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.

It’s not about the parents…

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:

I never knew there were so many ways to potty train a child until I started paying attention to the many varieties parents asked about. It seems parents read more on this subject than I ever did when my kids were that age. I will list all the types I’ve heard about, but I don’t endorse most of these. More on that later.

  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.
Mechanics of bowel and bladder function

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.

Pros and cons to the various types

There are infant training proponents. I am not one simply because I think it’s 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.

My thoughts and recommendations
If kids are falling asleep on the potty because they’re sitting too long, it’s time to give it a break!

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 as I share from my own stories, it doesn’t always last. 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

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). 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…

potty training, toilet training

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.

I knew I had to do something 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 (at 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 its 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. And she’s always been stubborn.

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 back 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. (Trust me.) 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 playdates 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! (Teenagers and toddlers are very similar in this aspect.

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.

potty training
Potty training is scary for a lot of kids.

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.

night accidents

Nighttime accidents are actually normal much longer, see my office’s bedwetting information.