Potty training problems and solutions: An evidence-based guide

© 2006 – 2022 Gwen Dewar, Ph.D., all rights reserved

Common potty training problems include

• fears and anxieties
• resistance to sitting on the potty
• refusals to use the potty
• an unwillingness to use toilet facilities outside the habitation, and
• accidents.

What can we practice about these issues?

If we programme ahead, we tin can prevent many of them from arising in the first place. At the end of this article, I offer tips for avoiding trouble.

Just first, allow's consider what you can do if you've already hit a stumbling block.

Here's an evidence-based guide to coping with common potty preparation problems.

1. Solving potty preparation problems caused by anxiety

When children refuse to cooperate, it might seem that they're being lazy or unreasonable. But many kids suffer from understandable anxieties almost toilet training.

Sometimes it's simply the fear of something new. The potty chair is unfamiliar; and then is the routine.

Sometimes children have specific fears about toilets. They might be frightened by the noises that toilets make, or by the mysterious way that flushed items vanish. They might fear falling into the toilet, or worry that something — a animal or monster — lurks inside.

And many kids accept had experiences — with constipation, urinary tract infections, or other medical problems — that have fabricated them associate toileting withpain.

Any the reason for a child'due south trepidation, being forced or pushed into toilet grooming doesn't assist. Nobody likes to be coerced and frog-marched through a mysterious procedure!

Immature children need to know what to expect. They demand to learn that there is null to fear.

And so if your kid shows signs of anxiety nearly toilet grooming, the kickoff order of concern is to reduce that anxiety.

Before y'all practice anything else, brand sure your kid isn't suffering from constipation, hard stools, or whatever other potentially painful condition.

And even if you run into no signs of medical problem, it's helpful to review your kid'south diet and fluid intake. Make certain your kid is drinking enough water, and consuming a high-fiber diet.

Then have the time to assist yous child learn: Teach your child what to look, and allow your kid the opportunity to investigate and enquire questions.

Let your kid get used to the potty chair by leaving it out in a identify where your child plays. Defuse potential fears past explaining how things piece of work. For case, prove how your child how the toilet works, and reassure him or her that there is nada to fear.

As your child becomes more relaxed, attempt introducing a series of exercise "potty sits," where your kid stays seated on the potty for a curt time.

For the first few do sits, your child may remain fully clothed, and sit for simply xxx seconds or so. Praise your child for cooperating.

As your kid becomes more accepting of the process, you tin accept your child practice bare-bottomed, and gradually lengthen the sessions.

Once you've overcome your kid's fears, your kid will be ready to resume toilet training. Run into this article for a discussion of dissimilar potty training techniques.

2. What to do when kids refuse to sit

Sometimes kids flat-out refuse to sit on a potty chair or toilet. What so?

Kickoff, brand sure your child has stability and leverage when he or she sits.

When children's anxiety are left dangling, kids aren't merely less comfortable. They besides have more than trouble controlling their voiding muscles (Christophersen 1991).

For this reason, researchers advise that toilet training is best accomplished using a child-sized potty. To use a toilet, place a child's training seat on top, and place a brusque stool under your child'southward feet.

2nd, consider your child's psychological readiness. Is there something more your child needs to learn before pushing ahead?

Pediatricians, like those of the Canadian Paediatric Society, contend that refusal is a sign that your child isn't ready for grooming. They recommend that you have a suspension from potty training for a month or ii, and try over again.

This isn't unreasonable advice. Trying to force toilet grooming on an unwilling child is a bad thought. Children may reply by trying to withhold urine or stool, increasing the risk of a urinary tract infection or constipation. A coercive approach could also increase your child's anxieties and fears — causing more potty training problems (Schmidt 2004b).

Merely you don't accept to simply expect it out. Instead, utilize the time to familiarize your child with the steps people take when they need to use the toilet.

Accost any fears or anxieties your child might have (see #1). Read picture books about the process, stage demonstrations, and model a positive mental attitude.

Then, as your child's resistance fades, you tin can introduce the practice sits mentioned above (#1).

And don't get out children to sit alone, bored, with cypher to practice. Provide them with companionship and diversions.

For more ideas about preparing your child for toilet training, read these bear witness-based tips.

3. Coping with kids who won't poop

Your child is willing to urinate in a potty or toilet, just refuses to have a bowel movement. What's going on?

Experts telephone call this "stool toileting refusal," and enquiry suggests information technology's linked with constipation and painful bowel movements (Blum et al 2004; Kimball 2016).

For instance, in a study tracking 380 American toddlers, i in four children developed stool toileting refusal, and in near cases the trouble was preceded past constipation.

In add-on, children who had experienced frequent, difficult bowel movements were more than twice every bit likely to suffer from stool toileting refusal (Blum et al 2004).

And then if you're coping with stool toileting refusal, information technology makes sense to take special care with your kid'south diet and fluid intake, and hash out the trouble with your pediatrician.

If you can make it easier for your child to pass a bowel movement, your child's potty training problems may soon resolve (Kuhn et al 1999).

In addition, there is bear witness that an upbeat, encouraging manner can help.

In study of more than 400 young children, half the parents were randomly assigned to accept this arroyo — praising babies for defecating, and fugitive the use of negative terms for feces.

The arroyo didn't forestall stool toileting refusal, but it shortened the fourth dimension it took for children to grow out of it (Taubman et al 2003). So information technology seems a good idea to monitor the way y'all communicate with your child, and avoid sending the message that defecation is disgusting or shameful.

iv. Overcoming resistance to using toilets when your child is away from habitation

Even adults tin exist reluctant to employ a public lavatory, so it shouldn't be hard to empathize. The simplest solution is to use a portable child's toilet seat — the kind that can be fitted over the top of a standard toilet. Practice with it at home, and bring information technology with you when you travel.

5. Agreement daytime accidents and wetting the bed

It's important to be realistic. Accidents are very common throughout the toilet training process! In fact, even after you've finished toilet preparation, you should expect the occasional mishap.

In a study tracking American children, researchers defined potty training every bit completed when parents reported "less than four urine accidents per week and two or fewer episodes of fecal soiling per month" (Blum et al 2003).

That's progress, only information technology's far from perfection.

And the younger your child is, the more difficult it'due south going to be to avoid accidents.

In a study tracking the development of approximately 60 Swedish children, researchers found that simply 31% of 2-twelvemonth-olds were reported to take good bladder sensation. By contrast, float awareness was reported in 79% of  3-twelvemonth-olds (Janssen et al 2005).

These researchers too found hints that bladder chapters matters. Children who developed larger float chapters at an earlier age tended to achieve daytime dryness sooner (Janssen et al 2005).

So your child's rate of accidents is going to depend on his or her age, also equally private developmental factors. To minimize accidents, the best approach is to monitor to your child's fluid intake, and add some well-timed potty sits to your child'south schedule.

What near night?

To stay dry at night, the bladder needs to receive a hormonal signal to produce less urine. Sleepers besides need to have good float sensation, and and so awaken when their bladders feel full.

Young children may face special challenges on all of these fronts: These abilities are still developing during early childhood. Every bit a result, many kids don't reach the milestone of night dryness until they are 4 or v years onetime (Fergusson et al 1986).

For instance, in the Swedish study just mentioned, only half the children had achieved nighttime dryness by the age of 4 (Janssen et al 2005).

So for young children, bed-wetting isn't a potty training trouble as much as it is a developmental phase. Reducing fluids before bedtime can help, but information technology won't eliminate nighttime accidents — not unless your kid has developed mature float function.

If your kid is still wetting the bed at the age of 5, doctors are more likely to view this every bit evidence of a problem (Kessel et al 2017). Read more nigh bed-wetting here.

Beingness proactive: 10 tips for preventing future potty training problems

To prevent hereafter mishaps and health bug, here is some additional advice.

1. Actively prepare your kid for potty grooming

As noted in the introduction, you can avoid some potty training problems by planning alee. See this evidence-based article for an overview of how to make it easier for your child to adjust.

2. Avert straight confrontations. Don't forcefulness your kid to sit down, or restrain your kid when he or she wants to go up.

Your child cooperated yesterday, but suddenly resists your request to use the potty. What should you do? Experts say it's meliorate to dorsum off and try again subsequently. Compulsion tin lead to all sorts of problems, including constipation, urinary tract disorders and phobias (Schmidt 2004b).

three. Don't permit kids experience lonely or bored.

Effort to make time on the potty more interesting by talking with your child, reading stories, or providing your kid with games and toys.

4. Don't punish or scold your child for accidents.

When children are subjected to punishment or scolding, they may start holding back their urine or stool — putting them at higher risk for urinary tract infections, constipation, and stool toileting refusal (Schmidt 2004b).

five. Avert potty chairs with splash guards.

Boys can catch their genitals on them when they are moving on or off the potty. If you teach your son to pee sitting down, prove him how to hold his penis down and then the urine goes into the potty. If your son prefers to stand up, allow him pee in a bucket (Schmidt 2004a).

6. Accept steps to prevent constipation.

Nosotros've already mentioned this, just it bears repeating: Constipation increases a child's risk for developing potty preparation problems (Taubman 1997; Blum et al 2004). Make certain your kid drinks plenty of fluids (at least four cups a day) and consumes plenty of cobweb (Sears et al 2002). If your child has a chronic constipation problem, consult your doctor.

vii. Beware of bubble baths and soapy bathwater.

The soap can crusade an inflammation of the urethra, which makes urination painful. Girls are more likely to develop this problem than are boys.

8. Don't encourage your kid to strain

Straining can crusade disorders of the bladder and sphincter muscles (Weiner et al 2000). If your kid can't urinate without straining, report this to your pediatrician.

9. Consider scheduling a few routine potty visits during the mean solar day

Some pediatricians (Brazelton and Sparrow 2004) recommend that all potty sessions exist kid-initiated (no prompting from parents).

However, this approach is a matter of personal preference. Another arroyo features regularly scheduled potty sessions, such equally immediately later on waking, after meals, and before bedtime. When potty sessions are treated as a part of the daily routine, kids larn to expect them without being nagged (Lekovic 2006). Scheduled potty sessions may also have health benefits, including the prevention of urinary tract infections (Bakker 2002).

10. Assistance your child wipe

Most children don't chief wiping skills until they are 45 months old (Schum et al 2002). Good wiping is especially important for girls. Because the female urethra is shorter than the male person urethra, it is easier for leaner to invade the female urinary tract and cause infection. Teach girls to wipe front-to-back.

If you lot suspect your kid has a urinary tract infection (UTI), seek handling at in one case. Whatsoever Ane of the following signs may bespeak a UTI:

• painful urination
• a sense of urgency (even when there is little or no urine to void)
• odor
• pinkish urine or claret in the urine

UTIs tin cause potty preparation problems. Merely, more than importantly, they can cause serious wellness problems. Untreated UTIs can harm the kidneys.

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References: Preventing potty training problems

For details on coping with potty training problems, encounter Dr. Barton Schmidt'southward article in Contemporary Pediatrics (Schmidt 2004b). This, and other articles cited, are listed below.

Bakker Westward. 2002. Research into the influence of potty training on lower urinary tract dysfunction. Unpublished MD dissertation, Department of urology, University of Antwerp, Belgium.

Blum NJ, Taubman B, and Nemeth N. 2003. During toilet preparation, constipation occurs before stool toileting refusal. Pediatrics, 113: 520-522.

Brazelton TB and Sparrow JD. 2004. Toilet training the Brazelton mode. Cambridge, MA: deCapo Printing.

Christopherson ER. 1991. Toileting issues in children. Pediatric Annals, 20: 240-244.

Fergusson DM, Horwood LJ, Shannon FT. 1986. Factors related to the age of attainment of nighttime bladder control: an 8-yr longitudinal study. Pediatrics. 78:884–890

Jansson UB, Hanson M, Sillén U, Hellström AL. 2005. Voiding pattern and acquisition of bladder control from nativity to age 6 years–a longitudinal study. J Urol. 2005 Jul;174(1):289-93.

Kessel EM, Allmann AE, Goldstein BL, Finsaas M, Dougherty LR, Bufferd SJ, Carlson GA, Klein DN. 2017. Predictors and Outcomes of Childhood Main Enuresis. J Am Acad Child Adolesc Psychiatry. 56(iii):250-257.

Kimball V. 2016. The Perils and Pitfalls of Potty Training. Pediatr Ann. 45(6):e199-201.

Kuhn BR, Marcus BA, Pitner SL. 1999. Handling guidelines for primary nonretentive encopresis and stool toileting refusal. Am Fam Physician. 59(8):2171-8, 2184-vi.

Lekovic JM. 2006. Diaper-Complimentary Before iii: The Healthier Fashion to Toilet Train and Assist Your Child Out of Diapers Sooner. Three Rivers Printing.

Schmidt BA. 2004a. Toilet training: Getting it correct the first time. Contemporary Pediatrics, 21: 105-119.

Schmidt BA. 2004b. opens in a new windowToilet grooming problems: Underachievers, refusers, and stool holders. Gimmicky Pediatrics, 21: 71-82.

Schum TR, Kolb TM, McAuliffe TL, Simms, Dr., Underhill, RL and Lewis Chiliad. 2002. Sequential conquering of toilet-training skills: A descriptive study of gender and age differences in normal children. Pediatrics 109: 48-54.

Sears Due west, Sears Thou and Watts Kelly C. 2002. You can go to the potty. Boston, MA Little, Brown and Company.

Taubman B. 1997. Toilet training and toileting refusal for stool just: A prospective written report. Pediatrics, 99: 54-58.

Weiner JS, Scales MT, Hamptom J, King LR, Edwards CL. 2000. Longterm efficacy of elementary behaviour training for day-wetting children. Journal of Urology, 164: 786-90.

Portions of this text appeared in a previous version of this commodity, entitled "Potty training problems: Evidence-based tips for prevention" (Dewar 2006).

Epitome credits for "Potty training problems and solutions":

Title epitome of father and child by Reuben Strayer opens in a new window/flickr

Toddler demonstrating potty sit past opens in a new windowDan Ox/flickr

Boy gardening and looking like he needs a toilet by Kelly Sue DeConnick/flickr

Daughter hosting potty party by opens in a new windowmliu92/flickr

Content of "Potty training bug" terminal modified v/2018

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Source: https://parentingscience.com/potty-training-problems-prevention/

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