Potty Training

by Warren P. Silberstein, M.D.
05/26/97

I've often wondered why some books state that bowel training is easier than bladder training. That certainly hasn't been my experience. I think that the confusion comes from the fact that when children are being potty trained they wet themselves much more often than they soil themselves. The reason for that, of course, is that most people urinate considerably more often than they defecate. It is true that the goal of toilet training is for children to stay clean and dry, but that shouldn't be where the initial attention is focused. Before children can stay clean and dry they have to learn to do their business into a toilet or potty. And since children urinate much more easily and much more often than they have bowel movements, it is easier to train them to urinate into a potty.

Children learn from their experiences. We can help them significantly by pointing them in the right direction, showing them what we want, and providing them with the opportunity to do what we ask and figure out what we're talking about, but the no matter how many times you show a child someone else using a toilet, he won't fully understand what it's about until he experiences it himself. Essentially I'm saying that for a child to learn to use a toilet he has to experience using a toilet. Does it sound like a Catch 22? It's really not. Since toddlers don't really care where they go, just like an untrained child can have an accident in his pants, so can he have an accident into a potty. All he needs is the opportunity.

Opportunity is the key. But just as important, keep it pressure free. Children love to please their parents. They love to do new things and feel a sense of accomplishment for their successes. If we demand things of them that they're not capable of or not ready for, it should come as no surprise that they don't cooperate. So just what is a toddler who isn't toilet trained ready for? He should be ready to sit on a potty or toilet.

The first step in potty training is to have a child sit on his potty regularly. If a child refuses, express mild disappointment, but don't insist. When he cooperates, praise him. Let him know how pleased you are when he sits on his potty. Then make it part of his routine. Take him to the bathroom before or after each meal, and at least once between meals. Set up a daily bathroom routine so your child gets used to it. Do it in such a way that it doesn't interrupt activities since few children are at their most cooperative when you pull them away from something they want to do. Sitting on the potty regularly provides opportunity. Sooner or later the child on the potty is bound to do something into the potty. That's when you tell him how pleased you are with what he has done. That's when he will get the first inkling of understanding of what you really want him to do. Don't get tempted to increase your demands on him yet. He needs a lot of those successes to build on. It's all pretty new to him, and the diaper is a safe, familiar friend. Too much pressure at this point and your child will be ready to stick with the in the diaper method with which he's already comfortable.

You may be wondering, since I said, "before or after each meal," which is preferable. Early in the course of training you should put children on the bowl after each meal to take advantage of the gastro-colic reflex. The gastro-colic reflex is the urge to have a bowel movement after a meal. Once a significant degree of bladder training has been accomplished, you should probably have your child use the facilities before each meal to avoid having to take your child to the bathroom during meals.

Only after a pattern of urinating and/or defecating into the toilet or potty has been established should you start asking a child to do his business into the bowl instead of his diaper. From that point forward praise staying clean and dry. Deal with accidents by expressing only mild disappointment and offer encouragement that you know your child can stay clean and dry by continuing to cooperate on the potty. Avoid making a big fuss about the cleanup for accidents. Sometimes, when we provide too much attention to our children for behaviors we don't want, even though the attention is negative, it reinforces the behavior. If necessary, increase the frequency of taking your child to the bathroom. If there is an identifiable pattern to the timing of the accidents, try to avoid the accidents by taking your child into the bathroom at the appropriate times.

Most children between the ages of two and three years of age stay clean and dry because they're taken to the bathroom regularly. After wearing diapers has become an old memory, most children will not want to have accidents. At that point they are ready to start assuming some responsibility for asking to use the toilet. Even then they should be asked regularly if they need to go. Some children will start to have an increased frequency of accidents after they are well trained because, in their effort to master control over these bodily functions, they try to hold it as long as possible, and when they finally become overwhelmed by the urge, they can't get to the bathroom in time. They will need to be reminded not to wait too long. It would also be wise to try to get them to use the bathroom before becoming involved in any long activity.

Constipation is the enemy of bowel training. Children who are constipated have difficulty having bowel movements to begin with, and so, are more resistant to having their bowel movements into the potty. They don't have the patience to sit and strain on the bowl when, in their minds, they already know that pooping in their diapers will work. It is best to have those children on high fiber diets including bran and prunes, and fruit juice, including prune juice.

Most children don't have bowel movements during sleep, but many wet themselves while they are asleep. This is called enuresis. Since it happens during sleep, it is not under voluntary control. Children can't be trained to stay dry at night, but that's the subject of another article.

Want to read more on the subject? Check these Web sites:

Dr. Greene's House Calls
Parenthood Web - Those Potty Training Blues

Read Ask Dr. Warren Column