Sunday, November 7, 2010

Potty training

Questioner: Cindy

Subject: Potty training

Question: I have a 3 1/2 year old son who has been potty training for 7 months. He still doesn't tell us when he has to go, will poop right in his underwear because he can't tell me he needs a pull up. If I leave pull ups on him all the time he will pee in them all time--
If I keep him in underwear he will at least pee in the potty most of the time. I have backed off several times thinking he is not ready. I have tried every incentive trick in the book. He is ready to go to school in the fall but I am very concerned about sending him to an environment that insists he is trained.


Answer: Dear Anonymous:

This seems to be the most common question put out here on the site. I have several detailed responses in prior questions posed.

What really happens is the parents have an idea and so does society, of when a child needs to be potty trained. However, children have their own timeframes for doing things and they don't consult our ideas or pressures to conform before they decide when and were they will change their behavior. (I know this is not what you wanted to hear!).

The other thing to discuss is that often times we believe we have done everything possible to change their behavior and what really happens is we have tried several different approaches and then given up before the miracle happens! Behavior changes work like this....change the reward....reward consistently......the behavior gets worse.......consistently reward ........the behavior continues to get worse.......parent decides the reward is not working and changes tactics.........

Here is how behavior changes work..........rewards.....behavior gets worse.......reward.....behavior continues to get worse.......reward......behavior really gets worse.........reward........reward......suddenly behavior is drops off.......reward.....rarely behavior......reward.....behavior is rare.........

Think back what was the longest you tried your strategies....a week? two weeks? several months?

Sometimes we have to just give up and let them tell us when it is time. (This is my preference.) Truthfully, they are not having a problem with their behavior. It is us, because we are inconvenienced, tired of the mess, or need to conform to someone else' demands (like daycare, or school).

Because this is such a common request I did some research on google by entering in "how to potty train children."

This is the best result that I liked the most. (Fits with my approach and expertise.) There are other topics on potty training on the side of the article with links you should check out as well.

While most children show signs of physical readiness to begin using the toilet as toddlers, usually between 18 months and 3 years of age, not all children have the intellectual and/or psychological readiness to be potty trained at this age.

Signs of physical readiness can include your being able to tell when your child is about to urinate or have a bowel movement by his facial expressions, posture or by what he says, staying dry for at least 2 hours at a time, and having regular bowel movements.

Signs of intellectual and psychological readiness include being able to follow simple instructions and being cooperative, being uncomfortable with dirty diapers and wanting them to be changed, recognizing when he has a full bladder or needs to have a bowel movement, being able to tell you when he needs to urinate or have a bowel movement, asking to use the potty chair, or asking to wear regular underwear.

Things to avoid when toilet training your child, and help prevent resistance, are beginning during a stressful time or period of change in the family (moving, new baby, etc.), pushing your child too fast, and punishing mistakes (treat accidents and mistakes lightly). Be sure to go at your child's pace and show strong encouragement and praise when he is successful.

Even after he begins to use the potty, it is normal to have accidents and for him to regress or relapse at times and refuse to use the potty. The process of being fully potty trained, with your child recognizing when he has to go to the potty, physically goes to the bathroom and pulls down his pants, urinates or has a bowel movement in the potty, and dresses himself, can take time, often up to three to six months for most children. Having accidents or occasionally refusing to use the potty is normal and not considered resistance.

While it is recommended that you don't insist that he sits on the potty and you should be prepared to delay training if he shows resistance, at some point if his resistance to using the potty persists, especially after he is 3 -3 1/2 years old, then you should consider him resistant to potty training and you will need to change your methods.

Early on in the training, especially if your child is less than 3 - 3 1/2 years old, resistance should be treated by just discontinuing training for a few weeks or a month and then trying again. At this age (18 months to 3 years), resistance is usually because your child just isn't ready to begin training.

Potty training resistance usually occurs because your child has had a bad experience at some point during potty training, especially if he was started before he was intellectually or psychologically ready. Other times, especially with strong willed or stubborn children, it may have nothing to do with your technique or timing, and you may have done nothing wrong.

Reasons for developing a resistance to potty training can include:

being scared to sit on the potty chair

flushing the toilet may have scared him from wanting to sit on the toilet

being pushed too early or fast before he was ready

severe punishment for not using the potty or being forced to sit on the potty

inconsistent training, especially among different caregivers

he may have had a painful bowel movement from being constipated. If this is the case, treat his constipation and wait until he is having regular, soft bowel movements before you begin training again.

or he may just be stubborn and is involved in a power struggle with his parents and is using his control over where he has a bowel movement

he may enjoy the negative attention he gets from not using the potty or from having accidents

although rare, there are medical conditions that can make it difficult for your child to hold in or delay urinating or having a bowel movement. Discuss with your Pediatrician if there are any medical reasons why you may be having a hard time teaching your child to use potty, especially if he seems to have other delays in his development.

At this point, if your child is totally resistant to being potty trained, then it is best to just make him responsible for when he wants to use the toilet. This includes not punishing him for mistakes and not reminding him to use the potty. If he seems fearful, you can try and discuss calmly what it is about using the potty that scares him.

While you may get a lot of negative feedback from friends or family members about not being more aggressive with getting your child potty trained, you should be firm and let them know that you are working on it and remind them that not all children potty train at the same time.

In addition, it can be helpful if you:

establish a reward or incentive for using the potty. This should include lots of praise and attention when he uses the potty. It can also include a star or reward chart on which you child can place stickers whenever he uses the potty. After a certain number of days that he has stickers, then he can get a reward, such as toy, etc.

have your child be involved in changing himself when he wets or soils himself. This can include getting a new diaper, taking the dirty diaper off, cleaning himself (although he will probably need help after bowel movements), and throwing the dirty diaper away.

At some point you can change him into regular underwear. You can talk about it beforehand and maybe have a ceremony where he throws away the left over diapers or you may just decide not to buy any new ones. Now, when he does wet or soil himself, you can have him help to clean out his underwear in the sink or bathtub. You may even have him put them in the washing machine and wait with you while they are getting washed and dried. He should then dress himself. This method is not for everyone, but is usually very effective. You can also have him clean up after himself if he wet or soiled the floor.

Limit him to having BMs in the bathroom. This isn't always possible, but is easy if he always asks for a diaper just to have a bowel movement. Next, have him sit on the potty to have a bowel movement, even if he continues to wear his diaper. Then work on getting his diaper off by opening it and eventually taking it off. During this process, you should give lots of praise and rewards during each step.

If he is having a hard time learning to use the potty, but isn't necessarily resistant to the idea, then developing a regular daily routine of sitting on the potty for five or ten minutes every few hours may be helpful.

Most importantly, avoid physical punishment for not using the potty, even in an older child. It can be appropriate to verbally let him know that you disapprove of his not using the potty, but this should not get to the point of yelling, shaming or nagging.

Hope this helps you to know that boys are more of a challenge. I think biologically it is because they are built different and are not adverse to the mess as little girls seem to be.

Best Wishes!

M Kay Keller

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