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Toilet Training

1. Make sure your child is ready.  It can be as early as 18 months and as late as 3 years depending on your child.  It is important not to pressure your child before he/she is ready.  It helps for the child to have regular meals, a diet that is high in fiber, and lots of fluids (water, not juice).  Consider starting when there isn’t too much transition for your child.  Try to start before or after there is a new sibling, new home, new daycare or babysitter, or any big change in the family schedule.

How do you know when your child is ready?

  • Understands the urge to go – holding genitals, making faces, squirming, knows when diaper is dirty.
  • Is able to verbally understand how it works and is able to verbally express they need your help.
  • Is physically able to walk over to the potty, pull pants down and sit.
  • Is aware of toileting – curious about other family members and wants to imitate them.
  • Any issues with constipation have been resolved and are well controlled.  Work with your pediatrician on this before initiating toilet training.

2. Introduce the concept first.

  • Teach the vocabulary (ie: “pee, poop, potty” or another terminology that works for your family and will be used consistently.
  • Help them recognize when they have a wet or soiled diaper.
  • Observe them and help them recognize the body’s signals for when they have to “pee” or “poop”.
  • Change the diaper FREQUENTLY and soon after they wet or soil the diapers so that they learn to prefer being dry.
  • Teach your child to come to you when they are wet.
  • Praise them for going in their diaper – keep it positive, and not refer to poop as “dirty” or “yucky”.
  • Show them the toilet and let them observe you and family members use the toilet.
  • Use teaching aids: read books, watch movies, use dolls or stuffed animals.

3. Getting a potty.  Make it special for your child.  Let them choose a special one for them.  Tell them it is a special time and privilege.

  • A floor level potty is ideal.  Make sure that their feet are firmly on the floor or another surface when using it – the ability to make a Valsalva maneuver (pushing) is important.  If your child prefers to use the family toilet, there are smaller seats that would fit on top and make it easier for your child to sit.  Make sure that there is a stool other surface for your child to firmly place their feet flat while they use it.  It’s ok to use more than one potty if that works for your home.
  • Start them sitting on the potty, with the diaper on if necessary, and have them reading or doing another activity you prefer (TV, ipad) just to get comfortable with the concept.  A nice basket of toys, activity books, favorite books to read can be left near the potty to be used specifically for potty time.
  • Dump poop in the toilet after they are done so they see what the potty is for.
  • Location: in the family bathroom so they can practice, (or they can use it while you do) or in the central area where they can easily access it.

4. Practice Runs – encourage sitting at certain times with diaper off, always encourage but NEVER pressure your child to sit, NEVER force, NEVER physically hold them on the potty.

Good times to encourage:

  • 20 minutes after meals.
  • Right before and after naps.
  • When making facial expressions, grunting, squirming, pacing, holding genital area, pulling on the diaper.
  • **It helps for your child to have clothing that makes it easy for them to pull down and take off on their own.  Avoid buttons, snaps, zippers and other clothes like onesies, rompers and jumpers, which are difficult to get out of during this time.  Dresses are helpful for girls.
  • You can stop practice runs after a couple of days.  It may take up to 1-2 months until your child is using the potty on their own.

5. Consistent and Positive Reinforcement

  • Make sure all caregivers are on board and in agreement with the plan (parents, daycare providers, babysitters, grandparents, etc.)
  • Initially reward sitting, follow with another reward for urinating on the potty, and then for making a bowel movement on the potty (peeing on the potty is easier and usually happens before the pooping).
  • REWARDS – always use verbal praise.  VERBAL PRAISE goes a long way for many behaviors!
  • You may also use stickers, tattoos, special pencils, cheap bracelets, or toy trucks and other healthy treats like goldfish.  For the really big movements like the first pee or poop on the potty or when a child initiates going on their own, you can try a “parade” around the house, or a trip to the toy store, etc.
  • Make sure the reward is immediate as children this age do not understand delayed gratification if the interval until being rewarded is too long.
  • Star or sticker charts can work because you are giving the sticker right away.  There would be an extra special treat (ie: trip to toy store) after a certain number of stickers or stars.

6. Dealing with Accidents – change immediately with words of encouragement and respond with sympathy – “you’ll get this”.

  • Please avoid criticism, scolding, yelling or another type of punishment.  Again please do not force or physically restrain your child to sit on the toilet.
  • There are also moments of regression as well.  This may occur at times of transition (see first sections about being READY above).
  • If your child is resisting on the toilet for whatever reason, take a break for about 1-2 weeks and then reintroduce training at that point.

7. Underpants – think of switching to underpants after your child has used the potty to urinate about 10 times or more.  Make is a special moment.  Think of taking them shopping to pick out their underwear.  Make sure to choose loose fitting and easy to pull down underpants.  Initially, you can use underpants for daytime and continue to use diapers or pull ups for night time, naps and travel – until your child as mastered those occasions as well.  Those can take a bit longer than daytime control.

If your child is 2 1/2 – 3 years old, you can also introduce training excited, telling the child “tomorrow you can wear your big boy/girl undies!”  The next day, make is seem special, and tell them it is potty time every 1-2 hours.  Asking them if they want to, will give them the opportunity to argue with you.  Just matter of factly include time for potty as you tell them “time for” everything else.

Dr. Marivic Botta