Flush with success: solving toilet-training problems

"Emilie peed and pooed on the potty last weekend!" her mom exclaimed at daycare Monday morning. "That's great!" I replied, enthusiastic about their progress. But I couldn't help feeling a little concerned too. My daughter, Bronwyn, who was not quite two at the time, had shown interest in the potty for only one thing: As a place to have books read to her while she enjoyed the freedom of being naked from the waist down. Bronwyn's little friend was taking to toilet training — why wasn't she?

In retrospect, the answer is obvious: Regardless of my ambitions for Bronwyn, using the potty was low on her personal list of Things to Do Today.

"Toilet training is a very important milestone for the parents, and it's a very not important milestone for the child," explains Fabian Gorodzinsky, a London, Ont., paediatrician with 25 years' experience, and author of the Canadian Paediatric Society (CPS) statement on toilet learning. For maximum success and minimum frustration for both parent and child, the CPS recommends holding off until your little one demonstrates he's ready and willing. If he stays dry for several hours between diaper changes, and can tell you when he's just urinated or had a bowel movement, those are your signs to introduce the potty.

Read more: Funniest potty-training stories ever>

Of course, training doesn't happen overnight. Sometimes early successes belie difficulties weeks or months down the road. And sometimes the process can become downright traumatic for everyone involved. Questions about potty training are among the most common on Todaysparent.com — and for those of you who've asked, help is at hand. We consulted a panel of early childhood specialists from across the country and distilled their best tips into a quick Q & A format. Read on for their answers to your toileting troubles.

Read more: Bathroom basics: A little routine goes a long way>

Q: My 21-month-old daughter opens the lid of her potty and tells me "pee-pee" and "poo," but she will only sit on it when she is clothed. I take her to the bathroom every time I go, but she won't do it herself. I have tried letting her run around the house naked and catching her just before she needs to go, but as soon as I get her to the potty, she stiffens up like a board! What can I do?

A: Sounds as if she isn't ready yet. Child development professionals say most kids gain control over their bladder and bowel functions between the ages of 18 months and four years — that's a wide range, and your daughter is at the lower end of it. Take a break for a month or two, then try introducing the potty again. At the beginning, it's OK if all she does is sit on it for a few minutes fully clothed. Once she gives it a warmer reception, invite her to sit on the potty without a diaper several times a day, at specific times she is likely to go (first thing in the morning, after lunch, before and after naps, before bedtime). With patience and praise from you, she'll start to pee or poo during these regular potty visits before long.

Q: My three-year-old son pees in the potty, but not just once: He goes several times in small amounts. I am using pull-ups to deal with this. I ask him every five minutes if he needs to go, but he says no and seems to be annoyed with my asking over and over again. Is it possible that he just isn't ready?

A: Of course he's annoyed — wouldn't you be? Rather than continually asking whether he has to go, which allows him to say no, calmly tell him at the same specific times each day, "It's time to go potty!" Then encourage him to stay seated, maybe by reading a story or singing a song he likes, until he has completely emptied his bladder. This will help him feel the difference between a full and an empty bladder, and discourage his multiple trips.

Q: My 3½-year-old son has been peeing in the potty since he was just over two. He also goes to bed without a diaper and stays dry all night. But he refuses to poo on the potty — he will ask for a diaper to poo in.

A: His asking for a diaper before a BM indicates he has enough bowel control to make it to the potty. So the issue here isn't readiness — but it could be one of comfort. Becoming constipated even once is often all it takes to turn a kid off the idea of pooping on the toilet or in the potty. Wearing a diaper allows him to stand in a corner and bear down in private and on his own time. So what can you do to make diaperless BMs more comfortable for your little guy?

• Make sure there is plenty of support for his feet and buttocks (this, in turn, supports the muscles in his abdomen to help with pushing). A low potty where he can plant his feet firmly on the floor is best, but if you're sitting him on the toilet, use a child seat insert, so he feels safe and stable, and place a stool under his feet for support.

• Watch his diet. Offer plenty of stool-softening foods, such as whole-grain breads and cereals, fibre-rich fruit and vegetables, and water to wash it all down. Limit binding foods like milk, rice and bananas.

It could also be that your son has gotten into the groove of a bad routine. In other words, he insists on going in a diaper because he's always been given a diaper to make bowel movements in. Wean him away from the habit by establishing a new BM routine that involves the potty. Rather than caving to his request for a diaper, invite him to use the potty in a positive way at specific times each day and give positive reinforcement by praising him when he has success.

Q: With our second baby due in January, should we continue trying to potty train our three-year-old daughter? I am wondering whether she'll simply regress when her brother comes along.

A: If you've seen some progress on the potty, stopping cold at this point would be a mistake. Consistency is an effective tool in toilet learning, so your best move right now is to keep at it. After the baby comes home, you may see a few more accidents, or even a full-out potty strike. In that case, you might take a break from training for a month or so while your daughter gets used to having her new brother around. When you feel the time is right, reintroduce training as a special activity only she — and not the new baby — can do with you. It's a wonderful opportunity to lavish attention on your first-born.

Q: Although he still wakes up wet every morning, my 33-month-old son has told me he doesn't want to wear his nighttime diaper anymore. I'm not sure how to go about nighttime training — should I begin waking him up nightly to go to the bathroom?

A: Before you take the drastic step of messing with his — and your — good night's sleep, try getting him into a bedtime potty routine. Avoid big drinks after dinner and make sure he empties his bladder immediately before sleep. (Do offer him plenty to drink earlier in the day to ensure he isn't going to bed thirsty.) These steps may help him stay dry through the night, and let you both say goodbye to the nighttime diaper.

Some parents swear by this method. But if it doesn't work for you, don't worry. Many children need a nighttime diaper until past their fourth birthdays, either because they sleep too soundly to make it to the bathroom during the night, or they haven't developed the ability to stay dry until morning. Your son is reluctant to wear a diaper at night, but perhaps he'd accept a pull-up that looks like "big boy" underwear.

Q: Although it's only been a few days since we introduced the potty, our daughter is basically accident-free, including naps, if we encourage her to go about every two hours. But she rarely does so on her own and will have an accident if we don't initiate a trip to the potty. By setting a toileting schedule for my daughter, am I teaching her anything?

A: Absolutely! By reminding her to go to the potty, you're establishing a routine and showing her how big girls pee and poo without a diaper. You can build up her confidence and set her on the path to initiating these trips on her own by praising her every time she has a successful trip. For the future, keep in mind that even children who've nailed toileting sometimes need to be prompted if they're reluctant to leave a fun activity or their environment is really stimulating.

Q: Are there different methods for potty teaching boys versus girls?

A: While most of the basics are the same, especially at the beginning, potty training is a little more complicated with a boy. That's partly because of the plumbing. A little guy has to not only make it to the potty on time, but also aim his penis in the right direction and (gulp!) possibly deal with an erection. And if he also has to do number two, there's the added worry of having to finish peeing, then switch to a sitting position. So much to think about!

If your son has been watching Dad stand up to pee, you might be inclined to start him off that way too. However, he'll have an easier time if you begin by inviting him to sit on a low potty the same as you would his sister. Reminding him to lean forward slightly and hold his penis pointing down will help reduce "misses" — though if he does overshoot, reassure him this is a normal part of learning and talk about some positive steps you can take together to help him master this new skill.

Once your fella has had some success, you can try guiding him through the move from potty to toilet, and from sitting to standing too. Toss in a few pieces of floating cereal as targets, which will encourage him to aim into the toilet (instead of the bathroom floor!).

Q: Is it normal for my four-year-old daughter to not be totally potty trained?

A: It is unusual for a child to begin kindergarten in diapers or pull-ups. If you've been consistent, gentle and generous with your praise for her potty successes, a trip to the doctor is in order to rule out medical causes.

Q: My boyfriend's four-year-old son stays with us two nights a week and every second weekend. Those weekends used to be fun, but now we're all stressed out because potty training is not going well: When we sit him on the toilet, he says he doesn't have to go — but minutes later, we've got a poopy bum. We've tried disciplining him with time outs and taking his favourite things away when he has an accident, but nothing, and I mean nothing, seems to be working. His mother says that he poops on the toilet when he's at home with her, at daycare and at her parents' home. What can we do to help him?

A: The first thing you and your boyfriend need to do is stop punishing the boy when he has an accident. It doesn't work. In fact, it will make training take even longer as your boyfriend's son grows more and more resistant to the process. More importantly, the punishments will hinder his relationship with his father and you.

Because he's having success at his mother's house, you and your boyfriend need to find out what she's doing, then do the same in your home. Given that his parents are separated, this may be awkward or difficult, but communicating with his mom is absolutely worth the effort in terms of how it will help the little boy's progress.

Finally, take a long, hard look at your overall relationship with him. It could be that he is intentionally having "accidents" to gain attention from his father and you. Children often feel jealous or left out when a divorced parent starts a relationship with someone new. If that's the case with your boyfriend's son, he may have decided that negative attention, even in the form of punishment, is better than no attention at all. So help him to feel included in your world by doing things as a trio — play games with him, hug him, talk with him. As his stress level decreases and his confidence increases, you'll see improvements on the potty as well.

Q: My three-year-old daughter is now holding her urine for hours at a time. Even if she goes to bed with a full bladder, she wakes up dry. Occasionally, she will sit on the toilet for me and release, but this is rare — usually she holds it until she cannot hold it any longer. When she finally does go, if she isn't on the potty, her pull-up overflows. I am afraid she is going to cause herself damage. Is there anything I can do? Am I just making things worse by encouraging he to pee on the potty?

A: Holding urine for long stretches can cause urinary tract infections, particularly in a girl, because her urethra — the tube that transports urine from inside to outside her body — is much shorter than a boy's. Some time-honoured inducements to try in the bathroom:

• Turn on the taps. Often the trickling sound of water encourages the release of urine.

• Offer plenty of water. If she's drinking a lot, your daughter will have to pee more often, whether in a diaper or on the potty.

• Make sure she's comfortable. Kids will withhold if they feel wobbly on an adult-sized toilet or poorly designed potty.

Meanwhile, take her in to see her doctor. She may be withholding because she already has a urinary tract infection, and peeing is so painful that she tries to do it as seldom as possible.

Q: My daughter has been potty training over the past two months. She is doing great at daycare and never comes home with wet pants. Once at home, though, it's another story. Most days I pick her up from daycare around 4:30, and before she goes to bed at 7:30, I've changed her out of wet pants about three times. I don't know how to encourage her to use the toilet at home.

A: It's very common for young children to do well in one environment (in your daughter's case, daycare) but not so much in another (home). The success your daughter is seeing at daycare is likely the result of a strong routine, with potty visits adhered to at the same specific times each day. If the daycare you use is typical, her caregivers aren't waiting for her to tell them she needs to pee (at this early stage, it's unreasonable to expect her to do so). Instead, they suggest in a positive way that it's time for a potty visit, thus heading off wet-pants syndrome. The fact that your daughter is peeing in the same room and at the same time as her little classmates would be a further inducement to full co-operation: Potty time is party time for toddlers in daycare!

While you may not be able to recreate the group potty action your daughter enjoys, you can encourage her to visit the potty at the same times each afternoon and evening at home. Be consistent, and you'll find that she's much more willing to play along with you too.

Our panel
Fabian Gorodzinsky, community paediatrician, associate professor of paediatrics, University of Western Ontario in London and author of the Canadian Paediatric Society statement on toilet learning.

Scott Cowley, early childhood education teacher, Centennial College Labschool Childcare Centre in Toronto.

Jane Scott, infant development program consultant and supervisor, Surrey-White Rock Infant Development Programme in BC.

Michaela Wooldridge, infant development consultant, Surrey-White Rock Infant Development Programme in BC.