Toilet training is the process of helping a child learn to urinate or have bowel movements in the toilet. Being "potty trained" is a learned experience. The process takes time and patience on the part of both the parent or caregiver and the child.
Readiness for toilet training
On average, a child is ready to start toilet training when he or she is between 18 and 24 months old. It is not uncommon, however, for children not to be ready until they are a little older. Girls are often ready to be toilet trained at a younger age than boys. Most children achieve bowel control and daytime urine control by 3 to 4 years of age. It may take months or years to achieve nighttime dryness. Most girls and approximately 75% or more of boys will stay dry at night after age 5.
The following general guidelines suggest a child may be ready for toilet training. The child prefers a dry diaper to a soiled one.The child understands the words used to describe bladder and bowel functions.The child understands the purpose of the toilet.The child can communicate when he or she needs to urinate or have a bowel movement.The child stays dry for at least 2 hours at a time and is dry after naptime.The child can follow simple directions, get to and from the bathroom independently, and pull his or her own pants down.The child shows interest in wearing underwear.
Preparation for toilet training
The caregiver will need to decide what type of toilet chair to use. Some people prefer a seat that attaches to the regular toilet. Other people prefer having the child use a toddler chair. A toddler chair lets the feet touch the floor and allows the child to get on and off the seat independently. This may help the child feel more secure.
A caregiver may have the child sit on the toilet to get comfortable with the seat. If using a toddler chair, it is sometimes helpful to put the chair in the room in which the child spends the most time. The child may want to sit on the seat fully clothed at first to get a feel for the chair. After the child appears comfortable with the seat, actual potty training can proceed.
The caregiver should encourage a child to make practice runs to the potty. Often children will a give some sort of signal indicating that they need to urinate or have a BM. It may be a facial expression or body movement. The child can be encouraged to sit on the potty set after meals and periods of sleep.
The caregiver should try to explain to a child what needs to happen. For example, "The pee or poop needs to come out. Let's try to use the potty." If a child is reluctant to sit on the toilet, a fun activity to do while sitting may help. This may include reading books or listening to music.
Avoiding toilet training issues
A child should never be forced to stay seated on the potty. The child should sit for a few minutes while the caregiver offers reminders about what should happen. If the child wants to get up, that should be allowed. After sitting for 5 minutes, he or she should get up and try again at another time.
Even if the child is not able to urinate or have a BM in the potty, he or she should be praised for trying. When the child does have success, rewards should be used. These include praise, hugs, stickers, or treats.
It is very important not to use negative words or punishments for accidents or refusals. If a caregiver gets upset or frustrated, toilet training may turn into a power struggle. A child who is resistant to potty training may not be ready for the challenge. Toilet training may be more successful if postponed for a few weeks.
If a caregiver is concerned over how the toilet training is progressing, he or she should consult with the child's healthcare professional. Stress is a common cause for a child's reluctance to be potty trained. Events in a child's life such as a new house or new baby may cause the child to have more accidents. It is not uncommon for a child to become constipated while being bowel trained. Constipation causes hard stools that are difficult to pass. The child should be encouraged to eat plenty of fruits, vegetables, and fiber to help keep stools soft.
Staying dry and clean
Some caregivers find it easier to potty train during the summer months when the child has fewer clothes to take off. Taking a child to the store to buy underwear may be seen as a reward for success. Once a child is put into training pants, diapers should be used only for naps and overnight. Some people like to use disposable pull-up pants during potty training.
It is also good to teach good hygiene when toilet training. Children should be encouraged to wash their hands after using the toilet. In addition, children should be taught to clean themselves properly after a BM. Girls should be taught to wipe from front to back to avoid urinary tract infections.
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Your Child's Health, Barton Schmitt,M.D. 1991