Toddlers Take to the Toilet

Help with Toilet Training

July 2003

Help with Toilet Training

Take Heart: Toddlers are Taking to the Toilet Later

By Elizabeth Heubeck

Before naively embarking on the long, arduous andmuch to my dismaycontinuing saga of toilet training my daughter, I thought it was one of those things that just “happened.” Just as one day she was holding onto my fingers for dear life and the next day she let go and began to walk, I assumed that she’d also progress from changing table to toilet with little fanfare. I also figured that this milestone would occur by the time she was about 2 years old, certainly not much later. How wrong I was, on both accounts.

I am somewhat consoled by recent data, which reveals that my 26-month-old daughter is not the only toddler her age still clinging ardently to her diapers. Recent reports reveal that less than 25 percent of today’s 30-month-old toddlers are toilet trained, whereas in the 1960s, 90 percent of toddlers were trained by this age. Moreover, a study published in the April 2003 issue of the journal Pediatrics suggests that it takes two to three times longer to toilet train toddlers younger than 27 months, although study author Dr. Bruce Taubman cautions that 27 months is not a “clear milestone for every child.”

But questions remain. Why is toilet training happening later? Has the training process changed along with the timing of it and, if so, how? And when can you tell if your toddler is truly ready? Read on for answers to these and other questions about toilet training.

Why Now Later

More than one theory seeks to explain why toddlers are taking to the toilet later than they did a few decades ago. One has to do with today’s disposable diapers. Though most of us take for granted the super-absorbent disposable diapers we simply toss in the diaper genie when our children are through with them, the first disposable diapers weren’t made until the 1960s, and since then they’ve been re-engineered several times for greater comfort. Because wet diapers are a lot more bearable than they once were, some theorists believe there’s little motivation to stop wearing them.

At the time of the disposable diaper revolution, the labor force was also in flux. As a result, we now have much more comfortable diapers¾and far more mothers working outside the home. This lifestyle shift leaves less time for mothers to wash mounds of dirty cloth diapers. It also leaves less time for the type of toilet training that took place when mothers spent more time at home with their toddlers, a practice that child development specialist Dr. Brenda Hussey-Gardner refers to as “parents catching the child.”

Now the protocol for toilet training has been reversed, with children learning to catch themselves, says Hussey-Gardner, NICU Follow-up Program Coordinator for the University of Maryland Medical System’s Neonatology Department.

With the burden of deciding when it’s time to go to the bathroom now placed on the child, toilet training becomes more complex. Rather than simply plopping the child on the toilet at regular and frequent intervals as was the “old” method, the “new” protocol expects parents to tune in to their child’s cues of toilet-training readiness and act on them in a positive, consistent manner. (See the sidebar on toilet-training readiness signals.) The good news, according to Hussey-Gardner, is that when a child is truly ready, toilet training should be relatively painless¾for the trainer and the trainee.

Laying the Groundwork

Just as life-long learning skills such as reading require a strong foundation for success, so too does toilet training, explains Hussey-Gardner. She suggests that parents prepare their children for the big event with some very low-key “pre-toilet training” activities. These simple steps, which offer exposure to the whole business of using the toilet, include the following:

· using words such as “pee” and “poop;”

· letting your child come into the bathroom when you use the toilet;

· changing your child’s diaper in the bathroom; and

· disposing of bowel movements (from diapers) into the toilet, in your child’s presence

Tips for Success

Once toilet-training readiness has been established, it’s on to the big event. According to Hussey-Gardner, children typically gain the muscle control required to regulate themselves somewhere between 18 months and 3 years of age. But, she stresses, the child’s level of readiness is a more important marker than chronological age. If a child is trained during a period when he or she is truly “ready,” the process generally takes six weeks, says Hussey-Gardner. But, she adds, the larger process—which includes pulling the pants up and down, flushing the toilet and hand-washing—may take much longer to master. She offers the following tips for success:

· Have a toilet insert on hand and casually introduce it to your child.

· Try to determine if your child exhibits “patterns,” and suggest sitting on the toilet during those times.

· Initially, let your child sit on the toilet with or without clothes on.

· Once your child has gained some experience, let him run around without a diaper on.

· Teach boys to sit down before they stand up and have them face the back of the toiletthis prepares them for proper positioning when they stand up.

· Limit nighttime fluids to reduce chances of bedwetting.

· If your child is in daycare, discuss your toilet-training strategy with the daycare providers; ideally, they should work with you as a team.

· Remember: Success doesn’t necessarily result in an end product. Praise your child for trying!

What Not To Do

Toilet training should be a positive learning experience. To this end, Hussey-Gardner suggests the following:

· Don’t get upset about accidents.

· Avoid using candy as a re-enforcer.

· Never make the bathroom a place for a “time out” punishment; you don’t want to associate it with anything negative.

· Don’t wait too long after your child exhibits readiness signals to begin the training process.

Motivating the Resister

You’ve tried the tips and avoided the don’ts, and you’re still not meeting with success. Now what? Sometimes, says Hussey-Gardner, parents simply need to back off and let the child take the lead.

But if a child is between 3½ to 4 years of age and is still not responding, she suggests finding a motivator. This could consist of a goody bag full of fun treats (not edibles) that the child can play with only on the toilet. Many children respond to sticker charts, too, says Hussey-Gardner.

When should parents seek professional help for a child who just isn’t catching on? “If a child has all her readiness signals, and she’s over 3 years of age, sometimes it’s helpful to hear from another person that it’s okay, and to get some new ideas,” Hussey-Gardner says.

It’s common for parents to become unduly anxious when toilet training doesn’t come quickly for their child, explains Hussey-Gardner. But children often sense their parents’ anxiety and, in turn, suffer from “performance anxiety.” To avoid this scenario, Hussey-Gardner offers the following advice to parents: “The most important thing you can do when toilet training your child is to make sure he or she feels comfortable.” BC

Signals of Toilet-Training Readiness

Child development specialist Dr. Brenda Hussey-Gardner has helped countless parents through the trials and tribulations of toilet training. In her book, Best Beginnings¾Toilet Training (VORT Corp., 1999), she shares the 14 signs of toilet-training readiness with readers. According to Hussey-Gardner, children need not exhibit all 14 signs in order to begin the training process, although the more they have mastered the more likely they are to meet with success. The signs include:

· Over the excitement of learning to walk and run.

· Can sit down and play quietly for about five minutes.

· Can help dress and undress self.

· Exhibits imitative behavior.

· Can follow a simple direction.

· Wants to put toys and other possessions where they belong.

· Takes pride in accomplishments.

· Not in a period of negativism.

· Has bowel movements at regular times every day.

· Makes well-formed bowel movements.

· Can remain dry for about two hours at a time.

· Can urinate a good amount at one time.

· Is aware of the process of elimination.

· Has a name for urine and bowel movement.