ANN ARBOR, MI -Potty training is an important milestone in a child's life. Training can easily turn aggravating, though, when a child isn't as responsive as hoped. U-M doctors have valuable toilet-training tips to help parents with the process, including signs that indicate when your child is ready to begin training.

Video

Watch related video clip. For faster downloading, choose the lo-res option. (Windows Media Player required)

Kristine Baker, a mother of 3-year-old son, Ben, is more than familiar with the struggles of potty training. She began toilet-training Ben a year and a half ago and is still waiting for success.

“This is something I consciously worry about,” Baker says. “When we sent Ben to preschool for the first time in June, I worried that people were going to look at my child and be like, ‘who's that 3-year-old not potty trained?'

While mom and dad were ready for their toddler to begin using the toilet, what matters most is whether or not the child is physically and mentally ready.

“There are a lot of things prior to actually having the urine go in the toilet that the child has to be able to do developmentally,” says Julie Lumeng, M.D., developmental and behavioral pediatrician at the University of Michigan Health System.

First, a child must be able to understand instructions, be physically capable of crouching down to sit on the potty and stand back up, and be able to remove his pants before potty-training can successfully begin. He should be able to recognize when he is urinating or having a bowel movement, and his bladder must be mature enough to hold larger amounts of urine between voids. A clue for parents: When a child wakes up from a nap with a dry diaper or keeps his diaper dry for two or more hours.

Psychological readiness is also an important consideration.

Children who are unwilling to sit on the toilet, disinterested in using the potty or unbothered by a wet diaper may not take as well to toilet training.

“If your child is not at a point yet where they'll sit still a minute or two or listen to simple one- or two-step directions, they're probably not ready to be sitting on the potty,” Lumeng says.

Research has shown that children aren't usually ready to begin potty training before 24 months of age.

“The average age of toilet-training in girls is 20-29 months, and in boys it's 31 months,” she says.

If your child displays signs of readiness, it's time to get to work. But don't expect immediate results.

It takes three months on average to toilet-train a child, Lumeng says, noting that 98 percent of kids are toilet-trained by 36 months of age.

Summer can be a good time to begin toilet training because children are typically wearing fewer clothing layers, which makes it easier for a toddler to undress himself.

Parents should avoid beginning training during high-stress periods such as around the time of a move or the birth of a new sibling.

Kristine Baker has learned this lesson the hard way.

“Ben was getting to the point where he was asking to use the potty and unfortunately things changed when the new baby came,” Baker says. “It has been a little frustrating for my husband and me. I would like the process to go faster than it has and Ben doesn't really have the interest.”

One of the first – and most basic – steps in toilet training is to buy a child's toilet seat. And while it may seem like an odd piece of furniture for the family room, it is helpful to put the chair in a place that's readily accessible and non-intimidating to the child.

“You might even put it in the living room, or in the toy room, or someplace the child frequently visits,” Lumeng says. “Have them take that first step, which would be just sitting on it, not even pulling their pants off.”

Once the child is comfortable sitting on the potty, the next step is teaching the child to associate the feeling of needing to urinate or have a bowel movement with the cue of going to sit on the toilet, Lumeng says.

“That's probably the trickiest part for most parents,” she says, “…Diapers are so good these days that children don't feel the wetness in a lot of cases, and so one step is to put them in underwear so they can tell.”

When the child wets his underwear, Lumeng says, it is an opportunity to help him make the association by saying something such as, “oh my goodness, your underwear is wet, that must mean you had to go potty.”

Throughout toilet training, continue discussing and modeling appropriate toilet behaviors, perhaps even reminding your child about his friends who are potty trained. One of the most important things in the training process is positive reinforcement, which has been proven to be more effective than punishment in getting children to do what you want.

When your child begins making steps forward in using the toilet, “that's the moment when as a parent you really should just shower the child with praise and be so excited and proud of them,” Lumeng says. “It will make them want to do it again.”

If the child becomes resistant or progress slows down, remember that regression is only a temporary setback to success.

“Praise them for when they do sit on the toilet, but ignore it when they do something you don't want them to do,” Lumeng says.

If toilet-training attempts still aren't working, it may be time to take a break.

“The thing that we tell most families is just let it lie for a few months,” Lumeng says. “Because if this is becoming a big battle and a power struggle between you and child, the pleasure the child gets from winning the power struggle may well outweigh the pleasure they're going to get from you praising them for doing what you want them to do.”

Starting too early may have been the Bakers' problem. According to a recent study reported in the journal Pediatrics, starting intensive toilet-training before 27 months doesn't necessarily mean finishing before kids who started later. The study found that the earlier parents started, the longer it took.

Even after a child is off diapers and using the toilet, wetting accidents are normal. Fifteen percent of children who were potty-trained at age 2 or 3 were still having wetting accidents at age 5, Lumeng says.

“It's just part of the development, and it still takes children some time to sort all of this out,” she says.

Visit your pediatrician if you are concerned about your child's potty-training delays or development. One common problem with toilet-training is constipation, which can be prevented by providing your child with a fiber-rich diet.

Tips :

• Start training when the child is most cooperative and after several readiness skills have been demonstrated.
• Coordinate potty-training efforts closely with other caregivers, such as day care providers, to keep the training process consistent.
• Do not remind the child too often to use the potty. This can create pressure, which can cause resistance.
• Encourage practice runs to the potty at promising times such as after a nap or 20 minutes after a meal.
• Praise the child for cooperation and any success.
• Introduce underwear as a privilege after the child starts using the potty.

For more information, visit these Web sites :

U-M Health Topics A-Z:

Toilet-training Your Child: The Basics:
www.med.umich.edu/1libr/pa/pa_btoilbas_hhg.htm

Toilet-training:
www.med.umich.edu/1libr/yourchild/toilet.htm

Toilet-training Resource List:
www.med.umich.edu/1libr/pa/pa_bltoilet_pep.htm

Toilet-Training Guidelines: The Role of Parents in Toilet-Training: pediatrics.aappublications.org/cgi/content/full/103/6/S1/1362

Toilet-Training Guidelines: The Role of the Day Care Provider in Toilet-Training: pediatrics.aappublications.org/cgi/content/full/103/6/S1/1367

Written by Jessica Schrader

Recent Press Releases