Most children can be taught to use the toilet when they are between 2 and 3 years old. Using the toilet to defecate is usually accomplished first. By age 5, the average child can go to the toilet alone, managing all aspects of dressing, undressing, wiping, and hand washing. However, about 30% of healthy 4-year-old children and 10% of 6-year-old children have not yet achieved regular nighttime bladder control.

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
• Shows an interest in sitting on a potty chair or toilet
• Is able to 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 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. The children are then encouraged to practice taking their pants down, sitting on the potty chair for no more than 5 or 10 minutes, and redressing. Simple explanations are given repeatedly and are reinforced by placing wet or dirty diapers in the potty bowl. Praise or a reward is given for successful behavior. Anger or punishment for accidents or for lack of success should be avoided.

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. Teaching children with unpredictable schedules is better delayed until they can anticipate the need to visit the bathroom on their own.

A child who resists sitting on the toilet may be allowed to get up and try again after a meal. If resistance continues for days, postponing the teaching for several weeks is the best strategy. 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 Once the pattern is established, rewards can be given for every other success and then gradually withdrawn. Power struggles are unproductive and may strain the parent-child relationship.