash the potty with a household disinfecting cleaner such as Lysol®, rinse and dry it with paper towels. Store all cleaning supplies out of children's reach.
- Children who are learning to use the toilet often put their hands on the toilet seat to brace themselves. To stop the spread of germs, it is important to wash the toilet seat and bowl with a disinfectant several times a week.
Rewards
Children learn faster if you reward them when they are successful in using the potty (Picture 3). Some examples of rewards are:
- Draw happy faces or use stickers on the clown chart (see page 4 on).
- Keep a few of your child's toys in a box where your child cannot reach them. When he has a success, give him a toy he has not seen for a while to play with.
- Offer a reward when the child has success with his first dry day.
Other Tips
- Your child should not be given toys to play with while sitting on the potty chair. Toys can distract him from learning to use the potty.
- Your child is a very active and busy little person. It is hard for him to "stay put" in one place very long. For this reason, do not expect him to sit on the potty chair longer than a few minutes each time.
- At this age, children like to copy what others do. It may help to let your child see other children use the potty or toilet. He may try to imitate them. A boy may learn to stand up to urinate by copying his father or an older brother.
- At first, your child may not stay dry all night, so you will want to use diapers at bedtime. It may help to waken your child once during the night to use the potty.
- Wearing "big boy" or "big girl" pants is often important to a child. Your child should be able to pull these pants on and off easily.
- Do not punish your child if he has an accident.
- Be sure to keep potty time a relaxing time. Encourage child to “just let come out” rather than “push” or “try”. A child who tries to push may actually be tightening the sphincter, making it ever more difficult to have a bowel movement.
Changes in Behavior During Toilet Training
- Some young children try too hard to please their parents and become fearful they will have accidents. This may cause problems in other areas of their development. For example, your child may seem to be doing well with the potty training, but will start refusing food or will not stay in his own bed.
- If these things happen, you should suspect the training has become "too much" for your child. You might try stopping the training for a week or so and see if the new problem goes away. If the problem remains, try easing up on the training or giving more praise when your child is successful.
- If your child goes to a babysitter or day care center, it is helpful if the same daily potty training routines are carried out there.
HH-IV-16 3/82, Revised 5/13 Copyright 1982, Nationwide Children’s Hospital