Potty Training 101 with Dr. JJ Levenstein
When is it most successful?
- Most girls will potty train fairly easily around 2, whereas boys may take a little longer (perhaps because language develops earlier (as a general average) in girls, and language is part of the preparatory checklist that needs to be intact before potty training can be accomplished.)
What to do AHEAD of time?
- From a preparatory standpoint, involve children in YOUR pottying – i.e. let your tot pull toilet paper for you, flush the toilet, and even sit on their own potty next to you with a book. These imitative behaviors are key, but NEVER let your child see you strain or look as if you are in pain – you don’t want them to witness what they then will think is a traumatic event.
- Grabbing a few children’s books about pottying, and incorporating them into your child’s reading routine is a good idea – that way the characters they love in books already potty, and serve as beloved role models.
- Adjusting your tot’s diet so that soft stools are the rule, rather than the exception. If your child has hard painful stools and/or suffers from chronic constipation, this is a situation that MUST be remedied for at least a couple of months BEFORE you start training. Stool must be soft enough to be "soft serve" in consistency, so when the urge hits, it’s NEVER painful or difficult. Toddlers almost immediately associate that feeling with negativism, and start to withhold stool willfully – after about 2-3 days of doing this the stool in their rectums is so rock hard (from dehydrating in the "chamber") that it’s impossible to cajole them into believing defecation will be pleasurable. Work on your child’s diet, with the help of your pediatrician, in order to achieve soft, easy to pass stools. Your pediatrician likely will recommend fewer dairy products, more water, and diet rich in fiber and produce. Use his/her guidance to make sure your tot’s diet is balanced, but potty-friendly.
- Understand that you must DAY train a child successfully before expecting your tot to be successful at night – and often night dryness may not be achieved for 6-12 months after the days have been mastered. Realistic expectations of your child are a must!
How do I know if my child is ready?
A few things absolutely need to be in place before you even try, and this way, odds are you’ll be successful…
- Your child doesn’t like the contents of his/her diaper – gestures like pointing at the diaper, asking/gesturing that it be taken off if wet or soiled indicate dislike. If your child is happy sitting in his warm wet one for prolonged periods, it’s too early.
- Your child can pull his/her pants down. Think about it – to be an independent "pottier", you should get the urge, take yourself to the bathroom, drop your drawers, and go. So this step is key from a motor readiness standpoint.
- Language – having the ability to gesture and tell that he/she must go helps us get our tots to the pot on time.
- SOFT stools are a regular.
- Neurologic readiness – ultimately, your child and his/her bladder need to be able to work with each other. How to know?
- Your child awakes from naps dry.
- You witness several hours of bone dry diapers, then a flood of urine.
- Your child wakes up dry in the morning, then floods his/her diaper.
Assuming ALL 5 elements above are in place (no matter what your child’s age), what’s the plan? This is the fun part!
- Carve out a week to dedicate to helping your child learn to potty, and announce this to your child. Let your tot know that great things happen in the bathroom. Here’s a suggested reward system:
- Purchase stickers of your tot’s favorite character/cartoon/obsession, and go to the store and purchase a few dozen small toys and characters, and then a few extra special goodies for the bribes (ok, let’s call them incentives!). Developmentally, kids this age love rewards.
- Go to your local office supply store and grab a big poster board and place it directly in front of the toilet where you plan to help your child potty.
- Just entering the bathroom gets them a sticker, sitting on the pot gets them 2, actually peeing gets them 3 stickers or a small prize, and pooping gets them a big prize.
- Developmentally, the growth of this sticker board is a constant reminder of the rewards associated with the bathroom, as well as a reminder of success. Training with candy treats is "in one ear and out the other;" there is no concrete reward (and the candy idea is just wrong as a reward, as it encourages a dependence on treats).
- Purchase a dozen pairs of underwear (not training pants) – this way if your child starts to go, your tot will FEEL the wetness (rather than it being absorbed by a training pant). They should be a little big/loose so that they are EASY to remove.
- Make sure your training bathroom is well lit, warm, and that you have a step stool for climbing onto the toilet, but also a platform for putting little feet so your tot can have the physiologic support needed to "push" if pooping.
- Place a potty seat over the regular toilet so your child doesn’t feel as if he is "falling in," and this seat gives his bum needed support to push when needed.
- Have a kitchen timer, a stack of your child’s favorite books, and a positive attitude. Now, let’s go!
OK, what now? It’s game day, and your are home with your child for a week to potty train.• We want to maximize success and getting there in time, so you little one can just wear underwear, a shirt and comfy shoes.
- Day 1: 2-3 hours of training time.
- Dress your child in the "game day uniform", inform him that if he needs to go before the timer rings, he should tell you, otherwise.
- Set your timer for every 30 minutes.
- Give your child frequent sips of water and fluids so that his bladder has something to work with!
- Take your child to the potty when the timer dings.
- Reward him for entering the bathroom by having him proudly put up a sticker. Have him sit, and read a book with him for 5-10 minutes to relax him and give his bladder a chance to relax and empty. If no pee, put up another sticker for sitting and cooperating, praise him, pants up, out of the potty you go.
- Repeat, every 30 minutes, and of course if he pees in the potty, it’s a party (you can even throw in some party music if wanted) and extra rewards come.
- If he urinates in his underwear, react in an "oh well, oops, let’s try again mode"…clean him up, change his gear, and move on.
- After the 2-hour mark, ask if he wants to continue, and then go for another hour; then back to diapers.
- Day 2: 3-5 hours.
- Day 3: 4-6 hours.
- Day 4: 6-8 hours.
- Day 5: all day, and diaper at night.
- Try to have your tot potty before leaving home, and anytime a bathroom is nearby. Don’t be surprised if there is a bit of reluctance in public restrooms or in the homes of others. The toilets are unfamiliar, the acoustics of flushing are loud, and the rooms may be a little cold. So be prepared for pushback, and offer a diaper if needed.
- Don’t let up on your child’s diet, maximize drinking fluids while at home, but cut back a little when on the road to reduce the chances of accidents.
• Pack extra clothes and underwear (and bring a few diapers) as likely there will be slips for a few weeks and NEVER punish your child for an accident. Praise his success, and be as blasé as possible about the accidents.
If you get through the first week, just remember that once back in the "real world" of errands, driving in the car, seeing friends, going out, that your rhythm at home can’t be duplicated once outside.
So a few key points:
JJ Levenstein, MD FAAP, is a Board Certified Pediatrician. You can take parenting classes with instruction by Dr. Levenstein online by visiting www.momassembly.com. Also, find helpful parenting products at www.mdmoms.com.