Potty Training Problems

by Belinda Chou, MD

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You are in the midst of toilet training. Things appear to be going relatively well. Your child appears to understand when she needs to use the potty, and is using it with some regularity. However, there's just one thing...

Problem #1: Your child is toilet trained at daycare/preschool but refuses to use the toilet at home.

This can be particularly frustrating for parents, as you know that your child can do it, but is just refusing to do it at home. Interestingly, I have found that this tends to occur in younger children (closer to 2 years of age), hence it may be more of a maturational issue.

Things to keep in mind:

• Your child may be feeling little to no pressure at school/daycare to use the potty as it may be merely “part of the routine” (all the children go to the bathroom at the same time so your child is not singled out).
• Copying what other kids do (or better yet, the older kids) is terrific incentive for a child, as opposed to parental pressure.
• As frustrating as it may be, kids will sometimes do things for teachers they won’t do for parents (i.e. they know which buttons they can push in whom!).

So what's a parent to do? Here are some things to try:

• Depending on your child’s age, level of language ability, and developmental level (i.e. a child closer to 3 years of age or older), it may be worthwhile trying to discuss this with your child. Keep it neutral and without pressure (“That’s so wonderful you are using the potty at school, your potty is here waiting when you are ready to use it at home”).
• Discussions with daycare providers/teachers may also shed light on the problem (What is their routine? what do they say or do with the children?).
• But most importantly, in this situation, especially if your child is closer to the age of two years, mere patience and backing off will frequently do the trick. Your child has taken a big step in using the potty at daycare. For whatever reason, s/he may not be ready to use the potty at home. You know s/he is capable, it’s just a mindset to get over. If there is no pressure on your part, your child will come around eventually.

Problem #2: Your child is completely urine trained. However, she continues to refuse to use the potty for bowel movements and specifically requests a diaper when she needs to have a bowel movement.

This problem is not all that unusual, and it may be attributed to either a fear of having a bowel movement in the toilet, the security of a diaper, or a coordination issue.

Things to try:

• Again, being patient and backing off may be your best bet, especially if your child is on the younger side (less than three years of age).
• If ongoing for several months, now may be the time to take some parental initiative. As per Dr. Iannelli’s article (Toilet Training Resistance), now may be the time to have the child go to the bathroom for bowel movements, gradually have the child sit on the potty with a diaper on, and eventually take it off to have a bowel movement. For those children who the diaper seems to lend much security, some experts even recommend cutting a hole in the diaper and allowing the child to wear the diaper on the potty, but having the BM go into the toilet.
• If you notice that your child always stands to have a bowel movement, posture may be more the issue than the security of the diaper. Focus on having your child stand (or whatever transitional stance s/he needs)over the potty and then gradually go to sitting. In one particular example, a mother told me that she let her child be naked from waist down and allowed him to run back and forth to the bathroom, essentially allowing him to experiment with different stances, until he was able to have a bowel movement sitting on the potty. She found that once he was successful sitting on the potty, he was able to do it subsequently.

Problem #3: You know that your child can use the potty, but she is being very erratic and staying motivated seems to be the problem.

Here is a situation where you may want to consider offering rewards for using the potty.

On the pro side:

• Experts and parents alike have found rewards to be helpful.
• It is frequently the incentive your child needs to get started (or to stay motivated).

On the down side:

• Other experts discourage use of rewards for behavior, as they feel that the child should be motivated from within to use the potty.
• Some children may not clearly understand and want a reward when unearned. This may cause more trouble than it’s worth.
• Candy, a very powerful and frequently used motivator, is the worst reward. Not only is it problematic with dental care, but it may also interfere with meals; and it is not uncommon to have a child peeing a drop of urine every 5 minutes for a candy treat.
• Certain children may prove stubborn (or should I say resilient) enough and prolong the reward system for months.
• Some children no matter what you try, will not be enticed by stickers, small toys or other rewards.

Conclusions:

• Rewards do work for some, but not all children.
• Keep rewards tangible and simple (i.e. 10 stickers to get a small prize may be too many for some children).
• If a child does not understand or is easily frustrated by the reward system you create, it’s best to not use it.
• For the sake of your child’s teeth and dietary habits, don’t use candy!
• Know when to end it. When mastery is achieved, it’s time to stop the rewards. Frequently kids lose interest as their mastery of toilet training occurs and you may have no trouble. Others may hang on. Sometimes in a very stubborn child one can trade the reward chart/system for one “final toy”.

Final words on toilet training (as it is onward to Sibling issues for my next series of articles): Patience and Perspective! I know I sound like a broken record, but it is true, your child will not be in diapers forever, and patience is a necessary component on the parent’s part. Also, it’s good to keep perspective when you hit a stumbling point: this is just a small snag and your child will be toilet trained.

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Important disclaimer: The information on keepkidshealthy.com is for educational purposes only and should not be considered to be medical advice. It is not meant to replace the advice of the physician who cares for your child. All medical advice and information should be considered to be incomplete without a physical exam, which is not possible without a visit to your doctor.