As a general pediatrician, parents often seek my professional opinion regarding development and expectations. For successful potty training, I generally offer an expected range of between 2 and 3 years. The fact is, in the United States, the community often frowns upon diapered kids beyond age 3. In some parts of the world, kids are expected to successfully toilet train at just 1 year of age.
Do we have it wrong in this country? Are some of our parents waiting too late?
The answer depends on whom you ask. I decided to turn to a few experts in pediatrics to review opinions in the medical community. Initially, I was surprised that one urologist, Dr. Steve Hodges, expressed very clearly that he feels we, in fact, potty train too early in this country. In his opinion our desire for potty training bragging rights has led to an increased incidence of potty and voiding problems. He contends that the culture of this country, with many working parents and a heavy reliance on child care outside of the home, disallows the supervision required to successfully potty train a toddler without creating some degree of “holding” behavior.
It is well accepted in medicine that holding behavior sometimes leads to voiding dysfunction, urinary tract infections (UTIs), encopresis (poop accidents), chronic constipation, etc. So how long should a parent wait to potty train? Dr. Hodges contends that few children are ready for potty training before age 3.
When I was first introduced to Dr. Hodges’ concept of holding potty training off until age 3 or 4, I thought, “Here we go with some extremist point of view. I am not OK with a 4 year old in a diaper.” And I’m still not OK with that. Instead of just shooting from the hip as I sometimes do, I decided to research more and read articles that he has written backing this opinion. (It’s kind of like watching the Presidential Debates. You pretty much know who your candidate is, but figure you just have to look to reaffirm what you have already come up with.)
I found that he does have some good points and most of them are centered around the risk of developing holding behavior.
- Children, although physically capable of holding, may actually overuse this capability in an effort to continue their daily activities. (Who wants to stop watching Dora to run to the potty? Not me!) This creates bladder thickening and the bladder become less sensitive and sometimes leaks (wetting accidents). The same applies to stool holding.
- The American diet, unfortunately, is low in fiber which predisposes children to large, firm stools. To avoid a painful stool, kids will hold. It is, therefore, unfair to impose the potty training expectations of another culture and diet on our own.
- Daycare and preschool often have a restrictive bathroom policy, placing all children on a schedule that is not their own. That fact, along with an unfamiliar (and sometimes unsanitary) bathroom environment, is often enough to encourage holding amongst tots.
Next, I turned to Dr. Barton Schmitt’s article in Contemporary Pediatrics. He gives a complete timeline for potty training that directly counters the previous opinion. Read below:
- Potty training with good results takes 3-6 months on average.
- Preparation for toilet training should begin at about 18 months with teaching potty vocabulary and how the body works.
- At 21 months, begin teaching about the potty and toilet. Dump poop from the diapers into the toilet. Give the child a potty chair and allow the child to observe a parent or older sibling.
- At 2 years, begin using toilet-learning books, videos, or a pretend potty training partner (a doll or stuffed animal).
- Delaying toilet training after 30 months may have disadvantages: child has become very comfortable with diapers, is more capable to testing adults, dislikes the change, etc.
So, what do I think? Here are my conclusions:
- Potty training is a process that must begin with preparation. A child must have the needed vocabulary and motor skills to make it to a restroom. For many children, successful training can start and finish before the third birthday. If your child is behind the developmental curve, adjust the expectation and focus on the readiness aspect.
- If your child is in daycare or any school before age 6, there must be very clear communication of the restroom policy and expectations between the parents and staff.
- It is difficult to potty train a constipated kid. Handle that issue first before you push the potty training issue too far. (Hint: Dr. Hodges says you kids poop should look like hummus. Great visual, right?)
- And finally, if your kid can aim an Angry Bird on his own Ipad with the precision of a military sharpshooter — well, it goes without saying!