Toilet Training

Toilet Training Readiness

Bowel and bladder control is a necessary social skill. Teaching your child to use the toilet takes time, understanding, and patience. The important thing to remember is that you cannot rush your child into using the toilet.

There is no set age at which toilet training should begin. The right time depends on your child's physical and psychological development. Children younger than 12 months have no control over bladder or bowel movements and little control for 6 months or so after that. Between 18 and 24 months, children often start to show signs of being ready, but some children may not be ready until 30 months or older.

Your child must also be emotionally ready. He needs to be willing, not fighting or showing signs of fear. If your child resists strongly, it is best to wait for a while.

Stress in the home may make learning this important new skill more difficult. Sometimes it is a good idea to delay toilet training in the following situations:

Your family has just moved or will move in the near future.
You are expecting a baby or you have recently had a new baby.
There is a major illness, a recent death, or some other family crisis.

However, if your child is learning how to use the toilet without problems, there is no need to stop because of these situations.

It is best to be relaxed about toilet training and avoid becoming upset. Remember that no one can control when and where a child urinates or has a bowel movement except the child. Try to avoid a power struggle. Children at the toilet-training age are becoming aware of their individuality. They look for ways to test their limits. Some children may do this by holding back bowel movements.

Look for any of the following signs that your child is ready:

Your child stays dry at least 2 hours at a time during the day or is dry after naps.
Bowel movements become regular and predictable.
Facial expressions, posture, or words reveal that your child is about to urinate or have a bowel movement.
Your child can follow simple instructions.
Your child can walk to and from the bathroom and help undress.
Your child seems uncomfortable with soiled diapers and wants to be changed.
Your child asks to use the toilet or potty chair.
Your child asks to wear grown-up underwear.

Stooling patterns vary. Some children move their bowels 2 or 3 times a day. Others may go 2 or 3 days between movements. Soft, comfortable stools brought about by a well-balanced diet make training easier for both child and parent. Trying too hard to toilet train your child before she is ready can result in long-term problems with bowel movements.

Talk with your pediatrician if there is a change in the nature of the bowel movements or if your child becomes uncomfortable. Don't use laxatives, suppositories, or enemas unless your pediatrician advises these for your child.

Most children achieve bowel control and daytime urine control by 3 to 4 years of age. Even after your child is able to stay dry during the day, it may take months or years before he achieves the same success at night. Most girls and more than 75% of boys will be able to stay dry at night after age 5.

Teaching your child to use the toilet

Decide what words to use
You should decide carefully what words you use to describe body parts, urine, and bowel movements. Remember that friends, neighbors, teachers, and other caregivers also will hear these words. It is best to use proper terms that will not offend, confuse, or embarrass your child or others.

Avoid using words like "dirty," "naughty," or "stinky" to describe waste products. These negative terms can make your child feel ashamed and self-conscious. Treat bowel movements and urination in a simple, matter-of-fact manner.

Your child may be curious and try to play with the feces. You can prevent this without making him or her feel upset by simply saying, "This is not something to be played with." Pick a potty chair

Once your child is ready, you should choose a potty chair. A potty chair is easier for a small child to use, because there is no problem getting on to it and a child's feet can reach the floor.

Children are often interested in their family's bathroom activities. It is sometimes helpful to let children watch parents when they go to the bathroom. Seeing grown-ups use the toilet makes children want to do the same. If possible, mothers should show the correct skills to their daughters, and fathers to their sons. Children can also learn these skills from older brothers and sisters, friends, and relatives.

Help your child recognize signs of needing to use the potty
Encourage your child to tell you when he or she is about to urinate or have a bowel movement. Your child will often tell you about a wet diaper or a bowel movement after the fact. This is a sign that your child is beginning to recognize these bodily functions. Praise your child for telling you, and suggest that "next time" she let you know in advance.

Before having a bowel movement, your child may grunt or make other straining noises, squat, or stop playing for a moment. When pushing, his or her face may turn red. Explain to your child that these signs mean that a bowel movement is about to come, and it's time to try the toilet.

It often takes longer for a child to recognize the need to urinate than the need to move bowels. Some children do not gain complete bladder control for many months after they have learned to control bowel movements. Some children achieve bladder control first. Most, but not all, boys learn to urinate sitting down first, and then change to standing up. Remember that all children are different!

Make trips to the potty routine
When your child seems to need to urinate or have a bowel movement, go to the potty. Keep your child seated on the potty for only a few minutes at a time. Explain what you want to happen. Be cheerful and casual. If he protests strongly, don't insist. Such resistance may mean that it is not the right time to start training.

It may be helpful to make trips to the potty a regular part of your child's daily routine, such as first thing in the morning when your child wakes up, after meals, or before naps. Remember that you cannot control when your child urinates or has a bowel movement.

Success at toilet training depends on teaching at a pace that suits your child. You must support your child's efforts. Do not try to force quick results. Encourage your child with lots of hugs and praise when success occurs. When a mistake happens, treat it lightly and try not to get upset. Punishment and scolding will often make children feel bad and may make toilet training take longer.

Teach your child proper hygiene habits. Show your child how to wipe carefully. (Girls should wipe thoroughly from front to back to prevent bringing germs from the rectum to the vagina or bladder.) Make sure both boys and girls learn to wash their hands well after urinating or a bowel movement.

Some children believe that their wastes are part of their bodies; seeing their stools flushed away may be frightening and hard for them to understand. Some also fear they will be sucked into the toilet if it is flushed while they are sitting on it. Parents should explain the purpose of body wastes. To give your child a feeling of control, let him or her flush pieces of toilet paper. This will lessen the fear of the sound of rushing water and the sight of things disappearing.

Encourage the use of training pants
Once your child has repeated successes, encourage the use of training pants. This moment will be special. Your child will feel proud of this sign of trust and growing up. However, be prepared for "accidents." It may take weeks, even months, before toilet training is completed. It may be helpful to continue to have your child sit on the potty at specified times during the day. If your child uses the potty successfully, it's an opportunity for praise. If not, it's still good practice.

In the beginning, many children will have a bowel movement or will urinate right after being taken off the toilet. It may take time for your child to learn how to relax the muscles that control the bowel and bladder. If these "accidents" happen a lot, it may mean your child is not really ready for training.

Sometimes your child will ask for a diaper when a bowel movement is expected and stand in a special place to defecate. Instead of considering this a failure, praise your child for recognizing the bowel signals. Suggest that he or she have the bowel movement in the bathroom while wearing a diaper. Encourage improvements and work toward sitting on the potty without the diaper.

Most of the time, your child will let you know when he is ready to move from the potty chair to the "big toilet." Make sure your child is tall enough, and practice the actual steps with him.

Your pediatrician can help
If any concerns come up before, during, or after toilet training, talk with your pediatrician. Often the problem is minor and can be resolved quickly, but sometimes physical or emotional causes will require treatment. Your pediatrician's help, advice, and encouragement can help make toilet training easier. Also, your pediatrician is trained to identify and manage problems that are more serious.

Bed-Wetting

Causes of Bed-Wetting

Toilet training a child takes a lot of patience, time and understanding. Most children do not become fully toilet trained until they are between 2 and 4 years of age. Some will be able to stay dry during the day. Others may not be able to stay dry during the night until they are older. Nighttime bed-wetting, called enuresis, is normal and very common among preschoolers. It affects about 40 percent of 3-year-olds.

All of the causes of bed-wetting are not fully understood, but the following are the main reasons a child wets the bed:

His bladder is not yet developed enough to hold urine for a full night, or
He is not yet able to recognize when his bladder is full, wake up and use the toilet

Often, a child who has been dry at night will suddenly start bed-wetting again. When this happens it is usually due to stress in the child's life. Such stress could be due to a big change, such as a new baby in the home, moving, or a divorce. Children who are being physically or sexually abused may also develop enuresis. If your child wets the bed after having been dry at night in the past, your pediatrician should do an evaluation. The bed-wetting may be a sign that stress or a disease is causing the problem.

In trying to find the cause of your child's bed-wetting, your pediatrician may ask you the following questions:

Is there a family history of bed-wetting?
How often does your child urinate, and at what times of the day?
When does your child wet the bed? Is she very active, upset or under unusual stress when it happens?
Does your child tend to wet the bed after drinking carbonated beverages, caffeine, citrus juices or a lot of water?
Is there anything unusual about how your child urinates or the way his urine looks?

If your pediatrician suspects a problem, he may take a urine sample from your child to check for signs of an infection or other problem. Your pediatrician may also order tests, such as X-ray films of the kidneys or bladder, if there are signs that wetting is due to more than just delayed development of bladder control.

If the tests point to a problem that may require surgery, your pediatrician may recommend that you see a pediatric urologist who is specially trained to treat children's urinary problems that require surgery.

Some parents fear that their child's bed-wetting is due to a disease or other physical problem. Actually, only about 1 percent of bed-wetting cases are related to diseases or defects such as:

Bladder or kidney infections
Diabetes
Defects in the child's urinary system

With any of these cases, there will often be changes in how much and how often your child urinates during the day. Your child may also have discomfort while urinating. Tell your pediatrician if you see any of the following signs at any age:

Unusual straining during urination, a very small or narrow stream of urine, or dribbling that is constant or happens just after urination
Cloudy or pink urine, or bloodstains on underpants or nightclothes
Daytime as well as nighttime wetting
Burning during urination

Most school-age children who wet their beds have primary enuresis. This means they have never developed nighttime bladder control. Instead, they have had this condition since birth and often have a family history of the problem. Children who are older when they develop nighttime bladder control often have at least one parent who had the same problem. In most cases, these children become dry at about the same age that their parent(s) did.

Tips for Managing Bed-Wetting

A small number of children who wet the bed do not respond to any treatment. Fortunately, as each year passes, bed-wetting will decrease as the child's body matures. By the teen years almost all children will have out-grown the problem. Only one in 100 adults is troubled by persistent bed-wetting.

Until your older child outgrows bed-wetting, it is important that you give him support and encouragement. Be sensitive to your child's feelings about bed-wetting. For instance, children may not want to spend the night at a friend's house or go to summer camp. They may be embarrassed or scared that their friends will find out they wet the bed.

Make sure your child understands that bed-wetting is not his fault and that it will get better in time. Do not pressure your child to develop nighttime bladder control before her body is ready to do so. As hard as your child might try, the bed-wetting is beyond her control, and she may only get frustrated or depressed because she can not stop it.

Set a no teasing rule in your family. Do not let family members, especially siblings, tease a child who wets the bed. Explain to them that their brother or sister does not wet the bed on purpose. Do not make an issue of the bed-wetting every time it occurs.

If your child has enuresis, discussing it with your pediatrician can help you to understand it better. Your pediatrician can also reassure you that your child is normal and that he will eventually outgrow bed-wetting.

Until that happens naturally, however, the following steps might help the situation.

Take steps before bedtime.
Have your child use the toilet and avoid drinking large amounts of fluid just before bedtime.

Use a bed-wetting alarm device.
If your child reaches the age of 7 or 8 and is still not able to stay dry during the night, an alarm device might help. When the device senses urine, it sets off an alarm so that the child can wake up to use the toilet. Use this device exactly as directed so that it will detect the wetness right away and sound the alarm. Be sure your child resets the alarm before going back to sleep.

These alarms are available at most pharmacies and cost about $50. Although they provide a 60 percent to 90 percent cure rate, children often relapse once they stop using them. Alarms tend to be most helpful when children are starting to have some dry nights and already have some bladder control on their own.

Protect and change the bed.
Until your child can stay dry during the night, put a rubber or plastic cover between the sheet and mattress. This protects the bed from getting wet and smelling like urine.

Let your child help.
Encourage her to change the wet sheets and covers. This teaches responsibility. At the same time it can relieve your child of any embarrassment from having family members know every time she wets the bed. If others in the family do not have similar chores, though, your child may see this as punishment. In that case, it is not recommended.

Other treatments.
Some pediatricians recommend bladder stretching exercises. With these, your child gradually increases the time between daytime urinations so that the bladder can slowly stretch to hold more urine. Should you and your child decide together to try bladder-stretching exercises, follow instructions from your pediatrician.

When no other form of treatment works, your pediatrician may prescribe medication. The use of medications to treat bed-wetting is in dispute. Since primary enuresis stops as a child matures, some pediatricians worry that using medication may have more risks than benefits. Not only can medications cause side effects, but they may not work.

Your pediatrician can talk with you about the different medications that are available, their possible side effects, and their success rates.

But keep this information in mind: because bed-wetting is such a common problem, many mail-order treatment programs and devices advertise that they are the cure. Use caution; many of these products make false claims and promises and may be overly expensive. Your pediatrician is the best source for advice, and you should ask before your child starts any treatment program.