Taking the Terror out of Toilet Training

She says “I don’t wanna!”
Don’t worry if she doesn’t want to yet, and don’t force it. There is no hurry for kids to be trained before pre-school; in fact, many pre-schools accept children who are not yet toilet trained. In the U.S., most children gain complete daytime bladder control by age 3. Although most will be fully toilet trained by 4 years, there are a small percentage of typically-developing children who won’t complete their toilet training until age 5.

A child’s readiness to begin the process is more important than their age. Here are some signs your little one is ready to start:

• She tells you her diaper is wet or dirty and it actually is
• She takes off her diaper when it’s dirty
• She tells you she is going poop or pee in the diaper, and she actually does
• She wants to sit on the potty bench when you are on the toilet (indeed!)

He pees in the potty but poops in the diaper
That’s ok. Children will usually toilet train for urine, then within 6 months or so, will toilet train for stool.

She hides under the dining table to go poop
That is fairly common. It is the emerging quest for privacy.

Tips:

• Try to have every toileting moment occur in the bathroom to encourage the association.
• Suggest privacy in a corner of the bathroom instead of under the dining table, even if she is going in the diaper.
• Do away with the changing table. Instead, clean her in the bathroom standing up the way day-care centers and pre-schools do it.
• After she gets used to that, negotiate with her to sit on the toilet with the diaper on to pass stool. When she gets used to that, the next step will be to pass stool directly in the toilet.
• Provide toys or books (not screens) to encourage staying on the toilet. If you use screens, she may never want to leave!
• Positive reinforcement and reward systems like sticker charts may be helpful.

“I’m holding it!”
Constipated children will resist toilet training because it hurts to go. In turn, the child who resists toilet training may become more constipated because they deliberately hold it in. It can be a cycle that is hard to break. When the stools are soft and they have no pain, kids are much more likely to stop holding it and proceed with toilet training for stool.

Tips:

• Increase water, fiber, fruits, and vegetables in the diet (not easy if you have a picky eater, I know).
• Limit milk to no more than 3 cups per day.
• If you allow juice, limit juice intake to 4 ounces of diluted 100% juice per day.
• Put a step-stool or a stack of books under the feet to allow for more comfort when passing stool.
• Allow your child to blow on a pinwheel (or blow up balloons while supervised) while sitting on the toilet to help pass harder stools.
• Talk with us if dietary changes do not help to soften the stool. There are safe medications that can help with this.
• Don’t force your child to use the potty; he will most likely resist using it and hold it in more.

She’s dry during the day but still wets the bed at night
Once children become dry during the day, some will be dry at night all at once. For many children, however, being dry at night may take several months to several years. About 20% of children will still wet the bed at 5 years, 10% at 7 years, and 5% by 9-10 years.

Tips:
Make sure the last drink is at dinner, or about 2 hours before bedtime.
Use the bathroom just before going to bed.
Get her up to use the bathroom again when you are going to bed, or about 2 hours after she falls asleep. Bed-wetting alarms may or may not be helpful.
The medication DDaVP (Desmopressin acetate) can be safely used as needed so that your child can enjoy sleepovers.
If your child is getting older and still wetting the bed, we may want to check for infection or other underlying problems.

Accidents
Just as falls are common when a child has just learned to walk, accidents are common when a child has recently toilet trained.

Call us if:

• Accidents are frequent or unusual after a long period of being dry during the day.
• Your child is urinating frequently.
• There is burning or pain with urinating.
• There is blood in the urine.

Many of these tips can be applied to, or modified for, children with developmental delays, including those who are non-verbal. Please feel free to talk with us about how you can get help for your child with special needs in developing toilet training skills.

Please feel free to use the comment section below – any and all comments, additional tips, or questions are welcome! Happy toileting!