Toilet Training

The process of learning to control the bowel and bladder and use the bathroom for elimination.

Most children are toilet trained by the age of two or two-and-a-half. Bowel control comes before bladder control, and daytime training is achieved before a child stays dry at night. Child care experts today recommend a more easy-going, low-pressure approach than was often used in the past. It has been found that when parents wait until their toddler has attained the greatest possible degree of readiness, the process is easier, faster, and accompanied by fewer lapses. The emphasis is on letting the child proceed at his own pace, motivated by the desire to be grown up and imitate his parents. Measures that may cause pressure and anxiety are avoided.

Children achieve some control over the sphincter—the muscle that controls elimination—as early as 9 months of age, and are able to cooperate in controlling themselves to some degree by the age of 12 to 15 months. However, most experts consider any training before the age of 18 months to be premature. When children are ready to be toilet trained, they exhibit certain signs of readiness, usually between the ages of two and three years. Unlike infants, they know when they are urinating or defecating and may assume certain postures or become quiet when they are about to move their bowels. They have also learned the vocabulary their family uses for elimination. Another sign is a sense of fastidiousness and desire for order that appears at this stage of development. Children are likely to ask parents to change their dirty diapers right away, and they show a general interest in orderliness that can be harnessed for purposes of toilet training. A child this age also has a pronounced desire to imitate the parent of the same sex, a trait that can be used to advantage in enticing her to use the toilet.

Pediatrician and author T. Berry Brazelton recommends the following steps in toilet training a child. A potty should be purchased for the bathroom floor, and the child should spend some time sitting on it, first in her clothes and then with her diaper off. The connection between what she is doing on her small potty and what the adults and siblings do on the big potty should be emphasized. Next, she should be brought to the potty with a dirty diaper and the contents should be placed in it so she can see that this is where they belong. Finally, the child can be placed on the potty if she's ready to try using it. Once the connection between the potty and the toilet has been established, the potty can be taken from the bathroom and placed where the child has easy, private access to it, for example in her bedroom or, during the summer months, in the backyard. Once she starts using it, her diapers or training pants can be left off for increasing periods of time. Some accidents will occur, and these should be treated casually.

Children are not ready for nighttime training until they can stay dry all day, or at least for four to six hours. Girls usually reach this point before boys; some girls begin to stay dry at naptime and even, occasionally, at night before the age of two. After the age of two, dry nights become more frequent: 45% of girls and 35% of boys stay dry at night at the ages of two to three. With many children, nighttime training is not done until the age of three and, in many cases, not complete until four or five. The signal from the child's bladder has to be strong enough to wake him from sleep and get him to the bathroom at least once or twice a night. As many as 25% of children have relapses after they have been dry at night for six months or longer, usually due to a temporary Stressor. In a minority of children, nighttime bladder control doesn't develop until after the age of five; this often occurs in families where there is a history of enuresis (bedwetting).

Brazelton and other authorities on child care emphasize that toilet training should be "child-oriented." It should occur when the child is physically and emotionally ready, interested, and motivated, and it should be the child who determines the pace. If anxiety or resistance is shown at any point in the process, the parent should back off: the experience should not take the form of a power struggle between parent and child. One potential negative effect of parental coercion is that the child can hold back bowel movements, resulting in constipation. This in turn makes elimination uncomfortable and even painful, creating even greater reluctance and resistance on the part of the child. Severe cases of constipation can cause painful anal fissures, fecal soiling (encopresis), or rectal enlargement. Special measures may be required (on the advice of a pediatrician), including enemas and stool softeners. Unusual delays in toilet training normal children, or regressions to soiling, generally indicate family stress and/or underlying emotional problems and may require counseling to be effectively resolved.

The basic parental strategy of encouraging and rewarding a child's progress toward bowel and bladder control can be enhanced by certain techniques and aids. Having the child model proper toileting by "teaching" a doll or stuffed toy to use the toilet is often an effective learning device. Special read-aloud books about toilet training are popular, as are videos. Small rewards can also be offered for progress in toilet training. For many children, simply progressing from diapers to training pants and then to regular underpants is an incentive and reward in itself. The example set by other children, such as friends and older siblings, can also be a powerful motivator.

Toilet Training

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