Adapted from the Canadian Paediatric Society Position Statement. Toilet learning: Anticipatory guidance with a child-oriented approach (2018)
First, keep in mind is that there is no specific age at which toilet training should begin. Rather than focusing on a certain age, parents and caregivers should watch for signs that the child is developmentally ready. A child must be physically able and emotionally ready to use a potty. This means that children need certain motor, social and language skills before toilet training will be successful. For most children, this happens sometime between the ages of two to three, but it could be earlier or later depending on the child.
Watching for the signs (see sidebar) takes some of the guesswork out of recognizing when a child is ready to begin. Usually it takes a child between three to six months to learn. Caregivers must also be ready to start the training. At least one adult must be able to dedicate daily time during this period. Do not start potty training while your family is in the middle of a stressful period. Moving, divorce, or adding a new sibling are already stressful times for families. Adding the stress of potty training may be a recipe for disaster.
It can help to make toilet training a regular part of your day. Children do well with structured routines, as they can anticipate events. Encourage them to use the toilet each day when waking up in the morning and after naps, as well as before meals and before bed.
Going through each step (see sidebar) during every attempt at using the potty can reinforce the needed actions. Children tend to do better with a small potty chair instead of a seat that sits on the regular toilet. They feel more secure and stable on the small seat. As well, it provides the right angle for elimination, especially stooling, if they can put their feet firmly on the floor. This is why it is better to first teach little boys to sit while passing urine. Once they are comfortable having a bowel movement on the potty, they can transition to standing while peeing.
Caregivers should make the process as positive as possible. Encouragement and praise tends to work better than offering material items or rewards. Punishment such as taking things away (negative reinforcement) may turn the child off the training process and is not recommended.
Families experience common challenges with training. Be prepared for accidents. Take an extra set of clothes and underwear in the car or a bag when leaving the house. Keep your child in loose, easy-to-remove clothing for easy undressing and dressing. Stay positive and avoid battles over toilet training.
If your child begins refusing to use the potty, take a break for a few months. Often, nothing is medically wrong. Your child may just not be ready yet. Do not force the issue as this can damage the relationship, harm your child’s self-image, and make toilet training harder in the future.
Urinating in a potty tends to be easier than having a bowel movement for many children. If switching to underpants is not successful, offer a diaper without shaming your child. It is better to have a bowel movement in a diaper to avoid constipation. Constipation will make training more difficult. If having a bowel movement is painful, children may hold their stool to avoid the pain. Unfortunately, this can lead to a vicious cycle as holding stool worsens constipation. Urinary tract infections can also cause problems. The signs include cloudy urine, new accidents, pain with peeing, or having to urinate more often.
Talk to your doctor if your child:
It is not uncommon for children to remain wet at night for many months or years after they have mastered daytime dryness. Up to 20 per cent of five-year olds and 10 per cent of six-year olds are still wet at night. Bedwetting can be caused by deep sleeping, a small bladder, or even constipation if the bowels are pushing on the bladder. It also tends to run in families. Generally it is not caused by a medical problem, especially if the child has ‘always’ been wet and has never gone more than six months dry at night. If your child begins to wet the bed again after being dry for more than six months, talk to your doctor.
Bedwetting usually does not require treatment and improves with age. If it begins to affect your child’s self-esteem or ability to attend social events such as sleepovers, your doctor may be able to help. The two mainstays of treatment include bed alarms and medications.
Rest assured that when your child is ready, toilet training will happen. If you suspect a medical issue, schedule an appointment. Your doctor can discuss various options for treatment, and whether other investigations are required.