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The Informed Parent

Potty Training…When To Start?

by Louis P. Theriot, M.D., F.A.A.P.
Published on Feb. 01, 1999
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Mrs. G. brought her 18 month old daughter in for her well check. As a young, first time mom, she had done a wonderful job in raising little Anna. Both mom and Anna always seemed so happy when they would come in for her visits. Mrs. G. always had her notes with her and was well prepared. She could almost anticipate my questions because she had done her homework so well.

This visit was different however. Mrs. G.'s grandmother (Anna's great grandmother) was with them. She was visiting from Italy, and in broken English was proud to tell me that she had raised 12 grandchildren and 8 great-grandchildren. She was the matriarch of the family, a sweet lady who was a throw back to the "old" country. Her wrinkled face could not hide the hard life that she had endured, and her tiny, seemingly frail frame, was deceptive for she was a strong and vibrant woman. I knew this when I shook her strong and sturdy hand.

I was surprised that Mrs. G. seemed so flustered when I started asking about Anna's developmental milestones. Everything seemed fine, Anna was developing right on tract for an 18 month old--yet something was clearly bothering mom. I asked if there were any questions before I examined Anna, and mom paused. She looked at me, and then at her grandmother, and then back at me. She reluctantly turned to her grandmother once again. She was sitting motionless with her wrinkled hands folded in her lap. She nodded her head once, as if to signal Mrs. G. to proceed. In Italian she told her, "Ask him!"

Mrs G. took a deep breath and said, "She wants to know why Anna is NOT potty trained. Back at home, ALL babies are potty trained by now...especially her grandkids". Obviously this was a bone of contention ever since she arrived from Italy. Mrs. G.'s entire household was up for grabs because of this very issue. There was much frustration and consternation.

When should a child be potty trained, and how? In the United States, most children are potty trained between the ages of 2 and 3 years. The bottom line however, is that it is a very individual thing. A child is ready, when he or she is ready. One thing is certain, if you push a child before they are ready, you will certainly prolong or delay the process. One study has shown that most children who start toilet training before 18 months of age are not completely toilet trained until after 4 years of age.

There is a lot of undue pressure nowadays to "get a child potty trained" so that they can go to day care or pre-school. If a child is not quite ready though, this can lead to frustration and tears on the part of the child...and the parents. It can also lead to a control issue that is disruptive to the entire household.

First and foremost, the child has to want to use the potty chair or toilet. They should initiate the process (not the parents), and it usually starts by them wanting to imitate a parent. This can start anywhere between 18 and 30 months. At this point, parents should be very receptive and encouraging to the idea, but they must keep the atmosphere relaxed and low key...almost a laissez-faire attitude. They should essentially follow the lead of the child. More times than not, the child will be curious and want to watch the family members of the same sex use the toilet. This is a good start.

The potty chair can be in the bathroom so that when they accompany mom or dad, they can sit on the chair while clothed, to get familiar and comfortable with it. Soon thereafter, the child will want to take off the diaper to be just like mom or dad. This is fine, although rarely does anything happen at first. There may be a number of false alarms, or "dry runs", these should just be taken in stride. It becomes a cute little game for the toddler, and is certain to favor a lot of attention.

Little boys usually learn to urinate while sitting as they use the potty chair. Later on, they will make the connection with standing up like dad or big brother. This may take time, just be patient. Remember, each child is different.

If the child is comfortable sitting in the potty chair, but doesn't yet know how to use it for a bowel movement, you might change the diaper while they are sitting in the chair. The contents of the diaper can be dumped in the pot, and then flushed down the toilet. It will eventually become apparent to the child that this is how it really is suppose to work.

It is important that the child is AWARE of the different sensations such as 1) having had a bowel movement 2) is having a bowel movement and 3) "I have to have a bowel movement. Usually when they have had a bowel movement, it is uncomfortable and smelly. They will walk wide based with a disgusted look on their face and pull at their diaper and say, "Ca ca!". In other words, please change this diaper. Next is the awareness that they are having a BM (bowel movement). They will stand there with a curious look on their face, or will turn beet red in the face as they strain as they say, "Ca ca". The tone of their voice leads one to conclude that they actually get the picture and make the connection. And finally is when they know that they are about to have a BM. They look at you with a surprised face and announce, "Ca ca", which means that they have to go NOW! Too often there is little warning and one has to get them to the potty chair and get the diaper off STAT.

If these awareness' are not there, it does little good to try to start to potty train. It will lead to frustration sand confusion for the child. It is important too, that once potty training has begun, parents and family members must downplay the accidents that are bound to occur. It is not just what the parent says, but the body language is critical as well. A child picks up on that look or frown of disappointment, or the under the breath muttering or complaining to a spouse. Parents must really take a low profile approach.

If parents are too regimented and take too much of the initiative before a child is ready, this can set the stage for the child to use the potty as a control issue. Some toddlers can really push their parents buttons and can be very manipulative regarding this. I have seen three year olds who have their parents all but jumping through hoops over potty training.

Once toilet training is well under way, if the child wants to transition to using the toilet be sure that they have a foot stool for them so that they can plant their feet for support and stabilization. It is also important for them so that they can fully use their abdominal muscles when they strain. This will make having bowel movements much easier.

As I was going through all of this with Mrs. G. , I figured that I wasn't making any points with her grandmother. Mrs. G. would translate to her in Italian. After each exchange, her grandmother would sit motionless and say nothing...her eyes would just dance back and forth between Mrs. G. and me. I started to get uncomfortable as I thought she wasn't buying anything I was telling her granddaughter. After all, it wasn't like this in the old country.

When we were finished, her grandmother started in. She rattled off a barrage of sentences in Italian with her hands moving energetically. I thought, oh boy, here it comes! Then with a big smile Mrs. G. said, "My grandmother said that you take good care of Anna, and that I should listen to her doctor and do exactly what you say!". Her grandmother then stuck out her hand and with a firm grip shook my hand. Whew!!!




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