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Toilet Training

"The most important thing to remember while toilet training is that your child will not be going to college in diapers. So at some point between now and then, your child will figure it out."

Every child is different. Some children reportedly pick up toilet training before they're a year old -- others don't quite get it until a few years later. Our advice? Don't sweat it. Toilet training can be frustrating (it's notorious for incidents of child abuse) but try to keep it in perspective. It's an important developmental milestone -- not the end (or beginning) of the world.

"But my mother/friend/co-worker says her son/daughter/friend's child was toilet trained long before now."

There's generally a window (a LARGE window) of time during which the vast majority of children are trained. Outside of that window, parents need to check with their medical practitioner and make sure there isn't a problem. If the child is younger than the window and isn't wetting and soiling enough diapers, the child might be dehydrated, otherwise failing to thrive or have a medical problem. Conversely, if the child is older and is still (or newly) wetting and soiling underwear, there might be a physical or psychological situation that needs to be addressed.

Other things to remember:

bulletIt's not about you:  The age at which your child is toilet trained is not a reflection on you -- or the child -- as a person. Every child develops differently, and no doubt at least a few Nobel Prize-winners weren't toilet-trained until they were 4 years old (and probably one or two serial killers were toilet-trained before they learned to walk).
bulletThere will be signs of readiness:  The best way to know when to start training is to watch your child. There will be several signs of readiness -- such as an increased awareness of a need to go, curiosity in others' bathroom habits, longer period of dryness (not because of dehydration), interest in neatness, understanding of "wet" versus "dry," etc.
bulletThey'll go when they have to go:  Your child can't go to the bathroom just because you want her to. Do ask if she has to go before leaving the house, but she'll go when she's ready (same as you). This means she might want to go on the way out the door, after the snowsuit is on, or on a bridge with traffic coming in both directions. She might want to sit on the toilet or child's potty and just think about it for a while. Keep a sense of humor, and don't nag her or force her to try, but do accommodate her when the urge strikes. She should feel secure that when she has to go, it won't be a problem and you'll be able to make it happen -- even if it means having to go in the middle of dinner, in the middle of the night, or in the middle of a traffic jam.
bulletDon't withhold liquid - or use laxatives - in an effort to control a child's bathroom habits: Withholding liquid is unfair to a child, and can only harm his well-being. If he's dehydrated, he'll also be much more difficult to deal with. Keep him hydrated, even at nighttime, and just be patient. Do avoid citrus juices or caffeinated beverages, however, especially at night, and do make sure the child empties his bladder completely just before bed. Don't wake him up before you go to bed; that won't help him learn to get himself up. (Also -- this hadn't occurred to us, but a knowledgeable reader asked us to note that parents should not use laxatives in an effort to control a child's bowel movements. Besides the potential harmful health effects, laxatives teach a child nothing about body control.)
bulletBe flexible:  Keep your child in clothing that's easy for her to manage (no snaps, buttons, belts, or buckles). At home, you can leave your child in a long shirt with no pants at all. Have a separate child-size potty at home, plus a foldable adapter in the diaper bag. An adapter means your child can sit by himself on virtually any toilet.
bulletTraveling in the car: If you travel at all, there will eventually be an urgent "I have to pee" from the back seat. You can prepare for this by bringing your child's potty in the car, but don't panic about letting her pee on the side of the highway (park well off on the shoulder, far away from the highway.). Every parent driving by will understand completely. If she has a bowel movement, however, do clean it up.
bulletBe prepared for a crisis: Your child doesn't always know when he has to go to the bathroom. Sometimes he'll have to go two seconds after he swore he didn't have to go (this is common after going swimming). Keep extra pants, underwear and socks in the car. Keep wipes in the car and in your purse. If he has to go, give him a break, and take him without complaint. And if he's already gone, tell him that mistakes are normal and that it's not a big deal.
bulletWatch the messages you send:  If you get angry about your child having to go to the bathroom (because it interrupts what you're doing), you're sending several clear messages to your child (none of them good). You don't want her to think that going to the bathroom is bad or troublesome, and you especially don't want her to think she is bad or troublesome. So no name-calling. No belittling the child in front of others, no jokes at her expense. No labeling behavior as "good" or "bad." No forcing the child to sleep in a wet bed. All of these can have an effect that's opposite to the one you want. Even if you're annoyed, keep a smile on your face, and stay calm and positive. Reinforce the behavior you want with simple rewards -- a hug, a sticker, words of praise, a few jellybeans.
bulletPatience is a virtue:  Toilet training might not happen all at once. Your child might learn daytime routines long before nighttime routines. Let your children find their own path and their own way. Expect accidents and don't have a fit when they occur. Guide, instruct, assist -- but don't push.
bulletMake sure caregivers are in sync: Talk to your child's baby-sitters and caregivers and make sure they're using the same or similar toilet-training technique. Your child will be more responsive if she isn't confused.
bulletExamples help:  It can be helpful to show your child what to do. Are you squeamish about letting your child see you in the bathroom? Try to get over this for now. Your child will benefit from watching you and your spouse or partner. It's easier and more effective to show proper wiping technique than it is to explain it.
bulletSet up good habits now:  Make sure your children (girls and boys) learn to wipe front to back (helps keep fecal bacteria from getting into the urinary tract). Make sure they always wipe, even after going pee. Make sure they flush. Make sure they always wash afterward with soap, even after going pee (you must set a good example and do it, too). Don't ever allow them to sit or play on the bathroom floor, especially in public toilets.
bulletIf they want to sit, let them sit:   Sometimes children like to sit on a toilet for a while. Let them. Leave the child-sized potty in an easily accessible place, and perhaps let them look at books or watch television while sitting on it. (For boys, it might be helpful to start by having him sit and allowing him to work toward standing.) Also, make sure their feet are planted on something solid (if their feet dangle, it tends to tighten their rectal muscles, which makes it harder to go).
bulletUse this time to teach:  Toilet training is a perfect time to teach about the body -- how it works, what the parts are called, and why things happen the way they do. Many people grow up knowing next to nothing about the parts "down there," and this ignorance sets them up for various health problems later. Use toilet training time to begin teaching.
bulletInvolve your child in the process:   Get feedback on how things are going. Some children are frightened of flushing or of the noise. Some children get upset about mistakes. Some are reluctant to use unfamiliar toilets (encourage them to do so on shopping trips). Generally, most children respond well to praise. Listen to your child, keep the process positive, and try to adjust your procedure according to what you're hearing.
bulletUse night lights: If your child is trained for the day but is having trouble at night, it might be that more patience is in order. But perhaps there's a reason he doesn't get out of bed. Talk to him. If he's afraid, put night lights in the bedroom, hallway and bathroom. If he gets too cold, keep the house warmer. If he thinks you'll be angry because he's up, reassure him that it's no big deal and that everyone has to go at night. If he has trouble navigating his pajamas, try just a T-shirt and underwear. And if he can't manage an adult-size toilet, leave his potty out -- perhaps in his room where he can find it. It might be that he's become used to having diapers at night -- in this case, work out a day with him when the diapers will no longer be needed. Mark it on the calendar, and get him excited about it. There might have to be a few wet nights after that big day until he learns to wake up (have a water-proof cover on the mattress -- just in case).
bulletTry having incentives:  Try offering your child a jellybean for each successful bowel movement. Or make a chart for the bathroom door, divided into squares. Allow your child to put a sticker or two in each square for every successful bathroom trip, and perhaps five squares will get him or her a special treat. But avoid punishing your child for mistakes.
bulletAt some point, there might be a relapse:  If your child makes a mistake or two, it's probably nothing to comment on. But if there's a longer relapse, see if you can gently elicit what might be the problem (urinary tract infection? too much change? control issues? child is stressed? you weren't accommodating?) and keep the accidents in perspective. If an older child has soiling or wetting problems, however, do take this seriously. There might be a physical problem (urinary tract infection), a stressful situation (child is getting bullied at school), or an abusive situation (soiling or wetting can be signs of sexual abuse). Take your child to a health professional and get this resolved right away. See the Safer Child Abuse & Neglect page for more warning signs.
bulletNo punishment is appropriate:   Punishing a young child for not being toilet trained would be like punishing you for not knowing how to fly a rocket. There are many factors to becoming toilet trained -- some physical, some mental, some emotional, and some environmental. And punishing an older child ignores the underlying causes. Although you can't control how quickly your child learns, you do have complete control over how you respond to the process. Your child is not to blame for your loss of temper. Keep a sense of humor and don't take anything personally. Remember that your child really does want to please you.
bulletGive it a rest:  If things aren't working out, try giving it a rest. Perhaps your child isn't ready. Perhaps you're pushing too hard or making your child feel badly. Perhaps your child is more interested in saying "no" than in learning to use the potty. Perhaps there have been too many big changes in your child's life, and this new challenge is overwhelming. Perhaps your child has a physical or emotional problem that's interfering with the process (make sure your pediatrician has a chance to rule this out). Remember that toilet training isn't a do-or-die proposition. Your child will get it. Relax and don't make it a battle of wills. Children are biologically motivated to learn this skill, and they will -- as soon as they're ready.

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Helpful Links & Resources:

bullet KidsHealth - "Toilet Teaching Your Child"
bulletSafer Child General Guidance page - for organizations and books devoted to general child care issues (many of these resources will have special sections on toilet training
bulletPARENTING Guide to Toilet Training (Parenting) - a book by Anne Krueger, with editors of Parenting Magazine
bulletWhat to Expect When You're Expecting, Third Edition - a book
bulletWhat to Expect the First Year, Second Ed - a book   
bulletWhat to Expect the Toddler Years - a book
bulletCaring for Your Baby and Young Child, Revised Edition: Birth to Age 5 (a book edited by The American Academy of Pediatrics)
bulletThe Parents Answer Book: From Birth Through Age Three (Parent's Picks) - a book
bullet It Worked for Me! Parents Reveal Their Secrets to Solving the Everyday Problems of Raising Kids - a book
bullet Dr. Greene's House Calls - choose "Potty Training" option
bulletCharmin - a commercial site that offers guidance on the toilet-training process. Click on "Toilet Training Tips"
bulletSafer Child Safety While Shopping page - includes safety tips for public restrooms
bullet KidsHealth - "Bedwetting" (written for children)
bullet KidsHealth - "Encopresis (Soiling)"
bullet American Academy of Child and Adolescent Psychiatry - "Bedwetting"
bullet About Encopresis.com

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