When should you potty train your kids?

It's common for parents to ask for help with potty training. Sometimes they're just done dealing with diapers. Or there's another baby coming soon. Often it's tied to wanting to be able to start preschool. Most preschools in our area require 3 year olds to be potty trained. Even daycares often require toddlers to potty train before moving up to the 3 year room. This move is usually accompanied by a price decline, which parents are excited to have.

Photo source: Wikimedia commons.
Fun seat, but I recommend smaller seats (potty chairs) for potty training.

Unfortunately, kids need to be ready to potty train. This typically happens between 18 months and 3 years, but it can be normal to not be ready until 4 years of age. Note: Nighttime dryness is not correlated with potty training. When kids are deep sleepers, they often urinate in their sleep despite perfect daytime control.

Types of potty training:

1. Infant potty training - the parent watches for infant cues and holds baby over the toilet (or wherever they want baby to pee/poop). The parent makes a noise each time baby pees/poops, and that sound becomes associated with toileting. 
2. Behavior modification - the parent gives the child a lot of fluids and puts him on the toilet frequently. When the child is successful on the toilet, he gets a reward. They are reprimanded for accidents. This is often called "train in a day."
3. Child-oriented - the parent educates a child about toileting and gets a potty chair for the child, but potty training only happens when a child shows interest. The parent uses praise and encouragement.
4. Parent-led - the parent sets the stage by allowing the child to get comfortable with the potty chair before the training begins. You do practice runs before going live. The parents offers praise and encouragement and simply changes clothing if there's an accident.
5. Bare bottom - just as this sounds, you let the toddler/preschooler run around naked with the expectation that they'll figure out what's going on.

Babies technically have the ability to hold their stool and urine much earlier than they are ready to potty train. Simply being able to hold urine or stool for a time doesn't mean a child is ready to potty train. Some kids tend to hold urine or stool too long if they potty train too early because they don't want to take the time to sit on the toilet. If they hold their urine, it can lead to over-distention of the bladder, daytime urine accidents, and urinary tract infections. If they hold their stool they become constipated, which can lead to abdominal pain, poor eating, and stool leakage.

There are infant training proponents. I am not one simply because I think it is time intensive and it trains the parent, not the child. If you're interested in training your baby, check out Infant Toilet Training. I haven't read any of the references listed after the article and have no experience with it. I'd love to hear comments from parents who have tried it - please comment below.

I hear many urologists discourage early potty training, but studies (here and here) fail to show that training early leads to long term problems. For one urologist's view, take a look at The Dangers of Potty Training Too Early.

There is relatively little research on the best approach to potty training, but the American Academy of Pediatrics supports the child-oriented approach based on expert opinions. One study found that children who had problems with daytime accidents or urinary tract infections were more likely to have been rewarded and punished during toilet training and children with no problems with the bladder and urination were more likely to have been encouraged by their parents to try again later. It also showed that waiting past 18 months correlated with fewer problems with urination years later.

I think a child needs to be mature enough to be able to stop what he or she is doing and take the time to go to a toilet. A child needs to be able to communicate the need (through words or sign) to go to the bathroom. Ideally a child will be able to remove clothing and get on the toilet without much assistance. Parents should encourage and praise kids for good results in the toilet. I would not recommend any negative consequences for accidents since negative consequences correlate with long term health consequences in studies.

Many kids show a temporary interest in potty training, but then it stops. I advise to not push the issue. Put them back in diapers for awhile and try again later. They know they will win this fight. They simply pee or poop whenever and wherever they want or they hold it too long, which can lead to physical health problems for them.

When to wait on potty training:

• If a child shows no interest in going to the toilet.
• If a new baby is on the way.
• If the child is afraid to sit on the toilet.
• If a move is planned.
• If there will soon be travel.
• If a child doesn't have the ability to communicate the need to toilet.
• If the child resists.

In the end, most children will potty train. They will not go to kindergarten in a diaper. Empower your kids with information on how things work. Praise them for good results. Don't yell or belittle kids for accidents. If you're frustrated, take a deep breath. Training doesn't last forever. If it's too much to deal with, give it a break. The more you can make it pleasant for your child, the more you will enjoy parenting!

References

• Among healthy children, what toilet-training strategy is most effective and prevents fewer adverse events (stool withholding and dysfunctional voiding)?
• Toilet training children: when to start and how to train
• The effectiveness of different methods of toilet training for bowel and bladder control
• Potty training problems: A evidence-based guide for prevention