Wednesday 15 May 2013

New thoughts on potty training

More and more children every year start school wearing nappies.  The advice of when and how to potty train is being debated.  Parents are getting conflicting advice: you must start potty training before two; children do it themselves when they are ready. Growing evidence, currently anecdotal but significant is suggesting two things:

1 Children need to be prepared for potty training; suddenly introducing a potty and pants at 2-3 years doesn't seem to be working

2 There is no evidence that potty training early does damage.

Children in real nappies tend to potty train earlier but it's not automatic. Some intervention as described below is necessary, especially for first-borns.

There is no set age for your child to potty/toilet train. Every child is different. The most important thing is to prepare your child. Then they can develop an interest and you can read the signs to see when they are ready for you to take away daytime nappies.

We don't delay cleaning our child's teeth until they can do it themselves. We start to clean their teeth as soon as the teeth come through, right? It's the same for toilet training. Teaching your child about pee and poo from an early age is important preparation. (This tends to be most important for the first-born who don't have older siblings as role models.) It means that when the time for potty training arrives (ie removing nappies during the day and using cotton pants - all day, every day) the process will be quicker and easier.

It's also important to note that control of bowels, control of bladder and staying dry at night are 3 different things. They tend to happen at different times. Children can be clean by one, dry by 18 months and dry at night around three. But it depends on the child - and possibly more importantly, you giving your child the stimulation and awareness to show you s/he is ready.

How do we prepare for toilet/potty training?

  • Always talk about poo and pee in a positive way - "Lovely poo, well done"
  • Talk about poo and pee. If your child wears cotton nappies talk about when the nappy is wet and when it is dry.
  • Get a potty. Your child can sit on a potty from an early age. Encourage your child to sit on the potty ONCE a day (if possible when you expect a poo) for a short time (a couple of minutes as a guide). It should be a relaxing time. Nothing needs to happen but if a poo or pee comes give praise to show this is what the potty is for. Warning: don't go overboard with the praise or it will be overwhelming for the child - although the prospect of you child coming out of nappies may be incredibly thrilling to you!
  • Open door policy: let your child see you on the toilet.
  • Visit the library and borrow different books about using the potty.
  • Create a game with your child about helping a teddy or doll to use the potty, praising teddy or dolly when they do a pee or poo on the pot and keep their pants dry. Get your child to role play being the teddy or doll and repeat the steps to you.
  • Visit a home where there are children of a similar age who use the loo and encourage your child to take an interest.

    When to potty train ie when to help your child stop wearing nappies during the day?
  • If you do this preparation your child is highly likely to show an interest - letting you know a nappy is wet or poo is coming.
  • The act of toilet training has been found to help the bladder develop so current thinking is that we do not wait until the child can stay dry for 2 hours
  • Your child may already be using the potty/toilet for poos

    How to start Potty/Toilet Training?
  • Choose a time when your child is showing an interest in the potty and you can spend some time together. Set aside a few days to spend mostly at home and devote the time to helping your child develop this skill. Prepare your child for what is going to happen - that s/he is going to stop wearing nappies during the day.
  • Tell your child that s/he is only going to wear pants from now on during the day and will only wear a nappy at night.
  • Make it exciting. Go on a special shopping trip with your child to buy some cotton pants. If your child is going to use the toilet straight away get a step and a special seat too.
  • For the first few days encourage her/him to sit on the potty/toilet every few hours - about half an hour after a drink. But make sure s/he knows that s/he can also tell you if s/he needs to go, and that you'll accompany her/him whenever s/he wants you to.
  • Some toddlers won't sit on the potty long enough to relax and let anything come out. Calmly encourage her/him to sit there for at least a minute or so. Stay with her/him and talk calmly, or read a story. It's best to start boys off with sitting too. Peeing standing up can be learned later.
  • When your toddler uses the potty successfully, give her/him lots of praise, though don't go too overboard, as s/he may find too much fuss overwhelming. Even if s/he continues to have accidents, s/he'll then start to grasp that getting something in the potty is an accomplishment.
  • When you think your child is ready stop reminding her/him to use the potty/toilet. There may be a few accidents but your child does need to get the feeling of when s/he needs to go to the toilet him/herself. 

    What do we do when we go out?

    Once this process has started be consistent. Stick with it and don't go back to nappies. When you go out you may need a portable toilet so s/he can use it. Choose to spend time at a park with toddler toilets (such as Coram's Fields) or a drop-in with small toilets so that your child will see 'big' boys and 'big' girls going to the loo.

    What if there is no progress?

    If you feel that your child is not ready after all go back to nappies and try again when your child shows an interest. This process takes co-operation. Your child should be an active participant. Be consistent in whatever seems right for your child.

    What about night training?
    Most children become dry at night within 6 months or so of becoming dry in the day but up to 20% will still wet at age 5 years. If so parents need to speak with their school nurse or GP re appropriate treatment to help their child become dry.

    What about children with special needs?
    Having special needs does not mean that your child cannot become toilet trained. Get expert advice
    Disabled Living
    Tel: 0161 607 8219
    PromoCon, working as part of Disabled Living Manchester,
    provides impartial advice and information regarding a whole
    range of products, such as musical potties and other toilet
    training equipment and swimwear and washable trainer pants
    for children who have delayed toilet training.
    Information is also available regarding which services and
    resources are available for both children and adults with bowel
    and/or bladder problems

    If you're interested in your child developing bowel and bladder control from an early age have a look at this post on Elimination Communication. In particular see comments from parents who have experience of this method.

    Help needed
    This advice is based on listening to parents, health visitors and paediatric continence professionals over the last 15 years.  Comments on this draft welcome!


    1. Thank you :) Very helpful and timely for us.

    2. Honestly, I don't like the tone of this article much and I know a lot of people it won't sit well with either, many of them at the more 'natural' end of the parenting spectrum and using cloth nappies.

      If you want to include the idea of praising the child that's fine, but I think you should also take into account (and mention) that some parents don't actually use praise to manipulate (as they see it) children into doing things. "Lovely poo"? On what planet is poo lovely? I'm a big fan of cloth nappies and I talk about poo/wee/nappies/bums a lot but I can't say I've ever found it lovely! We found letting LO 'praise' herself was better - she was proud to have done it so we really didn't need to add extra false praise.

      I think you ought to mention nappy free time as a way to help a child become ready. Summer time with no nappy in the garden is popular - nothing says "Oh yeah, I'm weeing" quite like wet feet!

      I don't think it's necessary to set aside a couple of days either. It depends very much on the child but you don't say that. My oldest, for example, was 'trainable' at around 23 months, we waited until 25 months when she was really ready (there's a different between trainable and ready, I feel). She's quite a shy child and takes 'failure' pretty hard so it was important for her to be able to do it well from the start, rather than expecting lots of accidents. She started off with no nappy or clothes on her bottom half for a week or so at home but still nappies when out of the house, then when she was confident she let us know she didn't want nappies outside either. It took maybe 3 weeks but it wasn't a full time thing so no need to take time off work if I had been working! So the 'don't go back to nappies' advice isn't what all children will need at all.

      1. Thanks for the comments. I'm hoping that parents will share their real experiences as you have. We can then include these as quotes on the web site version. As you know, there's no right way, only guidance. My children both took up pants during the winter months. It was when they were ready. Once again, Thanks!

    3. I think the advice on night training is a bit misleading. In my experience and those of most of my friends with children of similar age, it's not true to say that most are dry 6 months after daytime training. I have not come across any health professional who would suggest 'treatment' for a child who is still wearing nappies at night aged 5, or consider it to be a problem. Age 7 maybe. Most of the rest of the advice is helpful but i really feel that statements like this can worry parents unecessarily.

      1. Thanks for your comment. This response comes from an experienced paediatric continence professional:
        While the majority of children are dry at night by the time they are aged 5 years up to 20% will still wet the bed. While most children are unaffected by this a small number will be aware that wearing nappies at night is something their peers do not do and this can lead the child to become distressed and anxious about the wetting. If this is the case then it is perfectly reasonable for the family to seek professional advice to help their child become dry. We also know that bedwetting can occur as a result of underlying problems such as constipation so it is always prudent to seek advice and reassurance from the school nurse or GP even if treatment is not being sought at that time.

    4. Hmmm.. I would love to have done early potty training with my boy and I did do elimination communication when he was very little but as soon as he was on the move there was no way he was going to sit still anywhere any time!

      Now he's 18 months, we've had a potty and potty books since he was about a year old, open door bathroom policy and very open and positive about poos and wees, use cloth nappies... he's interested in all of that BUT whenever I suggest he tries sitting on the potty he says a very emphatic, determined NO. So I'd say he's not ready whatever I'd be forcing him to do if we lived in a different era or country! If I tried to encourage him too strongly to have a go, I'm pretty sure it would have the opposite effect! I might get a child's toilet seat in case that generates more enthusiasm but I'd love to have some suggestions on how to play it in our situation. But I'd also say to others don't feel guilty if your child isn't interested in using a potty early despite your best efforts!

    5. Thanks for engaging and sharing your personal experiences. We'd love to hear more! Anyone's first child made the transition to pants during the winter? Did you potty train your child in a central London rented flat with brand new white carpets and no garden? Can poo ever be lovely? Please keep your comments coming; exceptions to the rules ie real life stories are most welcome!

    6. Found this post on potty training today - worth sharing. Mum didn't want to do it but son did:

    7. Unfortunately, although my 2.9 year old is ready (she can tell us when she's done a wee or a poo, she doesn't want to stop wearing nappies and takes great pride in telling us she's done a poo knowing we want her to tell us before - she will wait until we've let her try for a wee or a poo on the toilet and then do it afterwards. She will even beg to have a nappy put back on. It's so frustrating!!

      1. Hi, Thanks for your comment. June Rogers answered this issue - a common one - on her Ask the Expert spot. Do have a look. It's the third one down:

    8. Is potty training boys harder than potty training girls? Some say "Yes", I say "No, not really." I only add the "not really" part because potty training boys properly requires a bit more preparation only because parents have to make a few more decisions before beginning (which I'll discuss below). But the basic approach is exactly the same for potty training boys and girls. Susan.N

    9. Potty training targets are a very popular toilet training resource. But do they work? Here are the advantages and disadvantages to using this simple potty training idea. Susan

    10. You will come across lot of physicians that will suggest the child to undergo the treatment of hypnosis bedwetting. You should know that each and every child should not undergo the treatment of hypnosis bedwetting. Those children who have a tendency of making the bed wet should undergo the treatment of hypnosis bedwetting. Susan

    11. Bedwetting is a problem caused by abnormally deep sleep, which doesn't allow for the bedwetter's brain and bladder to connect so they can effectively respond to each other. In 99% of all bedwetting cases, (based upon our research of tens of thousands of documented cases) the root cause is sleeping so deeply. It is an inherited deep-sleep disorder that results in bedwetting as well as a non-restorative, unhealthy sleep. it's time to potty

    12. Should the local authorities strip you of the right to wash your car? After all you do pay the water bills for it. And some people argue that banning this activity is hypocritical since commercial car washes have not suffered closures as well. Find out three points that we discuss on this issue by reading on. Tampa Pressure Washing