Potty Training

Potty training, also known as toilet training can be an exciting and challenging time as a parent. When should you start? There is no evidence to support potty training prior to 12-18 months. Most toddlers are trained at 18-40 months. 22% are out of diapers by 2 ½ and 88% are out of diapers by 3 ½. Why such a wide range? Toilet training is a life skill, and children develop these skills at different times. The sphincter muscles must have enough strength to be able to maintain continence, which takes time to develop. The most important thing to know is, make sure your child is ready. 

When my husband and I thought our son was ready to start potty training we tried every trick in the book. I was pregnant with my daughter and didn’t want to have two kids in diapers. We jumped up and down when he peed on the Cheerios, we bought potty presents if he pooped on the potty. None of these techniques worked until he was ready. Many toddlers are learning how to make decisions for themselves and gain some control over what they do. Make toileting as natural as possible, without too much excitement when they go. Children can sense their parents' frustration when things aren’t going well, or when they are jumping up and down during a successful poop. This can lead to power struggles and toddlers may refuse trying.

When my daughter was about 24 months old I started recognizing signs that she was getting close. I bought “big girl” undies, and when I brought them home from the store she saw them and asked what they were. I told her they were for when she starts using the potty. She said, “ok, I’m ready.” She started training herself that day. It was very easy and no big fuss.  As parents, our job is to assist them with learning this life skill. But, they are learning it!

Toileting is natural, and children become ready at different times. Some signs that your child is ready to potty train include: being able to walk, pull their pants up/down and get onto the toilet with minimal assistance, pulling on a wet or dirty diaper, expressing interest in using the toilet, having a dry diaper for longer periods of time. Just because your child is able to stay dry during a nap does not mean they are necessarily ready. 

If you have determined that your child is ready, make sure you choose a program that includes positive reinforcement. Research shows that negative reinforcement increases risk of withholding patterns that can cause constipation and urinary retention. Also, consider stressors that may affect your child's progress including a recent move, a new baby, major illness or loss of a family member. Many children can regress at these times, and it is normal. Communicate with your child. Ask them questions such as, “how does it make you feel when your diaper is wet?” Give them choices. If you make them feel like they are making the choice to potty train they will have a better experience and better outcomes.

The bladder trains more quickly than the bowels, so children usually have an easier time going pee on the potty at first. Bowel movements may take longer to control. Children start identifying the need to go, and may start going into a corner and “hide”. This doesn’t necessarily mean they are ready. Would you want to poop in front of other people? Neither do they. If your child starts to walk into a corner or behind the couch to go, don’t just pick them up and place them on the toilet. Communicate with them. Ask them if they need to go and would they like to try using the potty? 

Toddlers who are able to stay dry during the day may not be able to stay dry at night. That does not mean they are not potty trained. There is a hormone that is secreted at night to suppress the bladder. This occurs in most children by 4 years old, but in some cases, this does not develop until age 7 and is still considered normal. There are some conditions that delay the development of bladder and bowel control, such as Down Syndrome. Children with lower muscle tone will take longer to develop sphincter and abdominal muscle control. Be supportive and understanding of their development.

Physical Therapy can help children over 4 years old who are having daytime leakage. We can help children identify the causes of leakage and design a treatment plan to help them stay dry during the day. The most important thing to remember is that there are no “accidents”. Leakage is not something that they do on purpose and it should never receive a punishment. If your child is struggling with this life skill, we can help. 

Esther Globerman PT, MPT, DPT

President

Globerman Physical Therapy Inc

References:

Children’s Hospital Boston, Woolf, A., Kenna, M., & Shane, H., Eds. Children’s Hospital Guide to Your Child’s Health and Development. Cambridge, MA: Perseus Books, 2001.

Community Paediatrics Committee, Canadian Paediatric Society, 

(2000). Toilet learning: Anticipatory guidance with a child-oriented approach. Pediatrics & Child Health, 5(6), 333-335

Toilet Training: Common Questions and Answers.

Baird DC, Bybel M, Kowalski AW.

Am Fam Physician. 2019 Oct 15;100(8):468-474