Posts for: March, 2013
Potty Training: A synopsis for parents
In pediatric practices across the country, the delicate issue of potty training becomes a theme at preventive health visits typically around the 18th month visit. This period is fraught a good number of developmental changes and milestone acquisition in the toddler.
We frequently encounter children and parents for whom the transition to independent bowel and urinary sphincter control is more challenging than most, here’s a quick outline of steps to successful toilet training culled from the Zuckerman and Parker textbook of Developmental and Behavioral Pediatrics, 3rd ed. that will help.
· Buy a potty. Place it in a conspicuous location and colorfully emphasize its importance and purpose using the child’s (and yours) terms for urination and defecation. The whole activity should be fun themed to sustain the toddler’s motivation.
· Allow the child to familiarize and sit on the potty for about 5min a couple of times daily, typically after meals. This ideally should be about 30 min after a meal, to catch the reflex that propels contents of the colon down the intestines for evacuation. Loose fitting underpants (not diapers) are especially useful during these times. Do not force the child – remember!
· Move to have the child do the above without underpants on after the child is well acquainted with the potty. Proceed to move the potty from its conspicuous location closer to the bathroom gradually.
· Encourage the toddler to watch older kids and parents access the bathroom to reinforce the expected behavior. Involving the child in the process of flushing and participating in throwing the stool from the soiled diaper or potty into the toilet and waving ‘bye-bye” to the excreta is a great idea, as it reinforces the perception as to where the stool really belongs. Make it a fun activity to the extent possible.
· Ask child during daytime, “Do you want to go potty?” to help child familiarize with bodily and sphincter sensations. Observe closely for signs of impending urination or defecation and help in disrobing and sprint to the potty. Continually praise success and avoid criticizing failure
· Reinforce positive features of potty training to child (e.g., “just like a big boy.”)
· With the onset of a semi-consistent pattern of daytime control, involve the child in the process of giving up the diaper “like a big boy/girl” and make a show of disposing them in the garbage and wave the bye-bye to them.
· Once training with the potty is well advanced, try an over-the-toilet-seat chair
· Nighttime control happens a few months after daytime typically and remember to involve the child in the decision to try underpants at night.
There is no cookbook approach to this big developmental leap, and the above outline is a guide. Childhood temperament, social and cultural circumstances and pressure from day care centers affect the process of toilet training in many ways outside the scope of this post. The overwhelming caveats are to remember, this is not a contest. It has a number of false starts with ample successes and relapses. The toddler needs to be empowered to take responsibility for attaining the skill and the tendency to transmit a sense of disgust to the toddler should be resisted. The preferred approach to toilet training widely used in the USA is the “child-centered” approach described by Brazelton in 1962. There are cultures where potty training is attained at much earlier ages than expected in our society and we must be cautious in comparing standards since there are other factors not mentioned above that influence social and cultural norms and expectations.