Patience and understanding really pays

Toilet training is an issue that vexes parents, pediatricians, child psychologists, and the poor little kids the most! It starts with whether one should, If so, when? Moreover, once started, how much to enforce it? Additionally, there is so much conflicting advice coming at the poor, harried parents from all sides (everybody has an opinion – from the maid to the mother-in-law, and each one is on a different trajectory).

So let us try and approach this scientifically, well, at least what we know as science. What is the natural evolution of control of bladder and bowel?

Most children achieve bowel control at the same time as daytime bladder control. Now the time taken to achieve bladder control varies depending on the cultural background, how much time the parents can invest in helping the child achieve control, and how one defines toilet training. The most stringent definitions require the child to be continent for both urine and stool, both at night and day. The more acceptable definitions are when they are continent of urine during the day or when they can express their need to eliminate, whether or not they do so independently.

Ethnic and cultural factors have a great say in deciding when parents toilet train their kids. E.g., the Digo people in East Africa begin toilet training their infants during the first weeks of life and are continuously in contact with the child. The caregiver learns to recognize subtle cues given by the infant before elimination. They achieve stooling and urination on command by the time the child is four to five months old. Contrast this within the United States, where parents do not even begin toilet training until the child reaches two years of age.

There is a complex system that regulates bladder and bowel control in humans. Suffice to say that the system starts maturing around nine months and is complete by 18 months. So there is no point in starting toilet training before the age of twelve months.

I think, in the end, economic factors and the time that one can spend with the child that matters the most. Suppose you can afford diapers (in May 2021, at the time of the revision of this article, on a discount online site, medium size diapers were available for less than ten rupees apiece! if one bought 60 at a time). Most Indians cannot afford this and also cannot afford ambulatory children soiling the floor all over the place. So Indians, in general, tend to start toilet training around one year of age, give or take a few months.

Is my child ready?

Developmental Skills

• Do not start unless the child is ready – How do you know the child is ready? He should be able to:
  • Walk to the toilet
  • Sit up on the toilet
  • Stay dry for several hours or wake up dry after a nap
  • Pull clothes up and down
  • Follow simple instructions
  • Communicate the need to go to the toilet
  • Demonstrate independence by saying “no.”
  • Show interest in toilet training.
  • Express a desire to please (give gifts, enjoy praise)
  • Imitate adults and older children

Preparing yourself

• At least one parent has to allow enough time and commitment for at least 3 months – this can be difficult, and you may need to take leave from the office in turn to achieve this.
• All caregivers should be on the same page and work in cooperation and with understanding. It is quite easy to come back from a hard day at work and lose your cool if your child again has had a stool accident.
• No punishments. Reward-based methods only are recommended. Punishing is counter-productive and can lead to psychological disturbances later on in life.
• Setbacks are common! Don’t think that just because your child was dry through the day today, she will remain dry from now on! And just because a child has an accident because he was immersed in play or other activity does not mean he is doing it on purpose and is defying you.
• Be prepared for additional laundry – Accidents are common
• Some don’ts
  • Delay toilet training if additional stress factor like
    • Expecting another child
    • Moving house
    • You are putting the child in daycare
  • Do not compare your child to others – no tournaments here!
• Have reasonable expectations and time-frames
  • Girls achieve control earlier than boys
  • First-born children take longer
  • At least six months to achieve day time dryness (usually stool and urine control take the same time)
  • Nighttime urine control may take months to years longer (88% of all kids achieve nighttime control by five and half years of age.

How to start toilet training?

Change diapers frequently

The child should see and feel the advantage of remaining dry

Use the right words and language to describe the process

Do not use words like dirty, stinky, or wrinkle up your nose. Just be a matter of fact and refer to body parts and urine and stool. Many parents like to use the word bathroom or toilet to describe passing stools or urine interchangeably. This can confuse the child. In our native language, we have clear-cut differentiation like सुसु, छीछी, or शी. These are natural bodily functions. There is no need to teach your child that somehow they are dirty or to be ashamed of.

The training process

• Get a potty chair
  • Take your child to buy his chair – let him choose his favorite color
  • Decorate it and write your child’s name on it and let him be in charge of it. Please keep it clean, of course
• Do not try to make the child sit on an Indian-style latrine or the toilet seat as it frightens them. They feel that they will fall into the toilet!
• Keep the potty either in the child’s room or next to his eating area initially and then move it closer to just outside the toilet and then within the toilet.
• Finally, he graduates onto a child seat on the adult toilet.
• Make child sit initially fully clothed on the seat and read out an illustrated book on toilet training or show him the Elmo video on toilet training.
• Make the child sit on the potty first thing in the morning or after a meal when he is most likely to have a motion or pass urine.
• Next, encourage the child to sit on the potty without a diaper and reward him with words, hugs, and appreciation every time he obliges by pooing or peeing in the potty.
• Dispose off the result in the toilet bowl in his presence, flush, and use words like gone and now clean.
• Wash your hands and your child’s hands with soap and water and dry thoroughly.
• Do not shout/punish/threaten/speak harshly if he has an accident.
• If he seems to be mastering it, don’t be in a hurry to move him out of diapers.
• Please keep him in thick, cotton, washable clothes for a few weeks more so that there is no big mess in case of an accident.
• Boys should initially be trained to pass urine sitting and, once mastered, then standing on the toilet bowl.
• If a child is not making progress, stop training for a few days and then restart. Remember, persistence pays but not an obsession.
• To help – you can help him watch other kids or you using the toilet so that he can learn to imitate and try to emulate.

Problems associated with toilet training process

Temporary setbacks

• Commonly encountered
• Remind the child to sit on the potty after waking up, after a meal, while playing, and before going to bed or on a long trip.
• These are especially common if the child is temporarily ill.
• If there are problems even after the child is four years of age you should contact your pediatrician

Bedwetting

This is not considered a problem till five and half years of age. If he continues to wet his bed at night after that, then look at our page on bedwetting.