Toilet Training

There is no set age to start or finish toilet training. All children are a little different. However, most children can be toilet trained by age 4. The important thing is to do what is best for your child.  

WHEN TO START

Children do not have control of their bladder or bowel movements before the age of 1. They may be ready for toilet training anywhere between 18 months and 3 years of age. Signs that your child may be ready include:

  • The child stays dry for at least 2 hours during the day.

  • The child is uncomfortable in dirty diapers.

  • The child starts asking for diaper changes.

  • The child becomes interested in the potty chair. The child might ask to use the potty. The child might want to wear "big-kid" underwear.

  • The child can walk to the bathroom.

  • The child can pull his or her pants up and down.

  • The child can follow directions.

THINGS TO CONSIDER WHEN TOILET TRAINING

Toilet training takes time and energy. When your child seems ready, spend time each day on toilet training. Do not start toilet trainng if there are big changes going on in your life. It may be best to wait until things settle down before you start.

  • Before starting, make sure you have:

  • A potty chair.

  • An over-the-toilet seat.

  • A small step ladder for the toilet.

  • Children's books about toilet training.

  • Toys or books your child can use while on the potty chair or toilet. 

  • Training pants.

  • Learn the signs that your child is having a bowel movement. The child might squat or grunt. There might be a certain look on the child's face.

  • When you and your child are ready, try this method:

  • Help the child get comfortable with the bathroom. Let the child see urine and stool in the toilet. Remove stool from their diapers and let them flush it.

  • Help the child get comfortable with the potty chair. At first, children should sit on the potty chair with their clothes on, read a book, or play with a toy. Tell the child that this is his or her own chair. Encourage the child to sit on it. Do not force the child to do this.

  • Keep a routine. Always have the potty in the same location and follow the same sequence of actions, including wiping and handwashing.

  • Make regular trips to the potty chair the first thing in the morning, after meals, before naps, and every few hours throughout the day. You may even want to travel with a potty in the car for emergencies. 

  • Most children will have a bowel movement at least once a day. This usually happens about an hour after eating. Stay with the child while he or she is on the potty. You might read to, or play with the child. This helps make potty time a good experience.

  • Once the child starts using the potty successfully, try the over-the-toilet seat. Let the child climb the small step ladder to get to the seat. Do not force the child to use this seat.

  • It is easier for boys to first learn to urinate in the seated position. As they improve, they can be encouraged to urinate standing up. You may even play games such as using cereal pieces as target practice.   

  • While potty training, remember:

  • It helps to keep the child in clothes that are easy to put on and take off.

  • The use of disposable training pants is controversial. They may be helpful if the child no longer needs diapers but still has accidents. However, they may also delay the training process.

  • Do not say bad things about the child's bowel movements such as "stinky" or "dirty." Children may think you are saying bad things about them or may feel embarrassed.

  • Stay positive. Do not punish the child for accidents. Do not criticize your child if he or she does not want to potty train.

  • If your child attends day care, you may want to discuss your toilet training plan with them as they may be able to reinforce the training.

POSSIBLE PROBLEMS

  • Urinary tract infection. This can happen because of holding or from leaking urine. Girls get these infections more often than boys. The child may have pain when urinating.

  • Bedwetting. This is common even after a child is toilet trained. It happens more with boys than girls. It is not considered to be a medical problem. If your child is still wetting the bed after age 6, discuss it with your child's medical caregiver.

  • Toilet training regression. If a new infant is brought into the family, children that were previously toilet trained will sometime return to pre-toilet training behavior as a way to get attention.

  • Constipation. This happens when children fight the urge to go. It is called holding. If a child keeps doing this, he or she may become constipated. This is when the stool is hard, dry, and difficult to pass. If this happens, talk to the child's caregiver. Possible solutions include:

  • Medication to make the bowel movements softer.

  • Making trips to the potty chair more often.

  • Diet changes. The child may need to take in more fluids and more fiber.

SEEK MEDICAL CARE IF:

  • Your child has pain when he or she urinates or has a bowel movement.

  • Your child's urine flow is abnormal.

  • Your child does not have a normal, soft bowel movement every day.

  • You toilet trained your child for 6 months but have had no success.

  • Your child is not toilet trained by age 4.

FOR MORE INFORMATION

American Academy of Family Medicine: www.familydoctor.org/online/famdocen/home/children/parents/toilet/179.html 

American Academy of Pediatrics: www.aap.org/publiced/BR_ToiletTrain.htm

University of Michigan Health System: www.med.umich.edu/yourchild/topics/toilet.htm