•  Toilet Training Basics, Ages 1 to 3 •  Toilet Training Problems, Ages 3 to 6

Maybe your efforts to be encouraging have degenerated into a daily battle over diapers. Or maybe your child simply refuses to go near anything resembling a toilet. Whatever the circumstances, the reality is that potty training isn't going smoothly. Take heart; many families encounter bumps in the road to toilet training. Here are parents' most common complaints, along with suggestions on how to handle them.

If she seems genuinely uninterested, she may be trying to tell you that she wants to stay in diapers a while longer. To decide if your toddler is really ready, ask yourself these questions:

1. Does your child know what a toilet is for?

2. Does she like to come into the bathroom with you?

3. Can she stay dry for at least two hours at a time?

4. Can she follow simple instructions, such as those for washing hands?

5. Does she recognize at least a few moments ahead of time that she's about to go? (Typical signs: She may grimace, squat suddenly, grab her crotch, or run from the room.)

6. Can she sit on the toilet without help?

7. Does she understand the meaning of the words wet and dry?

If you weren't able to answer yes to all seven questions, wait until you can, then try again. On the other hand, if your toddler exhibits all the signs of readiness, something may be preventing her from focusing on potty training just now. Any big change, such as starting a new school, the arrival of a baby brother or sister, or moving to a new home, can temporarily disconcert a toddler. Wait until your child has settled into a comfortable routine before resuming toilet training.

Your child is probably resisting potty training for the same reasons she sometimes refuses to take a bath or go to bed. She's discovered that saying no is a way to exert power. The first thing to do is defuse the issue by backing off and letting her feel as though she's in charge. These tips will help:

•Resist reminding. Though it's hard not to intervene when you think an accident is imminent, too much reminding can make your child feel corralled and controlled. Instead of frequent repetitions of "Don't you need to go potty?" put a potty chair in a central location and let your child run around bottomless whenever possible, so she can use it at the spur of the moment without your involvement.

•Don't hover. Enforced potty-sitting ("Let's wait a little longer and see if anything comes out") can sow the seeds of rebellion. If your child sits for a moment, then jumps up to play, bite your tongue; the result may be an accident, but it's just as likely that she'll hop back on the potty when she feels the need.

•Be calm about accidents. It's not easy to stay serene in the face of a yucky mess, but keep in mind that overreacting to accidents can make your child fearful about having them, which in turn may stir up anxiety about the whole process. Be reassuring when your child wets her pants, and do whatever you need to do for your own peace of mind, whether it's putting away a favorite rug or spreading out layers of towels. No matter how frustrated you get, don't punish your child for having an accident, as this can lead to long-term resistance.

•Reward good behavior. Break the resistance cycle by paying attention when your child does use the potty instead of when she doesn't. Don't even mention the potty until your child surprises you by using it (and she will, eventually). Then fuss over her as much as you like.

It's common for toddlers to pee in the potty without problems but resist using it for BMs. Most likely your child is fearful of making a mess -- maybe she had a bowel movement accident at preschool and people overreacted, or maybe she witnessed another child having such an accident. Helping your child successfully have a BM in the potty and then heaping her with praise can go a long way toward overcoming her fear. If her bowel movements occur on a fairly regular schedule, make note of the times and try to make sure she's near a potty then (you'll need to get her daycare provider or preschool teacher in on the plan). However, if your child's anxiety is derailing her toilet training, suggest that she ask you to put a diaper on her when she thinks she's about to have a bowel movement; this makes a good interim solution for some children.

Start by finding out everything you can about her program's bathroom routine; something procedural may be confusing your child. Perhaps the teachers take the kids in groups and your child likes her privacy. Or it might be the toilet itself; if your child is having trouble switching from her own potty chair at home to a built-in toilet, try buying a second potty chair and putting it in the center's bathroom.

Seemingly small changes -- going from a crib to a bed or starting a ballet class -- can throw a toddler's equilibrium off, making her long for the familiar. And if she learned to use the toilet quite recently, the familiar might mean diapers. Be careful not to make her feel bad or ashamed about that; you don't want to push her toward toilet training if she's reluctant. At the same time, you want to find ways to make her feel like a big girl and reinforce any steps she takes toward independence.

Choose a relaxed moment to have a little talk, letting your child know that you think she's old enough now to be in charge of learning to use the toilet. Then just lay off the subject for a while. When she starts trying to learn again, you can use incentives to encourage her. Put up a calendar and place shiny stars on the appropriate day each time your child uses the toilet, or reward dry days with an extra bedtime story or an after-dinner walk to the park. (It's not a good idea to use rewards like candy with a child younger than 3; she's likely to focus solely on the sweet, which may trigger temper tantrums.)

However, if your child asks directly for a return to diapers, don't make an issue of it. Put her back in diapers for a few weeks or until she expresses an interest in using the toilet again.

Sometimes a child becomes so fearful about having a bowel movement in the toilet -- or about not making it to the toilet -- that she begins to hold it in. While many children do this for a brief period without harm, you definitely don't want her to keep it up. (A good rule of thumb: If you have to flush twice, your child's bowel movements are probably too few and far between.) Withholding bowel movements can stretch the wall of the intestine, weakening your child's perception of when she needs to go. Refusing to poop can also lead to constipation, which in turn makes bowel movements uncomfortable or even painful, prompting her to continue repressing the urge.

If you suspect that your toddler is getting caught in this cycle, consult her pediatrician. The doctor will probably recommend that you keep a record of your child's bowel movements to get a better sense of the problem. The next step will most likely be adjusting her diet to alleviate the constipation, typically by increasing the amount of water she drinks and giving her prune juice, pear nectar, or extra fiber. If the constipation persists, your pediatrician may recommend using a laxative such as mineral oil (1 tablespoon for each year of age a day, given by mouth) for several weeks to get your child on a regular elimination schedule.

Ease your child's anxiety by talking to her about the body's functions, making sure she understands that they're natural and universal. A great tool for this is the book Everyone Poops, by Taro Gomi -- it may just become a favorite of your toddler's.

References

First published July 29, 1999
Last updated May 22, 2007
Copyright © 1999 Consumer Health Interactive

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