What is the scoop on potty training?
As the mother of a rambunctious 18-month-old daughter who constantly follows me into the bathroom and likes to throw toilet paper into the bowl, I’m tempted to start potty-training my little lady.
The Family Physician in me, however, says wait until she is 2 years old. And I know from SO many patient questions over the years that many of you are with me there. We think they are ready but don’t want to deal with this process for months if we jump the gun. What’s a Mom to do? Here’s your answers.
The Scoop on Potty Training: What Skills Do They Need?
Potty training requires developmental and physical skills from your little one. They must first be able to:
- Put on clothing and remove clothing
- Follow simple instructions, such as sit on that chair
- Show interest in using the toilet or imitate toilet behaviors
- Grimacing, squatting, or grunting with bowel movement
- Show discomfort with a dirty diaper
- Show bladder control with a 2 hour nap or overnight
For most children in the United States, this occurs between the ages of 18-30 months. Girls do usually show readiness earlier than boys (24 vs 29 months). And up to 1/3 of kids may not be ready until 30-months of age. So, don’t stress if your 18-month-old is not ready. They are not behind in life already.
The Scoop on Potty Training: How Should You Get It Done?
When it comes to potty training, everyone agrees on one thing: lots of positive reinforcement with realistic expectations. There will be accidents, There will be set-backs. And you must wait until your child shows signs of readiness.
How you get it done is a different story. There are 2 basic camps on potty training your little one based off who is running the show and how quickly you want it done. Let’s break them down:
Brazelton Method (Slow and Steady)
- Supported by the American Academy of Pediatrics
- Have your child sit on the potty chair fully clothed initially and interact through talking or reading to them to get them used to it.
- After 1-2 weeks, remove diaper and have your child sit on the potty chair. The do not have to go on the toilet. When they go in their diaper, empty it into the toilet and explain that this is where stool goes.
- As your little one seems to understand, start placing them on the toilet on a scheduled time frame.
- When your child becomes more confident with this, remove the diaper for short time frames and assure that the potty chair is nearby.
- Then progress on to pull up diapers for more independence
- Snacks and rewards can be given at each step and steps are driven by your child’s progress
Azrin and Foxx Method (Quick and Directed)
- Can start as early as 20 months
- Goal to potty train in as short as 1 day if your child progresses well
- Be prepared with snacks, treats, a doll that wets, and fun rewards
- Demonstrate correct behaviors with a doll – have your child change the doll after it wets.
- Start by placing your child on the potty chair. After they go, have the child empty and replace it.
- As your child masters this, give praise only when successful on the potty.
- Set consequences for accidents, such as a verbal reprimand and do not give positive rewards. Reprimand for being uncooperative.
- Check your child’s training pants before meals and naptime. Give praise for dry pants. Have your child change him or herself if wet. This may continue for up to 3 days before progressing.
- When you are ready to progress, encourage your child to go to the potty chair and sit for 10 minutes. If your child goes, reward with praise and a treat. Provide immediate positive reinforcement.
- Perform pant checks every 3-5 minutes and reward dry pants.
- Give your child enough fluids to create a desire to urinate frequently.
- Tell your child their friend (Elmo, Daniel Tiger, etc.) is happy that you are learning to keep your pants dry.
There are methods used in other countries as well: The Eliminations Method has parents look for cues that their child is about to go (grunting, hiding, straining) that signals the parent to make a sound that the child will associate with toileting. When the child associates this sound, they then position the child on the toilet and encourage elimination.
The Scoop on Potty Training: What If Your Child Has A Complication?
There are a few common complications that may arise with potty training. What, training a stubborn toddler to take off their pants and make a mess in a small hole only can come with complications? No Way.
What if your child refuses to poop on the potty?
Studies show that up to 20% of kids may refuse to poop on the potty chair. Most commonly this comes from 2 causes: pain (from constipation or an irritated bottom) or stress (confusion, anxiety about going, or a disrupted schedule). Most of the time this is easier to correct than you would think. Don’t push your child any harder. Don’t abandon training altogether but do not go onto the next step for a few weeks. Give your little one a little time to adjust and the majority of the time their stools will too.
If your child does not adjust, it’s time to head to the Doctor. Rarer cases of encopresis can develop. Refusal in which your child deliberately avoids going can lead to chronic constipation. Chronic constipation can lead to a reduced sense of the need to defecate and complications from that. Your child may also have a food allergy or anatomic abnormality leading to the constipation.
What if your child hides to poop?
Most kids do at some point. In fact, one study found that 2/3 of toddlers will do this during potty training. It is nothing to worry about as the vast majority of cases will resolve on their own. It does not mean you have done something harming and shameful to your child.
What if your child wets the bed at night?
Nearly half of little ones will struggle with wetting the bed at night even after they are potty trained during the day. That’s ok. Studies on this are as mixed as the children with one study showing increased rates if your child starts training before 2 years of age and another showing increased rates in children over 2 years of age. Just know that this may last a bit and be prepared accordingly.
What if your child has special needs?
Most children with developmental delays will need to be a little older to initiate potty training. Knowing that to begin with will save you a lot of frustration. Most children with Down Syndrome, for example do not initiate potty training until 3 years of age and complete the process until 5 years. For little ones with cerebral palsy, the average age is 5 as well. Children with autism often begin potty training before a diagnosis is made. This can prolong the potty training process with an average of 2 years before bowel control is achieved. And that’s ok. They will get there in the end.
So, in the end, I really do think my 18-month-old is ready for potty training. I guess I had better get the potty ready. Follow me on Instagram https://www.instagram.com/doctormomem/ (or click below) for updates on our progress. Here goes …
Simple Solution: Potty training readiness is different for every child. Start by assessing developmental readiness then determine the right method for your child and your schedule. Be prepared with positive reinforcements and try to make it fun for success.
For More Blog Posts on Toddlers, check out: https://doctormome.com/post/what-should-my-one-year-old-be-eating/
For More Information on AAP Recommendations, check out: https://pediatrics.aappublications.org/content/103/Supplement_3/1359