It was exactly a week after my son’s 4th birthday when he announced that he was going to use the potty exclusively to do his business.  He finally threw in the towel…and the diapers…on his own time, certainly not mine.  I had spent the better part of a year begging, pleading, bribing, cajoling, manipulating, and any and every other trick to get my very stubborn boy to use the toilet.  I pulled out all the stops from my pediatric training, and also fell into the toilet-training market trap and bought every book, toy, and video out there.  Why did it take him so long?  I have many theories, but the most likely answer seems be that he just finally had to decide he was going to do it.  What makes it difficult is when there is a “deadline” that’s not their own.  The good news is many daycares/preschools (including Head Start) do not require kids to be totally potty-trained.

Most youngsters are ready to potty-train somewhere between the ages of 18 months and 4 years.  They typically need to be able to recognize the signals telling them they need to go, communicate their need to go, and hold it until ready.  Once they have those physiologic and developmental skills, the rest is behavioral.  Depending on the unique characteristics and personality of your little one, the behavioral component can go anywhere from “easy” to, well… “drive you to Crazy Town.”

What are some of the behavioral obstacles to potty-training?  They can be numerous, but here’s some of the most common:

1.  Anxiety/Fear—Either they’ve had a painful experience (hard stool) or they’re worried that having a part of themselves go down a pipe with a loud “whoosh” means it’s possible something else could fall down there too. If there’s been constipation, try backing off on milk and having them eat more fruits and drink a little bit of apple juice to soften their stool.  You may even have to use a little laxative powder for awhile.  Polyethylene glycol (MiraLax or generic brands) powder draws more water into the stool to soften it up.  You can use 1-2 tsp in 4-6 oz of water/juice a day until stools are soft.  Once the stool is mushy again, it won’t take very long for them to feel like it won’t hurt anymore and you can try the potty again.  If there’s a fear of the toilet/flush itself, slowly introduce the potty beginning with a toddler potty seat.  Take them with you when you go, have them sit on the potty with their clothes/diaper on first, then have them flush the toilet with just toilet paper in it. You can also try having the potty in a more comforting area first, like the living room, and slowly move it closer to the bathroom. Tell them, “Your poop wants to go down the pipe and join the others down at the ‘Poop Party’.”  I know…but desperate times call for desperate measures people.
2. Loss of Control– For many toddlers, there may be a lot of change going on and running behind the couch to go in their diaper immediately after you sang five versus of the potty song might be the one thing they feel they can control.  New sibling?  Move to a bigger home?  Starting a new daycare or preschool? You can expect that any potty-training efforts will most likely be thwarted by change.  So, give them something besides their bodily functions to control. Provide positive reinforcement by letting them decide what rewards they get for going potty.  This will give your little control freak something to take charge of. Having a routine and schedule that is as predictable as possible for your toddler will help him/her settle into change.  
3.  Your Reaction- A dirty diaper should result in a stoic, emotionless parent who quickly changes their kid’s pants (Note: even negative, frustrating remarks are attention in the eyes of a child).  Your child’s effort on the potty should result in an engaging and happy parent offering a treat (M&M), prize (sticker), or fun activity (2 minutes on the smartphone). Lavish them with all kinds of attention.  Sometimes, telling a toddler that they can be a “big kid” might back fire.  They’re probably thinking, “I don’t want to be big, I just want to be the same as I am now!”
4. Just Not Interested/Too Busy—Many toddlers couldn’t care less whether they use the potty or not.  Frankly, it is much easier to just go in their diaper and wait for someone to notice.  Here’s where some peer pressure from others might help. Making them go at the same time as other kids, such as after meals and snacks (timed bathroom time) might result in something.  If they wake up dry from a nap, put them on the potty and see what happens.  Make it fun.  Training a boy in the summer can be easy when they can go outside!  Of course, then there’s teaching the proper social constraints of that male privilege (outside is okay when camping, not at Pioneer Park).

Whatever your potty-training battles may be, most parents win the war eventually.  The diapers go away, and then it’s on to the next behavioral challenge…

About
Michelle Pierson, MD

Hi! My name is Michelle Pierson and I am a wife, mom, and general pediatrician at the Billings Clinic. I am excited about this blog and the opportunity to reach out to parents in my hometown of Billings. Growing up here and raising my own kiddos in this community gives me some perspective on how we can take care of our children's health with the resources we have in the region. I get great joy from my family and job, and a good piece of chocolate cake! A good book and "cuddle time" with my kids on the couch rank up there pretty high too. View all posts by Michelle Pierson, MD