Toilet Training

The following tips may help you get started with toilet training:

• If your child has siblings, ask them to let the younger child see you praising them for using the toilet.
• It’s better to use a potty chair on the floor rather than putting the child on the toilet for training. If you decide to use a seat that goes over the toilet, use a footrest for your child's feet.
• Children should be allowed to play with the potty: Sit on it with clothes on and later with diapers off. This way they can get used to it.
• Never strap your child to the potty chair. Children should be free to get off the potty when they want.
• Your child should not sit on the potty for more than five minutes. Sometimes, children have a bowel movement just after the diaper is back on because the diaper feels normal. Don’t get upset or punish your child. You can try taking the dirty diaper off and putting the bowel movement in the potty with your child watching you. This may help your child understand that you want the bowel movement in the potty.
• Children often learn to go to the potty for bowel movements before urine, so you may want to start with bowel training first.
• If your child has a usual time for bowel movements (such as after a meal) you can take your child to the potty at that time of day. If your child acts a certain way when having a bowel movement (such as stooping, getting quiet, or going to the corner), you may try taking your child to potty when he shows it is time.
• If your child wants to sit on the potty, you may stay next to your child and talk and read a book.
• It is good to use words for what your child is doing ("potty," "pee" or "poop"). Then your child learns the words to tell you. Remember that other people will hear these words. It is best not to use words that will offend, confuse, or embarrass others or your child.
• Avoid using words like "dirty," "naughty" or "stinky" to describe bowel movements and urine. Use a simple, matter-of-fact tone.
• If your child gets off the potty before urinating or passing a bowel movement, be calm; do not scold. Try again later. If your child successfully uses the potty, give plenty of praise (smile, clap, hug).
• Children learn from copying adults and other children. It may help if your child sits on the potty while you are using the toilet.
• Children often follow parents into the bathroom. This may be one time they are willing to use the potty.
• Initially, teach boys to sit down for passing urine, as, at first, it is difficult to control starting and stopping while standing. Boys will try to stand to urinate when they see other boys standing.
• Some children learn by pretending to teach a doll to go potty. Make this teaching fun for your child.
• Make going to the potty a part of your child's daily routine, such as first thing in the morning, after meals and naps, and before going to bed.

What happens next?

• Once children start using the potty and can tell you they need to go, taking them to the potty at regular times or over-reminding them to go to the potty is not necessary.
• You may want to start using training pants. Wearing underpants is a sign of growing up, and most children like being grown-up.
• If your child has an accident while in training pants, don’t punish him. Be calm and clean it up without making a fuss about it.
• Keep praising or rewarding your child every step of the way: for pulling down pants, for sitting on the potty and for using the potty. If parents show that they are pleased when children urinate or have bowel movements in the potty, children are more likely to use the potty next time.
• Remember that every child is different and learns toilet training at his own pace. If things are going poorly with toilet training, it is better to put diapers back on for a few weeks and try again later. In general, have a calm, unhurried approach to toilet training.
• As children get older, they can learn to wipe themselves and wash their hands after going to the bathroom. Girls should be taught to wipe from front to back so that germs from bowel movement are not wiped into the urinary area.
• Most children have bowel control and daytime urine control by age 3 or 4. Soiling or daytime wetting after this age should be discussed with your child's physician.
• Nighttime control usually comes much later than daytime control. Complete nighttime control may not occur until your child is 4 or 5 years old, or even older. If your child is age 5 or older and does not stay dry at night, you should discuss this with your child's physician.
• Even when children are toilet trained, they may have some normal accidents (when excited or playing a lot), or setbacks due to illness or emotional situations. If accidents or setbacks happen, be patient. Examples of emotional situations include moving to a new house, illness or death in the family or a new baby in the house. In fact, if you know an emotional situation is going to be happening soon, do not start toilet training. Wait for a calmer time.

The main thing to remember is that toilet training isn’t something that happens all at once; it’s a process that can go on for some time. It’s important to stay positive and make sure your child feels comfortable and loved every step of the way.

Toilet training can sometimes be an emotional time. A child’s initial enthusiasm can give way to temper tantrums, accidents and frustrations.

The first — and most important — thing is to take a deep breath and remember to be patient.

Though it may take some time, you and your child will get through it — and your child will soon become comfortable and independent on the toilet.

Read on to learn more about toilet training and how you can help your child be successful.

Stage one: getting started

When your child shows some (or all) of the signs that she’s ready for potty training, you can start right away. One important thing to remember: Take it slow.

Children should be allowed to play with the potty: Sit on it with clothes on and later with diapers off. This way they can get used to it.
If your child has siblings, ask them to let the younger child see you praising them for using the toilet.

How long will it take my child to potty train?
Everyone’s different. Some kids might train in a day or two; others might take several months.

Why might my child take longer?
There are a number of reasons, some of which we’ve outlined below:
Too young — We don’t recommend starting before your child turns 2.
Toddler independence — Your child might be testing out the limits of her independence, including saying “no” to the potty.
Caution — Some kids have a hard time adapting to changes.
Fear — Your child may not really understand the toilet and therefore be afraid of it or falling into it.
Busy — Your child may be having too much fun playing to want to concentrate regularly on learning how to use the potty.
Alternatively (or additionally) your busy lifestyle may make it harder for your child to develop his new routine; consider slowing down for a few weeks to help your child get comfortable using the potty.

There are two other factors we identified in a study at Children’s Hospital Boston:

Constipation

?In our study, 78 percent of 46 children who had difficulty toilet training were constipated.

Constipated children have painful stools, large stools and need to push hard.
Other studies have shown that constipation comes before toilet refusal; presumably, since it hurts, the child is more reluctant to go on the toilet.

?Temperament?

Temperament is a child’s behavioral style — the innate tendencies that determine how she interacts with, and responds to, her environment.

About 10 percent of children have difficult temperaments, 40 percent are easy, 15 percent are slow to warm up, and the remaining 35 percent are intermediate. Several traits cluster into these four temperament classes.

?Our study found a difference in difficult temperament traits when 46 difficult toilet trainers were compared to 62 preschoolers who trained easily.

Difficult toilet trainers were more likely to be "less adaptable," meaning that they have more trouble adjusting to new situations.

They were more negative and frustrated, cried and whined, were less persistent and gave up more easily.
They were also more likely to withdraw from a new situation — like toilet training — rather than readily accept it.

Because of temperament, difficult toilet trainers usually have difficult behavioral styles. In our study, 42 percent of children who toilet trained easily had easy temperaments, but only 2 percent of difficult toilet trainers had easy temperaments. In this study, if you had an easy temperament, you were 33 times more likely to be easily toilet trained!

With that in mind, don’t despair if your child is having a hard time. No one goes to college in diapers, so your child will get it — toilet training may just take some extra time and effort.

So, how do we start?
Children often learn to go to the potty for bowel movements before urine, so you may want to start with bowel training first.

If your child has a usual time for bowel movements (such as after a meal) you can take your child to the potty at that time of day.
If your child acts a certain way when having a bowel movement (such as stooping, getting quiet going to the corner), you may try taking your child to potty when he shows it is time.

Should we use a potty chair?
It’s better to use a potty chair on the floor rather than putting your child on the toilet for training.

If you decide to use a seat that goes over the toilet, use a footrest for your child's feet.
Never strap your child to the potty chair. Children should be free to get off the potty when they want.

My son won’t pee or poop in the potty, but as soon as he gets down, he goes in his diaper. Should I keep him on the potty longer?
Your child shouldn’t sit on the potty for more than five minutes.

Sometimes, children have a bowel movement just after the diaper is back on because the diaper feels normal.

Don’t get upset or punish your child. You can try taking the dirty diaper off and putting the bowel movement in the potty with your child watching you. This may help your child understand that you want the bowel movement in the potty.

How should we talk about the potty?
It is good to use words for what your child is doing (“potty,” “pee” or “poop”).

This way your child learns the words to tell you.

Remember that other people will hear these words. It is best not to use words that will offend, confuse, or embarrass others or your child.

Avoid using words like “dirty,” “naughty” or “stinky” to describe bowel movements and urine. Use a simple, matter-of-fact tone.


Should I let my child watch me while I’m using the toilet?
Yes. Children learn from copying adults and other children. It may help if your child sits on the potty while you are using the toilet.

Children often follow parents into the bathroom. This may be one time your child is willing to use the potty.

Should I teach my son to pee sitting down or standing up?
Initially, teach boys to sit down for passing urine, as, at first, it is difficult to control starting and stopping while standing.

Boys will try to stand to urinate when they see other boys standing.

My daughter likes to play “potty” with her dolls. Is that OK?
Yes, it can be very helpful.

Some children learn by pretending to teach a doll to go potty. Make this teaching fun for your child.

What about wiping?
As children get older, they can learn to wipe themselves after going to the bathroom.

Girls should be taught to wipe from front to back so that germs from bowel movement are not wiped into the urinary area.

And don’t forget to have your child wash her hands even if she didn’t “go.” It’s an important part of the routine.?
Use warm water and scrub hands for about 15 seconds.
You can teach your child a rhyme or have her count to ten to better gauge the time.

We don’t seem to be getting anywhere. What do we do?
It’s good to measure success by small steps. Your child might not poop or pee in the potty every time (or even anytime in the beginning); however, he might start getting comfortable sitting on the toilet or wiping or washing his hands.

Celebrate each step forward, no matter how small: pulling down pants, sitting on the potty, using the potty, washing hands.

If you show that you are pleased when your child urinates or has a bowel movement in the potty, your child is more likely to use the potty next time.

My child did it! Now how do we make it stick?
Make going to the potty a part of your child’s daily routine, such as first thing in the morning, after meals and naps and before going to bed.

And read on for some tips about how to help your child continue to succeed on the potty (as well as some hints about how to handle setbacks).

Stage two: success and setbacks ?
By now, your child has had some success using the toilet. Congratulations!

Here are some tips on how to reinforce the lessons she’s learned and help her if she’s having problems.

Do we need to keep to such a strict schedule now?
No.

Once children start using the potty and can tell you they need to go, taking them to the potty at regular times or over-reminding them to go to the potty is not necessary.

When should we introduce underpants?
It’s good to wait until your child has had some success in toilet training, so that she doesn’t get discouraged by having too many accidents in her underwear.

You have a few different options:

Disposable training pants (Pull-Ups) are good in the beginning, but some kids understand quickly that they’re like diapers and so use them that way.
They are good to use during the training process for naps, at night or when you’re traveling.?
Cotton training pants absorb urine with an extra layer of fabric.
They can be a good intermediate step between Pull-Ups and underwear.?
Underwear is thinner and allows your child to feel the urine faster, which can encourage the use of the potty.
However, without the extra layer of material, accidents will take longer to clean up.
When you first start toilet training, limit the time that your child wears underwear to minimize the possibility of accidents.

Make sure to change your child’s soiled underwear or training pants quickly; you don’t want her to get used to the feeling of wet or soiled underwear.

How should I react to an accident?
If your child has an accident while in training pants, don’t punish him.

Be calm and clean it up without making a fuss about it.

Are all these tantrums and breakdowns normal?
Yes. Keep in mind that this is a big change for your child who is caught between wanting to be independent and wanting to be taken care of — as well as being overwhelmed and excited by all these new things he’s learning.

Pay attention to your child and try to figure out what’s causing the tantrum. Is he tired? Sick? Needing attention?

Once you figure out the cause, treat it the same way you’d treat any tantrum — with patience. Then let him know you understand that he’s upset but that he will have to calm down.

You can say something like, “I know doing your job of sitting on the toilet can be hard, but you can do it. When you’re done being angry, then you’ll need to sit on the toilet.”

Most important, stay calm yourself. Let the tantrum pass and then get back to business.

If things are going poorly with toilet training, it is better to put diapers back on for a few weeks and try again later. In general, have a calm, unhurried approach to toilet training.

My child is really having a lot of trouble. What do we do?
First, make sure that your child isn’t constipated. Talk to your primary care provider. A constipated child can be treated with diet or medication, depending on the extent and duration of his constipation. You cannot expect a child to go if it hurts to go!??Then, break the task of toilet training into manageable parts.

Rather than expecting your child to poop in the toilet, start by merely having him sit on the toilet, poop in the bathroom (in his diaper; not on the potty), wipe or flush.
Make it a positive experience by rewarding your child with small treats for succeeding in these tasks, such as stickers, a special activity with you or a star on a chart.

Remove added stress your child may feel. Don’t talk about toileting other than at the time of your child's toileting tasks.?
Then, every week, offer your child the opportunity to work on a new task.

Rewards should continue and pressures should be avoided.
Continue to monitor your child's bowel status, ensuring that stools are soft and controllable, and easy to pass.

It’s still not working and we’re going crazy. Help!?

If all else fails, take a break for a month or two.

Be sure to avoid conversation about the issue and to eliminate any pressure your child may feel.

Use that time to improve your child's stooling regularity with diet changes or medication suggested by your child's doctor.
Later, introduce a task your child is sure to be able to do (such as flushing) so that he feels confident with success.
Slowly add more toilet training jobs, such as wiping or sitting on the toilet.

In rare instances, help from a developmental pediatrician or behavioral psychologist may also be necessary.

My child still isn’t toilet trained. Should I be worried?
Remember that every child is different and learns toilet training at his own pace.

Most children have bowel control and daytime urine control by age 3 or 4.
Soiling or daytime wetting after this age should be discussed with your child's physician.

Nighttime control usually comes much later than daytime control. Complete nighttime control may not occur until your child is 4 or 5 years old, or even older.
If your child is age 5 or older and does not stay dry at night, you should discuss this with your child's physician.

Even when children are toilet trained, they may have some accidents (when excited or playing a lot), or setbacks due to illness or emotional situations, such as moving to a new house or a death in the family. If accidents or setbacks happen, be patient.

The main thing to remember is that toilet training isn’t something that happens all at once; it’s a process that can go on for some time. It’s important to stay positive and make sure your child feels comfortable and loved every step of the way.

Questions to ask your doctor?
You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider and that you understand your provider’s recommendations.??If your child is suffering from a medical condition that’s making toilet training more difficult and you’ve set up an appointment, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling like you have the information you need.??You may want to suggest that your child write down what he wants to ask his health care provider, too.??Some of the questions you may want to ask include:

• Will this condition go away on its own?
• What are our treatment options?
• How can we help at home?
• Are there any alternative treatment methods?
• Where can we go for further information?

Keep in mind that your doctor will want to ask you some questions, too.

These can include the following:

• How long have you been trying to help your child learn how to use the toilet?
• What’s the process been like?
• Is there a history of this condition in the family?

Coping and support?

For most kids, toilet training is just another step on the developmental ladder. However, some children have medical conditions that make toilet training more difficult. If your child needs extra help, you’re in the right place. ?

Children’s Center for Families is dedicated to helping families locate the information and resources they need to better understand their child’s particular condition and take part in their care. All patients, families and health professionals are welcome to use the center’s services at no extra cost. The Center for Families is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.

On our For Patients and Families site, you can read all you need to know about:

• getting to Children’s
• accommodations
• navigating the hospital experience
• resources available for your family