Toilet training can be a prolonged and frustrating experience for both parents and children.
Most children potty-train by 3 years of age, with an average training time of 6-7 months. Daytime continence (urinating in the toilet) with dry pull-ups or underwear precedes night-time continence. Most of the developmental skills necessary for toilet training success begin at about 2 years of age. Certain physiologic signs should be present before successful training: voluntary bladder control (usually starts at 12-18 months), awareness of urge to go (15-24 months) and ability to maintain dryness for more than a 2 hr period (usually 25-30 months). Children should be able to follow commands and communicate that their diaper is wet/dirty. Children with developmental delays may need extra time/attention especially if communication skills are an issue. Children also need the motor skills necessary to get to the bathroom, remove their clothing and sit on a potty chair or the toilet. In the early stages, a child will also need to understand what the potty is for; imitating or watching adults or older siblings go the the bathroom is useful. Some children continue to need pull-ups at night until 5-6 years of age, so being completely dry at night is not necessary to begin the toilet-training process.
Toilet training may begin when children start to show readiness and interest, either by imitating adults or by attempting to remove soiled or dirty diapers. This may begin anywhere between 18-24 months; however, some 2 year old children are not showing readiness signs, and shouldn't be pushed. Buying a potty chair and talking about the potty can occur, and children can "practice" by sitting on the chair fully clothed, then with pants off and only wearing a diaper, etc. when the parents are using the bathroom. This imitation of parent activity can be a positive and enjoyable experience for kids. As children develop urge, it is important to notice this and associate urge with voluntary release of urine or stool. Constipation is a frequent issue with children, especially at toilet training age, and can definitely interfere with the toilet-training process. Family pressure and stress, a change in environment, new baby in the family, or a change in family dynamics may retard the process.
Tips:
1. Focus on ownership of the process - recognize what skills your child has and what they can do. Start with small steps and work up as children show success. For example, take off dirty diapers in the bathroom, have the child help with clean up/new diaper. Once this is established, you can work up to potty-sitting (with or without a diaper) if the child is not resistant.
2. Eliminate stress - talk about the potty, make it a positive experience and don't push; if a child shows regression (was previously interested, now is not) - back off, put them back in diapers or pull-ups and try again in a few weeks. You can still have them come in the bathroom with you or talk about peeing/pooping, even if they won't participate.
3. Schedule potty time - regular times that your child can sit on the potty with or without actually going; the gastrocolic reflex leads most people to go 30 min. after a meal. Sitting time should be about 10 min.
4. Reward systems work - star charts, M and Ms, stickers, etc. Have the chart in the bathroom and reward kids for sitting on the potty - even if they do not actually go. Heap praise on your child when he does go in the potty. Talk about how proud you are of them learning to go potty.
5. Stay positive, and be flexible - adjust tactics if needed, and don't get discouraged for children who regress or take longer
6. Address constipation and stool withholdiing if this interferes with the process. For many children, constipation needs to resolve before they can truly have good urinary continence. Address constipation issues with your child's medical provider.
7. Seek out books that are age-appropriate that discuss children learning to go potty. Point to the pictures, and talk about what is going on. This will reinforce the normalcy of the process, and repetition will breed comfort with the activity of sitting on the toilet.
