Toilet Training 101

An important milestone for children and parents
One of the first real opportunities a child is given to independently manage an activity of daily living
Recognizing signs of readiness
Guidance on methods of toilet training

Age varies by time, culture, and definition of endpoint of toilet training
US: 98% children are potty-trained by 36 months
Digo people in East Africa begin toilet training infants during first weeks of life, usually achieve stooling and urination on command by 4-5 months old
A study out of Belgium in 2000 showed the age at which children begin to toilet-train has increased over time
US: Daytime vs nighttime bladder control
- Nighttime bladder control not expected until 5-7 years of age

1) Parent-oriented:

2) Child-oriented:

Child:

Physiologic: Sphincter control (reflex ~9-12 mo, voluntary conditioning ~12-15 mo)
Developmental: Ambulate, stability while sitting, remain dry for several hours, pull clothes up/down, language skills (receptive to follow command/expressive to communicate need to use toilet)
Behavioral: Ability to imitate behaviors, place things where they belong, show independence by saying “no,” expression of interest, diminishing oppositional behaviors/power struggles
Toilet-training should not be delayed in children with chronic illness

Parent:

Clinicians should discuss toilet training with parents at each health supervision visit beginning at age 12 months
Plan toilet training when at least one caregiver can give the time/energy necessary to be consistent on a daily basis for a minimum of 3 months

Once the child demonstrates readiness, parents can bring a potty into the home
Encourage child to play with it, set it where he wants, sit on it fully clothed, to help with “ownership”
Some place the potty in the bathroom, some find greater success by keeping the potty in the bedroom where it is easily accessible after a nap, or kitchen after a meal
Deciding on a vocabulary for bodily fluids to use consistently
After a week of sitting on the potty fully clothed, child should be encouraged to sit on the chair naked
Placing a soiled diaper or stool in the potty and explaining that this is the purpose of the chair
Demonstration of disposal of the feces or the urine into the “adult” toilet
Transition to training pants or cotton underwear after at least 1 week of success using the potty

Pretend play even before starting toilet training
Reading kids books on toilet training
Trying not to refer to pooping as “stinky” or “smelly” (try not to make them averse to the toilet)
Positive reinforcement
Sounds of toilet or disappearance of feces may scare child, can try encouraging them to flush toilet paper itself or wave “bye-bye” to feces before flushing
“It’s not a reflection of your parenting, every child is different!”

Length of time to establish bladder training:

Operant conditioning principles:

Brown Med-Peds Residency