You're trying not to worry, but your child's third birthday is behind him -- and maybe his fourth or fifth -- and he's still in diapers. Don't despair. Learning to use the toilet is a skill much like learning to tie shoes or ride a bicycle, and it poses a different set of challenges for each child. Here are seven common problems and strategies for solving them.
My child refuses to use the toilet.
If your child seems genuinely uninterested in learning to use the toilet, he may not be ready to take on this challenge. To find out, answer these questions:
1. Does your child know what a toilet is for?
2. Does he like to come into the bathroom with you?
3. Can he stay dry for at least two hours at a time?
4. Can he follow simple instructions, such as those for washing hands?
5. Does he recognize at least a few moments ahead of time that he's about to go? (He may grimace, squat suddenly, grab his crotch, or run from the room.)
6. Can he get on and off the toilet without help?
7. Does he understand the meaning of the words wet and dry?
If you answered no to one or more of these questions, drop the issue for a while. Toilet training is most successful if done according to the child's own schedule. If you answered yes to all seven questions, your child is developmentally ready to start, but fear or nervousness may be holding him back.
My child is ready to use the potty but seems scared.
Your child probably wants to learn as much as you want him to, but he may feel intimidated. He may also have become self-conscious about using the toilet if many of his friends at daycare or school already know how. Here are some ways to generate enthusiasm:
- Foster your child's natural independence. Children want to feel grown-up, and not being toilet-trained yet probably makes your child feel just the opposite. Support his impulse toward self-reliance by telling him that he's a big boy now and free to use the toilet whenever he wants. If he's in daycare or school, ask his teachers to let him go to the bathroom by himself if he can do so reliably.
- Get him cool underpants. Take him shopping for big-kid underwear decorated with his favorite movie hero or theme. Link these directly to toilet use: "Kids who use the potty get to wear cool underpants."
- Offer incentives. Show your child how much you value his efforts to learn by putting up a calendar and placing shiny stars on the appropriate day each time he uses the toilet. Or reward dry days with a big-kid treat such as an extra bedtime story, a favorite video, or an after-dinner walk to the park. Some parents swear by the candy method -- rewarding successful trips to the toilet with M&Ms or other treats. But this approach can backfire, giving rise to a power struggle, as some kids become intensely focused on the sweets.
- Use toilet targets. For boys, learning to pee standing up is great fun when they have something to aim at. Put some Cheerios in the toilet bowl, and show your child how to sink them.
Toilet training has become a battle.
Your child won't use the toilet for the same reason he refuses to take a bath or go to bed: He's experimenting with limits and autonomy. Your job is to keep your child's limit-testing from turning into a power struggle, because he will win -- it's his body, after all. Follow these steps to defuse the issue.
- Back off. Tell your child he's a big boy now, old enough to take charge of learning to use the toilet. From now on, it's his responsibility; you're not going to bother him about it.
- Resist reminding. Frequent repetitions of "Don't you need to go potty?" can make your child feel corralled and manipulated. Instead, whenever possible, put a potty chair in a central location and let him run around bottomless, so he can use it at the spur of the moment without any help.
- Lighten up. Enforced potty-sitting ("Let's wait a little longer and see if anything comes out ...") may sow the seeds of rebellion. If your child sits for a moment, then jumps up to play, bite your tongue; the result may be an accident, but it's just as likely that he'll hop back on the potty when he feels the need.
- Be calm about accidents. Overreacting can make your child fearful of having them, stirring up anxiety about the whole process. Reassure your child that it's perfectly okay to have an accident from time to time. Meanwhile do whatever you need to do for your own peace of mind, whether it's removing your favorite rug or spreading out layers of towels. No matter how frustrated you get, don't punish your child for having an accident, as this can lead to long-term resistance.
- Reward good behavior with your attention. Break the resistance cycle by giving your child attention when he does use the potty instead of when he doesn't. Don't mention the toilet until your child surprises you by using it (he will, eventually). Then make all the hoopla you want.
My child won't have a bowel movement in the toilet.
If your child pees in the potty without problems but resists using it for BMs, he's probably fearful of making a mess -- maybe he had a bowel movement accident at school and people overreacted, or maybe he witnessed another child having such an accident. Helping your child successfully have a BM in the potty and then heaping him with praise can go a long way toward overcoming his fears. If your child is fairly regular, make note of the times he usually has a BM and try to make sure he's near a potty then; you'll need to get his daycare provider or preschool teacher in on the plan as well. You might also try giving your child a special reward, such as a small toy or a bedtime video, for having a bowel movement in the potty. Another slightly wacky trick is to make tiny little "poops" out of brown clay and pretend that a favorite stuffed animal is pooping into the toilet.
If his focus on bowel movements is derailing his toilet training, however, you can put him back in diapers any time he's about to have a BM. (He'll have to let you know when it's imminent.) This makes a good interim solution for some children.
My child won't use the toilet at daycare or school.
Start by finding out everything you can about the bathroom routine at his center; something about the procedure may be confusing him. If the teachers are taking the children in groups and your child likes his privacy, ask them to let him go by himself. Or it may be the toilet itself. If your child is having trouble making the switch from his potty chair at home to a built-in toilet at daycare or school, try buying a second potty chair and keeping it in the center's bathroom.
My child was toilet-trained, then started having accidents again.
Has there has been a big change in his life -- a new sibling, a move to a different home, a change of school? If so, his regression is a natural reaction and it's probably best to wait until things settle down to resume toilet training. Even seemingly small changes -- switching from a crib to a bed or joining a soccer team -- can rattle a child. Don't make him feel bad about having accidents, and avoid getting into a power struggle. If he's still making it to the potty most of the time, just stay the course and clean up the accidents without comment. However, if he directly asks for a return to diapers, don't make an issue of it. Put him back in diapers for a few weeks or until he expresses an interest in using the toilet again.
My child isn't having BMs as often as it seems he should.
Sometimes a child becomes so fearful about having a bowel movement in the toilet -- or about not making it to the toilet -- that he begins to hold in his BMs. While many children do this for a brief period without harm, you definitely don't want him to keep it up for long. Withholding bowel movements can stretch the wall of the intestine, weakening the sensation of needing to go and causing long-term complications with toilet training. Refusing to poop also can lead to constipation, which in turn makes bowel movements more uncomfortable, or even painful, causing your child to continue to hold back.
If you suspect that your child is getting caught in this cycle, consult his pediatrician. The doctor will probably recommend that you keep a record of your child's BMs to get a better sense of the problem and that you adjust his diet to lessen the constipation by increasing the amount of water he drinks and adding prune juice, pear nectar, or fiber. If he continues to be constipated, your pediatrician will probably suggest using a laxative such as mineral oil (1 tablespoon for each year of age a day, given by mouth) for several weeks to get him on a regular elimination schedule.
Address your child's anxiety, too, by talking to him about the universality of bodily functions. A great tool for this is the book Everyone Poops, by Taro Gomi, which may help your child understand that having a bowel movement is natural, not shameful.
American Academy of Pediatrics. Toilet Training. http://www.aap.org/healthtopics/toilettraining.cfm
Zweiback, Meg. Keys to Toilet Training, Second Edition. Barron's Educational Series. 2009.
American Academy of Pediatrics. Caring for Your Baby and Young Child: Birth to Age Five. 2009. Bantam Books.
American Academy of Family Physicians. Evaluation and Treatment of Constipation in Infants and Children. February 2006. http://www.aafp.org/afp/20060201/469.html
National Guideline Clearinghouse. Functional Constipation and Soiling in Children. May 2007. http://www.guideline.gov/content.aspx?id=13432