Toilet training with a smile

July 24, 2018
Toilet training with a smile | Texas Chilldren's Hospital
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Toilet or “potty” training is a huge milestone for both caregivers and their developing young ones. It represents a big step in independence for children and will also make life a whole lot easier for caregivers who are leaving behind diapers. This process can be a challenging experience overall if it’s done in a stressful or agitated manner. If you’re a caregiver, let’s get one thing straight – you can’t make a child eat, sleep or poop on command. Regardless of how big or bad we think we are as adults, our children are always in charge of those three functions.

When undertaking the process of helping a child learn to toilet independently, we must consider a few basic principles:

Avoid toilet training if your family is in the midst of a major change or stressor. For example, if a mother is in her third trimester of pregnancy, it’s definitely not a great time to introduce a major process like toilet training. If father’s job schedule drastically changes, the family is moving or a close relative has a major illness, any of these changes can be stressful for a young toddler and might lead to toileting refusal.

Be consistent. If you’re going to initiate toilet training, consistency is critical in helping a child conquer these new skills. In other words, don’t slap a diaper on your toddler to make a Target run if you’ve put him in big boy underwear for the past two days. This is confusing for the child and might send mixed messages, resulting in routine disruption.

Don’t punish your child during the toilet training process. This is a whole new set of skills, and they take time to master. Punishing a child for toileting accidents can lead to toileting refusal and delayed toilet training.

Toilet readiness can be determined through observable signs in behavior, physiological maturation and developmental milestones. If children don’t demonstrate the signs of toilet readiness, they are most likely not ready to use the toilet independently yet. Consider these signs:

  • Physiological skills
    • Child demonstrates voluntary sphincter control
    • Child is dry for several hours
  • Motor skills
    • Child sits without support
    • Child walks independently
    • Child pulls down pants and/or removes diaper
  • Language skills
    • Child follows one- or two-step commands
    • Child alerts an adult when diaper is wet or soiled
    • Child says “no” to show independence
  • Cognitive skills
    • Child understands the function of the toilet
    • Child knows where things belong
  • Behaviors
    • Child wants to please parents
    • Child imitates parents well
    • Child desires to be independent
    • Child tries to remove soiled diaper

There are no hard and fast rules when it comes to toilet training a child. The key is to consistently use the method that works best for your child and family. Consider these tips:

  • Purchase a potty chair for each bathroom in the house to make toileting easily accessible to your child. If your child is upstairs, he probably won’t make it to the downstairs bathroom in time to sit on the potty.
  • Change your child’s diaper in the bathroom to help her make a connection between the bodily functions of peeing and pooping and the room in the house where this should take place.
  • If your toddler follows you to the bathroom, use this as a teaching opportunity. Encourage him to sit on the little potty while you sit on the big potty and talk about what is happening.
  • Read children’s books about using the potty, such as “Everyone Poops” by Tarō Gomi or “Once upon a Potty” by Alona Frankel. This is a wonderful way to introduce new concepts and skills to your children.
  • When you change your child’s diaper, place the dirty diaper into the potty chair to show her where the waste is supposed to go, and even allow her to flush the toilet if you dump the solid contents into the commode. Just make sure your child doesn’t start flushing other items down the commode!

There are 10 steps in toileting independently, so allow your child to practice each of them as often as possible.

  1. Be aware when your rectum and/or bladder are full
  2. Walk to the bathroom
  3. Pull down your pants/diaper
  4. Sit on the potty/toilet (with stool under feet if necessary for stability)
  5. Eliminate
  6. Wipe
  7. Flush
  8. Pull up pants
  9. Wash hands
  10. Walk out of the bathroom

If your child is constipated, he will not successfully toilet train until the constipation is treated and resolved. Constipation is a major reason behind why some children might be delayed in toilet training. Also, if your child has developmental delays, it might take him longer to develop the skills necessary to toilet independently. For example, a child with a speech delay may not be able to follow the commands for using the toilet.

It’s important to remember that if your child is not ready to toilet independently, you cannot force him/her to do so. This is an opportunity for parents to practice patience. If your child resists using the toilet, wait one to three months before trying again. Children will sometimes spontaneously develop an interest in toileting independently once the pressure from training is gone.

There are many resources addressing toilet training on the market. Some that use evidence-based approaches include:

  • “Toilet Training in Less Than a Day” by Nathan H. Azrin, Ph.D., and Richard M. Foxx, Ph.D.
  • “Toilet Training – The Brazelton Way” by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D.
  • “Guide to Toilet Training” (Second Edition) from the American Academy of Pediatrics
  • Toilet Training (healthychildren.org)

Post by:

Adiaha I.A. Spinks-Franklin, MD

Dr. Spinks-Franklin's research interests are in the areas of the cultural aspect of child development. Her previous research experience included studying the development of children in Senegal, West Africa, and studying the mental health impact of the aftermath of Hurricane Katrina on school-...

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