Q: My son is almost three and refuses to use the toilet — he gets upset if we even suggest he try. Did we wait too long to start toilet training?
A: There’s no magic window when it comes to introducing the idea of toilet training, says Judy Arnall, a Calgary parent educator and author of Discipline Without Distress. “Most children just have their individual timetable, the same way some kids walk or talk sooner than others.” That said, boys tend to start a little later than girls, adds Alicia Szielasko, a psychologist in Halifax. But the worst thing a parent can do is try to push the idea on an unwilling child. “If your son doesn’t want anything to do with the potty, it’s best to just back off and wait,” she says. “When he gives you a sign he’s ready, only then is it time to try again.”
Q: My daughter has completely mastered toilet training at home, but refuses to go when we’re out (we’ve had a few accidents at the mall). She says the bathroom is loud and scary, and she won’t even go inside. What should we do?
A: An aversion to using unfamiliar public restrooms is common for kids, not to mention many adults. “To decrease that anxiety, make home a comfortable place, then maybe move on to Grandma’s, then the neighbours’ — and slowly work up to expanding her comfort zone,” says Anita Greig, a family doctor in Toronto.
The important thing is to help your daughter face her fears, instead of trying to rescue her by avoiding them, adds Alyson Schäfer, a psychotherapist in Toronto and author of Honey, I Wrecked the Kids. She recommends simply being supportive and doing what you can to make the situation less threatening. “If it’s the sound of public bathrooms in general or the loud flush that frightens her, teach her to put her hands over her ears or to hum the Happy Birthday song in her head.”
Q: It looked like things were going really well. Lately, though, our daughter has been having some accidents again. Is it normal for her to regress — seemingly for no reason?
A: Going from diapers to totally trained is a process that can take anywhere up to a year, with plenty of ups and downs along the way. Regression is normal, especially if a child is experiencing any kind of stress or change, such as the arrival of a new baby, moving house or starting school, says Szielasko. “If your daughter feels insecure about anything, even a minor disruption to her routine, she may begin having accidents again.”
This sudden change may simply mean a child is just not ready for whatever reason. She can be very into the whole training thing for a while because it’s fun and new, then suddenly stop — which can be pretty frustrating for parents, says Schäfer. It might help to know that other than the teen years, the toddler years are probably the most rebellious stage of a child’s life. “Most bathroom problems are not physiological, they’re interpersonal between the child and parent, like getting undue attention or creating a power struggle,” says Schäfer. “If she’s resisting in an attempt to assert her independence, the minute you take the pressure off is the minute she’ll likely stop resisting.”
If accidents start happening on a regular basis, try using cloth underpants instead of Pull-Ups. “Pull-Ups can become just an expensive diaper and sometimes kids need to feel the wet against their skin to tell them: Oops, I just had an accident,” Arnall says. Sweatpants or plastic underpants over cloth underwear can be helpful so that when accidents do happen, they’re a bit more contained.
There’s nothing wrong with putting her back in diapers for a few weeks or months until she’s ready to resume toilet training, says Greig. “She has been dry before, so she knows how nice it is. Just give her lots of support and gentle encouragement, and it will come back.” Try taking a one- to three-month break before trying again. “You can always reintroduce toilet training when she’s in a better space and at a more co-operative stage,” says Arnall.
Q: My son will pee in the toilet, but that’s it, and I’m worried that he will get constipated. How can we get him to have a bowel movement in the toilet too?
A: From a practical perspective, if you’re worried about constipation you can try increasing the fibre in your son’s diet as well as his water intake, so that his stools stay soft, says Schäfer. When it comes to being physically able to have a bowel movement on the toilet, she says, your son’s feet need to be planted firmly on the floor or on a stool. “If his feet are dangling over the edge, he can’t engage his pelvic floor muscles.”
Constipation can sometimes become a problem if your child feels pressure or anxiety around toilet training. And once he starts holding it, he can end up with an anal fissure when he finally does go — which can cause him to associate bowel movements with pain, meaning that he’ll start holding even more. “Because you want to avoid this at all costs, there has to be no pressure around the process,” Schäfer says. “We have to forget our own agendas, the preschool’s agendas, the grandparents’ agendas — this is the child’s job and we’re just the assistant. Period. We’re like poop doulas and we’re only there to provide support.”
If your son is already nervous about pooping in the toilet, it’s important to minimize discussions about it, especially if you find yourself constantly saying things like “Did you go? Did you go?” or “Honey, did he go when you had him?” Children overhear this and it can make them more anxious and resistant, Schäfer says. Look at the underlying reason for your son’s reluctance and try to address it without making it a big issue.
Q: How do I know when my son is ready to try toilet training?
A: One sign that your son might be ready to ditch his diapers is if he remains relatively dry after a two-hour nap, or if he shows you he’s aware of the fact he’s about to go (and not just that he already went). “There’s no sense inviting him to the toilet until you see some kind of holding, like doing the pee-pee dance, which shows he’s figured out those muscles,” says Schäfer. “Children need to develop that physical sensation and awareness of having to pee to be successful at toilet training.”
Once you think your son might be ready, start introducing him to the idea slowly. Let him watch you in the bathroom, buy a potty and pick up a children’s potty-training book. Letting him just sit on the toilet (clothed or otherwise) for a minute or two before bath time will help make it part of the routine and seem less scary. “Make it relaxed and fun,” Schäfer says. And don’t rush it, she adds. “Research shows that, often, the earlier you start, the later you’ll finish.”
Q: Daytime dryness is no problem for our four-year-old daughter, but nighttime is a different story. Is there anything we can do to help her stay dry at night?
A: Nighttime dryness can remain elusive for months or even years after a child has successfully mastered staying dry during the day, says Greig. “Some children are just really deep sleepers, while others’ bladders take longer to mature.” To avoid emergency bedding changes in the wee hours, try keeping drinks to a minimum a few hours before bedtime and make sure your daughter empties her bladder completely before tucking her in. Some parents, when they go to bed themselves, will also wake their children so they can squeeze in one last trip to the bathroom.
You can also try “lifting” your child — a process that involves waking her every night around 3 a.m. for an additional trek to the toilet. “But it can take months or years for nighttime dryness; you have to decide whether you’re willing to get up at 3 a.m. for that length of time,” says Greig.
A simple plastic sheet under the bedsheet might be the most convenient alternative for all concerned. You can also keep your daughter in a diaper at night, but encourage her to use the toilet if she has to and let her know it’s OK to call for help.