GROWING UP GREAT! Series developed by Dr. LORI RAPPAPORT

 

TOILET TRAINING

 

SIGNS OF READINESS

     Although your parents may tell you that you were out of diapers by your first birthday, current trends don’t support most children learning to use the potty at such an early age.  The phrase “two in diapers” holds little meaning for those of us raising children in the age of disposable diapers.  Learning to use the potty is a milestone for children and the beginning of the road to independence.  There are several signs to look for from your child to help you decide whether or not they might be ready to learn to use the potty.

 

·          Periods of dryness throughout the day.  During the first two years, your child will empty his or her bladder so frequently, control is often difficult to achieve.  At some point, you may notice the diaper changes being less frequent with periods of dryness in between.   Some children might even occasionally wake from a nap with a dry diaper.  

 

·          Predictability in bowel movements.  Paying attention to patterns in your child’s bowel movements each day will help when you begin teaching. 

 

·          Child has an awareness of  his or her bodily functions.  Your child may let you know either by grabbing at their diaper when it is wet, going off into a corner and “grunting” , assuming that certain “look”, or maybe even announcing to you that he or she has or is going at that time.  A child who can ignore a stream of urine running down his or her legs may not quite be ready while one who is might be annoyed by this same event. 

 

·          A preference for being clean and dry.  Children who are ready tend to insist on their diapers being changed as soon as they have soiled them while those who are not do not mind waiting quite a bit. 

 

·          An interest in wearing underpants instead of diapers.

 

·          The ability to pull down pants, lift up a skirt, and pull underpants up and down on their own. 

 

·          Curiosity about the bathroom habits of others.  This may include following in family and friends and/or trying to imitate them.

 

·          An understanding of the difference between wet and dry, clean and dirty, and up and  down. 

 

·          Familiarity with toilet words used in your household (pee, poop, BM), and the   ability to communicate needs and to understand and follow simple directions.

 

GETTING READY TO BEGIN

     Learning to use the potty starts long before buying Elmo underwear!  Teach your child about when and how others use the potty.  Notice places that have a potty, other people using them,  and take them with you when you go, teaching them the steps you take (such as hand washing) and why you do them.   Explain that all big people use the potty and that some day, when they are big enough, they will too, just like Mommy and Daddy.  Talk about their using the potty as off into the future.  Be careful not to pressure them or continually ask them if they want to try to use the potty.  While it is ok to inform them of a friend’s success, do not think you will be aided by peer pressure.  Your child needs to make the decision to use the potty for themselves, not because he or she realizes you are invested in this.  You can give them the tools, but ultimately when and where is in their control.   Pressuring them can lead to behavioral issues, withholding, and constipation.

 

PARENTAL READINESS

     While it is important for your child to be ready for learning, it is equally important as a parent that you make the commitment to follow through.  When a child is ready, the initial teaching typically takes only a few days, but requires consistent monitoring, assistance and attention from the parent.  If you are not in the position to do this, put it off for a bit.  It is better to postpone toilet teaching if you are nearly due with a new baby or have just had one, have an illness, new child care situation, move, or other serious family problem or life event.  Your child will not be harmed by waiting awhile even if he or she might ready.

 

THE DAY ARRIVES!

     It is usually a good idea to commit three days to toilet teaching, when you can remain close by a potty, preferably at home.  Remove the diapers from your child and have them put on underwear.  Explain to them how to use the potty including how to get their pants on and off, wipe, flush and wash their hands.  You may want to leave them in just underwear at this time to make it easier.  Tell them to let you know when they need to use the potty.  Now, offer them plenty of appealing liquids!  The more practice you have with a skill, the easier it is to master, and learning to use the toilet is no exception. Encourage your child to drink by providing them with varied juices (kids love the boxes!). 

     When your child seems like he or she needs to go, lead them to the potty and sit with them.  If you are pumping your child with liquids, this may be approximately every 20-30 minutes.  You can bring a book to read to take the focus off of them.  Don’t worry about whether or not they actually go, but rather praise them for sitting and trying.  Be very casual, tell them they did “good trying” and that next time it will probably come out.  Make sure they sit for 2 minutes, not just a quick “on and  off.”   If they do not have success suggest they

come back and try again later.  When they are successful, be sure to praise them and give them a hug.  Remind them again to tell you when they need to use the potty next time.

 

REWARDS

     In addition to praise and hugs, offering your child an immediate reward can also help to motivate and reinforce appropriate toilet behavior.  Stickers or small candy such as m&m’s, gummy bears or gourmet jelly beans work well.  There is no need for large items or promises of toys or shopping sprees.  If your child does not ordinarily get candy, then these small treats are quite reinforcing.  

     You can keep a small jar of these treats in the bathroom so your child can see them and so they are readily available as needed.  Offer them one sticker/m&m/jelly bean for sitting without any success, as we want to reinforce sitting behavior.  Be sure your child sits for 2-3 minutes each time in order to receive the treat.  For urinating in the toilet reward them with three stickers/m&m’s/jelly beans , and for bowel movements five.  As you venture out in public, keep a bag of these treats with you at all times, to reward  immediately.  If your child goes to preschool or daycare, discuss with their teacher whether they might be able to maintain this reward program as well.  They may be willing to work out a way to reinforce your child while being unobtrusive to the other children.   As your child becomes more consistent in their success, you can begin to  fade the reinforcement.  Begin by waiting until your child asks for the treat and then stop taking treats with you outside the home, and finally stop them at home, commenting on how grown up your child has become and how he or she does not need rewards anymore.  

 

ACCIDENTS

     Be relaxed, they will happen!  Let them know it is ok and do not tell them they need to “try to remember” as this only puts pressure on them.  Reassure them that they will learn and that everyone has accidents.  After the accident lead them to the potty to see if “any more comes out.”  It will help them to learn where the urine should have gone.  Finally, help them get into clean clothing.

     Always carry a change of clothes in the car.  Even the most experienced toilet trained child will at some point have an accident.  You might consider keeping a small potty in the back of your car, for those times when a restroom is not conveniently located.  Invariably, your child will need to use the potty once you have just gotten back to the car, having  asked him or her if they needed to go five minutes before!  The first two years, children usually tell you they need to use the restroom at the moment  they must use it!   Until they feel such urgency, they do not truly believe they need to go.  Having a potty on hand saves you from venting your frustration on your child.     

    Another source of frustration for parents is nighttime wetting.  While this is normal, a sleep deprived parent is not always a calm and reassuring one.  To make evening sheet changes most efficient, purchase a large waterproof pad for your child’s bed, in addition to the waterproof mattress cover.  Place the mattress pad cover on the bed and then a sheet.  On top of the sheet, place the waterproof pad (this is usually not a full size mattress cover but covers a large area where the child will be sleeping).   Finally, on top of the waterproof pad, place another sheet.  At night, when your child wakes up with a wet bed, you can take off the top sheet and waterproof pad, leaving a clean sheet already on the bed.  This allows you to help your child change pajamas and get back to bed sooner.

 

NAP TIME AND AT NIGHT

      Often dryness when sleeping comes later than waking control, so put your child in some type of training pants such as “Pull Ups.”  As opposed to diapers, these type of pants allow your child the opportunity to use the potty, pulling down the pants themselves, and also make them feel “bigger” as they are out of diapers completely.  If your child is dry several mornings or naptimes, they are ready for underwear at these times as well.   

 

MY CHILD IS RESISTING

     If your child whom you thought was ready suddenly refuses to use the potty and it becomes a struggle, listen to them.  Stop the training and let them know that it is ok and that one day they will be ready but right now they can have their diapers back.  Do not alternate between a day in diapers and one in underwear, or let them wear the underwear sometimes, or even over their diapers.  Underwear is for “big kids” and while you need not be punitive or pressuring, you need to gently let them know that when they are ready they can have the underwear. 

     Give it time.  Eventually your child will decide they are ready to give up diapers.  In the meantime, stop pushing for that time to come, for it will. 

Lori Rappaport, Ph.D. is a  Licensed Clinical Psychologist specializing in child and family issues.  Dr. Rappaport has over 15 years of experience working with children and families experiencing chronic and life threatening illness.  She is a consultant to the Jenna Druck Foundation which provides support to families that have lost a child (www.jennadruck.org).  
In addition, Dr. Rappaport has a private practice in Del Mar, CA.
  (858) 481-2188.
 
www.growingupgreat.com