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* This is the Consumer Version. *

Toilet Training -ˌtrān-iŋ

By Deborah M. Consolini, MD, Jefferson Medical College;Alfred I. duPont Hospital for Children

Most children can be taught to use the toilet when they are between 2 years and 3 years old. Using the toilet to defecate is usually accomplished first. Most children can be trained to control their bowels between age 2 and 3 and to control their bladder between age 3 and 4. By age 5, most children are able to control their bladder during the day (called daytime urinary continence) and manage all aspects of dressing, undressing, urinating or defecating, wiping, flushing, and handwashing. However, about 30% of healthy 4-year-old children and 10% of 7-year-old children have not yet achieved regular nighttime bladder control (called nighttime incontinence or nocturnal enuresis—see Urinary Incontinence in Children). For children who have trouble controlling their bowels (called stool incontinence or encopresis), see Stool Incontinence in Children.

Recognizing signs of the child's readiness is the key to toilet teaching. Readiness is signaled when the child

  • Has dry periods lasting several hours

  • Wants to be changed when wet or soiled

  • Shows an interest in sitting on a potty chair or toilet and shows signs of preparing to urinate or defecate

  • Can place things where they belong and can follow simple commands

Children are usually ready to start training between the ages of 18 months and 24 months. Despite physical readiness to use the toilet, some children may not be emotionally ready. To avoid a lengthy struggle over toileting, it is best to wait until children indicate emotional readiness. When children are ready, they will ask for help in the bathroom or make their way to the potty chair on their own.

The timing method

The toilet training routine should be consistent among all caregivers. Babysitters, grandparents, and childcare workers should follow the same routine and use the same names for body parts and bathroom acts.

The timing method is the most commonly used method of toilet teaching. Children who seem ready are introduced to the potty chair and gradually asked to sit on it briefly while fully clothed. Children are then encouraged to practice taking their pants down, sitting on the potty chair for no more than 5 or 10 minutes at a time, and redressing. Simple explanations are given repeatedly and are reinforced by placing wet or dirty diapers in the potty bowl. Children are also encouraged to practice using the potty whenever they sense the need to go. They should be taught about flushing and hand washing each time they urinate or defecate.

Praise or a reward (such as stickers) is given for successful behavior. Anger or punishment for accidents or for lack of success should be avoided because the teaching process for the child will become negative and overly stressful. Parents should understand and accept that toilet training may take a long time (usually 3 to 6 months) and that their child may have accidents along the way.

The timing method works well for children who have predictable bowel and urine schedules and who can be placed on the potty chair at their normal time of elimination. It may be better to delay teaching children with unpredictable schedules until they can anticipate the need to visit the potty chair on their own.

A child who resists sitting on the toilet should try again after a meal. If resistance continues for days, postponing the teaching for several weeks is the best strategy. Children who refuse to use the toilet or potty may just not be ready. Giving praise or a reward for sitting on the toilet and producing results is effective. Once the pattern is established, rewards can be given for every other success and then gradually stopped.

Power struggles should be avoided because they often cause setbacks in any progress that has been made and may strain the parent-child relationship.

Toilet-trained children may also return to an earlier stage of development (called regression) and have more accidents when they are sick or emotionally upset or when they feel the need for more attention, such as when a new sibling arrives. In these situations, parents should try to avoid pressuring their child, can offer rewards, and, if possible, can give their child more care and attention at times when toilet teaching is not involved.

* This is the Consumer Version. *