Normal toilet training

For most children, the right time to start thinking about toilet training is when your child starts to signal before he or she goes in the diaper or around 2 years of age. Around this time you should set the potty up in the bathroom. Explain to your child in a matter of fact way what it is for. Make it clear that you do not expect them to use it right away. Rather tell them, "Someday you will be ready to use the potty like mommy and daddy". Research shows that starting "serious toilet training" before 2 years is not associated with toilet problems (constipation or stool withholding). But toilet training can take longer the earlier it is started. For most kids the time they will be successful with toilet training is after their child's second birthday. The age at which your child is trained has no relation to their intellect or your ability as a parent. It is a very individual process.

• First, decide what toileting words you want to use. Let other people who care for your child know what these words are and what they mean. Avoid words no one else would know or those that suggest something bad like "stinky". Commonly used words like "pee" and "poop" help your child handle situations away from home. They also don't make the necessary task of toileting seem dirty.
• Teach your child to sit on the potty. Make this time brief, enjoyable and unpressured. You can start with your child's pants on just so they get the idea and don't feel startled. Do not expect your child to go in the potty yet. Once your child gets used to sitting on the potty encourage them pull their pants down when they practice.
• Start with either "peeing" or pooping. Suggest your child try to "pee" or urinate or poop in the potty when you see him or her get still or start to strain like they have to go. It may take several days or weeks or months before your child does this. All kids have a different timeline. Remember do not pressure your child to use the potty and do not punish them for accidents. Instead always reward them right away when they pee or poop in the potty. Stickers are a great inexpensive reward. Talk about what your child's body feels like when they need to pee or poop. This will help them link a physical feeling with the drive to use the potty.
• Initiate regular times for sitting on the potty. Start with the times that your child regularly has to go in addition to 15 minutes after meals. Overall aim to sit your child on the potty and sit with them about 4 times daily for about 5 minutes each time. Give a reward and praise for when your child poops or pees in the potty. Make sure boys sit to go so they will be willing to sit to poop. Eventually you want your child to tell you when they have to go. So encourage this. If your child doesn't poop or pee, praise their effort. If they have an accident you can act disappointed but say "Maybe next time!"
• Start your child in underwear. Once your child is clean and dry for a week then it is time to "graduate" to underwear. It is better not to use pull-up diapers. They keep the child too dry and many kids lose motivation to use the potty. Make a family celebration of it! This is a big step! Explain to your child that they are now a "big kid" and are old enough to use the potty for pooping (or "bm's") and peeing. Make sure to start this process when you have lots of time to devote to your child. For example, don't try to potty train right before a big trip or before a new baby is born. Also you should start underwear when your child is having soft and regular stools. If you child is constipated do not start underwear yet.
• Expect accidents and setbacks. This is a hard thing for children to learn. Some children learn to use the potty for pee first and then only later learn to poop in the potty. Be supportive and don't get worked up or criticize your child. This can set your child back. If your child doesn't poop for 3 days go back to diapers for a while. They are probably feeling too pressured. Too much pressure can lead to painful constipation. Back off and wait for more interest from your child.

For more information talk to your pediatrician or read:

• The American Academy of Pediatrics Guide to Toilet Training by the American Academy of Pediatrics (2003).
• Toilet Training: The Brazleton Way by T. Berry Brazleton, M.D. and Joshua D. Sparrow, M.D. (2004).
• Mommy I have to go potty! By Jan Faull (1996).

Reinforcing your child's desire to use the potty is important. Reading books is a great way to do this and spend time with your child. Here are a few suggestions of picture books and videotapes dealing with toilet training:

• It's Potty Time edutainment video by Barbara Howard, MD
• Once upon a potty by Alona Frankel.
• I have to go by Sesame Street.
• Everyone Poops by Taro Gomi.
• My potty book for girls (for boys) by Mary Atkinson.