Potty Training

The question of when and how best to potty train a child can raise many different answers within a family.  Contemporary theories on potty training are based on child-oriented, gradual training.  The skills needed for a child to successfully toilet train generally develop after the age of 18 months at the earliest, most children are closer to 2 ½ - 3 years old.

Signs of readiness include: being able to walk and undress; being able to indicate when he or she is stooling or urinating then being able to recognize the urge to go before "it" happens; expressing interest in the potty or imitating toileting behaviors.

1. Is a 2 year old who is dry overnight ready to toilet train?

Being dry overnight is not really related to readiness to toilet train.  It is probably secondary to a large capacity bladder or low evening fluid intake.  A mature "bladder-brain " reflex awakens a child during sleep when the bladder is full.  The child must then arouse fully and get to the bathroom.  A mature 2-year-old could be ready for this, but if she has no interest when she is already awake, I think I would leave her in a diaper for now.

A diaper will not encourage nighttime laziness in a child who is ready to stay dry.  It will save midnight pajama and bedding changes due to accidents.

2. My child has been potty trained for over a year, but is still bed-wetting.  Is there any such a thing as "nighttime potty training?"

Bed-wetting is usually the result of immaturity of the so-called "bladder-brain" reflex mentioned above.  Many children are very heavy sleepers.  They do not arouse for a full bladder, which will eventually spontaneously contract and empty.

Even wet p.j.'s and bedding will not awaken some children until they move into a lighter stage of sleep and realize that they are cold and wet.  Others are afraid of getting up alone at night. 

Most children will grow into nighttime dryness by the time they are seven years old.  Please talk to your pediatrician if your child is seven and still wetting the bed.  Strategies to promote nighttime dryness include no fluid intake after 6:30 p.m., ensuring that the child empties her bladder before bedtime and having a night light on in the hall and the bathroom. 
Periodic nighttime arousal to void by a parent may help a child learn to arouse with a full bladder.  Use of "wee alarms" is controversial, but successful for some motivated families.

3. My child will pee in the potty but refuses to have b.m.'s in the potty.  Is that normal?

Yes, most children will toilet train more readily for urine than for stool.  There are several factors to consider.  The most important thing is passing a soft stool on a regular basis.  It really does not matter in the short run if that happens on the potty or in a diaper.

If a child is underwear all day for urine but asks for a diaper to stool that is a big achievement and deserves positive reinforcement.  A child who has large, hard stools may be experiencing some pain with the process.  Your pediatrician can make recommendations on rectifying that problem. 

Some children are afraid of the splash or noise of a toilet; others are distressed by seeing a product of their body being flushed away.  If the process of stooling on the potty becomes a battle, the parent will lose. Back off for awhile, show that you do not care and then they are ready.   Most children learn by the age of 3 years to hold their stool till it is convenient for them to go (most prefer to be at home to poop whether in the potty or a diaper).  This is assuming the child does not have problems with chronic constipation.

Using positive reinforcement to reward stooling on the toilet when the child is ready can be effective.  Collecting stickers to attain a better prize is popular.  The more often a child uses the toilet, the more rapidly they will collect their 3 or 5 stickers for a better toy. Once over the initial resistance to use the toilet, they rarely regress.  If the child prefers to take a diaper, one is given with little commentary.

4. How should one coordinate toilet training around life changes, such as a new baby ?

When to facilitate the potty training process, depends on when your child is showing signs of readiness.  If the child perceives the above changes as stressful, they will likely not be showing signs of readiness.  The time it takes for a child to acclimate to life changes depends on the child's temperament as well as the family's response to the changes.