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Friday, August 26, 2011

Potty Training


I remember long ago when I was a relatively new mom I still had insecurities about what I was doing (despite the fact that I was a pediatrician with extra training with kids). Well, to be honest, I still have lots of great advice for parents, but with my own kids I often struggle to know what's best.  But my kids are way beyond the potty training years, so I feel like I have that hurdle down now...

My son's baby book's potty training page shows my naivety.  He started showing interest in the potty and even telling me appropriately when he needed to go about 18 months of age. I knew that he was on the early side of potty training (normally between 18 months and 3 years). This is especially unusual for boys, but he was a smart kid, was directing it all himself, and why not potty train him if he's interested?  I was so excited for him (and me!) that he was interested. We put out the potty chair. We clapped and praised. He was so happy to make pee in the potty.

Then he lost interest. Out of the blue. Done.

It is almost a year to the day later that the baby book says he was interested again. I actually tried to not let him train, since my 2nd baby was due soon, and I didn't want him to regress.

When the daycare teacher said, "he's been in the same diaper all day for 3 days in a row, he needs underwear!" I decided it was okay to break out the Buzz Lightyear underwear. When he did it this time, he did it well. He easily mastered the skill and didn't have accidents.
 
When my daughter started using the potty early (about 15 months) I thought it was a fleeting interest as well, but she continued to regularly use the toilet. Wow! Easy... she did it all on her own. (Her independent streak has it's negatives, but I liked this aspect of it.) She never had accidents. Ever. I stopped bringing extra clothes for her cubby at daycare, she was that good.

Then she lost interest. Out of the blue. Done. At 3 years!
One day she woke and said she was a baby and needed a diaper. By this time, we had no diapers. I told her she was a big girl, got her dressed, and sent her off to daycare as usual. When I picked her up there was a bag of other kid's wet clothes. She was on her 4th outfit of the day, but we had no extras at school because she was my never has accidents kid. I knew she wasn't sick. (UTI's can cause accidents.)  She had simply decided that she wanted to be treated like a baby. 

I had to go out and buy diapers. We stocked her cubby with extra clothes. She LOVED being treated like a baby. The daycare even moved her to the toddler room because the 3 year room didn't allow diapers. She loved being with the babies, so it suited her just fine.  The problem was the teachers made such a big deal about how she was a big girl and didn't need the diaper. When I finally convinced the teachers to just matter of factly change the diaper and ignore her behaviors, she decided it wasn't fun any more to be a baby. Suddenly she was potty trained again. No more accidents. Ever.

Kids develop at various stages.  My advice has always been to let them take the lead when to start potty training, which can happen anywhere from 15 months until 3 years of age.

Kids leading the way? They are ready to take the lead and potty train when they show interest (wanting to sit on a potty chair, wanting a wet diaper off, telling you when they are wet).  If you push, they will resist.  Teens and toddlers are one and the same: they both try to exert independence and do it their own way. The more you push, the more they pull.

If you think your child is aware of when he/she needs to urinate or have a bowel movement, put out a potty chair that is in full view when in the bathroom.

Buy potty training books geared toward toddlers.

Show excitement and give praise for interest and any steps in the right direction (sitting on potty, peeing in potty, washing hands, etc.).  You can do a potty dance, give stickers, call Grandma, and do whatever makes a big deal for each little step!

Praise others for using the bathroom.  Invite play dates who are similar ages and are potty trained over so your child can see them in action.  Praise older siblings for going to the bathroom.

You can put the idea in their head:  "I'm going to the potty.  Boy, do I feel good!  I went on the potty, didn't get my pants dirty, got to flush the toilet, got to use the foamy soap, etc." but don't tell them directly to go.  They resist being told anything!

Scoop on Poop: Many kids are ready to go pee in the potty, but are afraid to poop there.  That is okay.  Offer a diaper at the time of day they often have a bowel movement.  It is not good to try to force stooling in the toilet if they don't want to go there.  They will hold it and end up constipated. Don't go there!

You can take them to the bathroom after the bowel movement and drop the stool into the toilet, then have the child flush.  Then they associate the stool going down the toilet, which sometimes helps.  Encourage lots of fruits and water so the stool stays soft.  If it hurts to poop, they hold it longer, which then hurts again, which reinforces holding and then constipation.  (See also our website page on constipation for more hints to keep the stool soft.)

Don't worry about setbacks.  (See above!!!)

Many kids show a temporary interest in potty training, but then stop wanting to go completely.  Return to diapers, but leave the potty chair visible.  When the child starts to show interest again, give praises.

Remember: normal children do not go to kindergarten in diapers!  They will all potty train.  If your child isn't potty trained during the day by 3 1/2 years, talk to your doctor.

Nighttime accidents are actually normal much longer, see our bedwetting information.