The first step in toilet training is to make sure both you and your child are ready. Okay, I realize no one is ever really totally ready for toilet training. But your child should be at least developmentally and behaviorally ready. That means your heretofore untrained child should be at least 2 years old and be able to do such things as walk from room to room, raise and lower his or her own pants, sit independently, and follow a few one-step commands without raising a big fuss.
Children also should have some awareness of the need to urinate. So if they’re acting like they have ants in their pants but don’t, that’s usually a good sign they know, on some level, that they need to go. They should show the need only about five or six times a day. Your home life also should be fairly stable at this time (e.g., no home construction going on, in-laws who stay more than three days, major marital disputes, or other distractions).
Next, get a potty chair. Or, if you choose not to use a potty chair, get a stool your child can use while on the toilet. If you want to know why this is necessary, I suggest you try having a bowel movement while your feet are dangling above the bathroom floor. Much will be made clear to you. Comfort is a commodity that is hard to overrate when the task at hand involves having a bowel movement (regardless of the age of the bowel mover), and it’s hard to be comfortable when the person engaging in that task does not have good support for his or her feet. You also might consider purchasing an adaptor for the toilet seat that makes the seat child‑sized. One new adaptor on the market even has a stepladder attached. It is a relatively easy way for children to move up in the world.
Parents often are worried that their child will be afraid of falling in the toilet. There are no factual accounts of children (or adults) falling in. No one has ever admitted falling in. No one knows of someone who has fallen in. But the fear survives, resistant to history, facts, and outright logic. Let’s deal with it this way: It’s a parent fear, not a child fear (at least until it spreads from the parent to the child; it’s a very catchy fear). So it’s good to suppress this fear and remember that children are actually naturally curious about the toilet. They also usually enjoy flushing it over and over, which can lead to a different and more realistic fear for parents.
Also, be aware that long after your child is toilet trained, daytime wetting and soiling accidents will happen from time to time – and that’s the good news. The bad news is that bedwetting accidents are common all the way up to age 7, especially in boys. These continued accidents are merely God’s way of reminding you that procreative activity (i.e., sex) was supposed to be about having children and not having fun. They also can provide just the right amount of humility for your child. It’s hard to be too full of yourself when your pants are full of poop. If accidents do become a frequent problem, you should probably ask your child’s doctor about them. In general, try and remember that a child who is learning to use the toilet has to master many different skills and success does not come all at once. So give your child time and expect some accidents. After all, wouldn’t you rather be surprised than disappointed? Finally, try to remain calm and patient.
Now let’s get down to business. The letter P will figure powerfully in our plan. In fact, let’s call it:
The Seven P Potty Problem Prevention Plan
1. Parent modeling. Frequently allow your child to go with either you or your spouse to the bathroom. It’s like anything else; a smart kid can learn a lot by watching an expert. If you have some modesty about this, please park it for a while. After all, its just you and your child, and both of you have seen all there is to see, so to speak.
2. Potty chair. Give your child a chance to get used to and comfortable with the potty chair. Set it out and let your child sit on it, name it, put stickers on it, and pound his or her brother or sister for trying to sit on it.
3. Practice. Let your child practice using the potty chair. This practice should be "play" practice, with clothes on. Just remember to be prepared for what you might call “method acting.” In theatre, method acting involves actors actually experiencing the emotion they are trying to portray in the performance. In potty training, method acting involves actually eliminating during practice. True, there will be a mess, but hey, you’ve seen hundreds just like it and this one is a sign of good things to come. The next part may be difficult for some dads, but it’s only temporary, trust me. In the beginning, boys should be trained to sit on the potty chair or the toilet, for two reasons. First, sitting encourages bowel movements and so you might get a “twofer,” which is a bowel movement and urination during the same sitting. Second, sitting will help avoid what one might call the “garden hose” effect. Untrained boys have not yet had to stand, urinate, and aim all at the same time and may (will) accidentally spray the room (missing the potty or the toilet). So, if you can stand it, so to speak, boys should sit. Later, when toilet training is well established, they can stand.
4. Pampers and Pull-ups. Unfortunately for your child (but fortunately for your budget), to make the program work, your child must go “cold turkey” on Pampers and Pull-ups, except at bedtime. (Daytime and nighttime training programs should be separate, and while you are working on daytime training, it is fine to keep kids in Pampers or Pull-ups at night.) The reason for the cold-turkey approach is simple: Pampers and Pull-ups are actually wearable toilets, and your child is unlikely to see much need for using the one in your home when he or she can much more easily use the one he or she is wearing.
5. Prompting (Tell, don’t ask). As discussed in P #3, practice is important. Unfortunately, its importance will be much more apparent to you than to your child. In fact, let’s tell it like it is – he or she could probably care less. So you will need to prompt your child to go to the bathroom and sit for a few minutes multiple times a day. Tell, don’t ask. Asking very young children if they have to go to the bathroom is sort of like enrolling them in lying school. They will routinely say no, even if they are about to burst. But look at it from their point of view. When we ask, what children actually hear is something like, “Would you like to go and sit on a large, cold porcelain receptacle that is full of potty water and into which mommy and daddy are afraid you might fall?” You can see how the logical answer to this question is “no.” So instead of asking, just tell them it is time to go and then take them and have them sit. Then refer to P #6.
6. Praise. MCs at concerts often say something like, “Ladies and gentlemen, give it up for (name of the star, band, or act)” when urging a crowd to show its approval and excitement. Well, in a sense, I am the MC for toilet training, and I want to urge you to give it up for your little trainee. In the early stages of a training program, toileting behaviors are like little sprouts in a spring garden: Both need something to help them grow. For little sprouts, its water and fertilizer (so to speak). For toileting behaviors, praise and approval are the water and fertilizer that help them grow and blossom. So come on and give it up for the little poopers and pee-ers. Said differently, every time your child does any toileting behavior correctly – pulls down his or her pants, sits on the potty, whatever – be sure to praise him or her. Do this even when your child is having more accidents than successes. Remember, as children enter into the training phase, the training is likely to be way more important to you than it is to them. But if they get the idea that pooping and peeing into the potty is a way for them to get their names in lights, the importance of training will quickly increase for them, along with their cooperation. You can take this a step further and use rewards. One method I often use is to wrap little items – stickers, tiny toys, beads, gum, etc. – in tin foil and put them in jar near the bathroom. When the child achieves a success at any level, he or she gets to grab one prize (not one handful) from the jar. Praise and rewards make the training experience fulfilling, and make it more likely that children will repeat the positive toilet behaviors.
7. Postpone. Here in P #7 we have some really good news. You can always postpone. You can always put them back in Pampers or Pull-ups, declare a moratorium on any discussion about toileting for a few weeks or even months, and then start again. They will ultimately be motivated to be trained, possibly by something other than your prompting. For example, the rules of social life in childhood weigh heavily against toileting accidents in school-aged kids. In fact, research shows that having an accident in school is the third greatest child fear, behind the death of a parent and going blind. (And I know that high school kids frown on their peers who wear Pampers or Pull-ups.) So the point of P #7 is that if training is going badly, for whatever reason, you can use the time-honored method for winning a war that is being lost – declare victory and retreat.
Summary
Wait until your child is at least 2 years old.
Frequently allow your child to watch you go to the bathroom.
Make sure both you and your child are ready.
Let your child practice on a potty chair, with clothes on.
Prompt your child – tell, don’t ask
Postpone toilet training for a few weeks if it isn't going well or if you are getting tense about it.
Expect accidents.
If your child has a lot of accidents or if you must use intensive toilet training, ask your health care provider for the guidelines on positive practice.
Praise your child every time he or she does any part of toileting behavior correctly.
Wait! Before You Begin Toilet Training...
Many parents get nervous when they think about toilet training their young child. The folklore about toilet training may have a lot to do with their anxiety. For example, parents hear stories about children being toilet trained at six months of age. Those kinds of stories are ridiculous; a child who can't walk cannot possibly go to the toilet without help, which is what being toilet trained means. Or, a mother hears from relatives that as a child, she was easily trained and then never had an accident – day or night. Such folklore makes parents think there is some simple way – if only they knew it – to toilet train a child once and for all. No wonder parents question whether they or their child is up to the task of toilet training.
We’d like to help you get past these myths and misconceptions and give you some practical, common sense information that can help make potty training your child a more pleasant and satisfying experience.
Forget the Folklore
You can toilet train your child effectively and efficiently if you keep in mind some basic guidelines. Do these four things before you get started with potty training:
Relax. Toilet training is often the first task that parents take a strong stand on. Sure, it is important to you, but adding tension and pressure to the process will not make it any easier for you or your child. Remember, unlike eating, sleeping, and playing, there is no natural, immediate payoff for your child when he or she uses the toilet. Your child may not always cooperate with you during toilet training, but your tension will just make things worse. You know your child eventually will learn to use the toilet, so don't make it a contest of wills. Be calm and patient, and allow your child some time to get the idea.
Wait. Most children are toilet trained when they are 2, 3, or 4 years old. A few children are ready earlier, but just to be on the safe side, wait until your child is at least 2 years old.
Make sure you are ready. Do you really want to find out where the bathroom is in every store and restaurant you go to and on every highway and street you drive? Are you ready for potty interruptions all day long? Have the grandparents let up on their pressure about toilet training? (Remember, toilet training need not be a community affair. If you don't want to, you don't have to mention your child's efforts to anyone else, even grandparents.) Has the crisis at work passed? Is the household relatively stable now, and will it continue to be so for a few weeks? (Having other parts of your life running smoothly will help ease the chore of toilet training.)
Make sure your child is ready. If you are really ready to toilet train, see if your child is ready. Parents and others (grandma, aunt, friends) sometimes push toilet training before there are clear signs that the child is ready. Your child is not ready:
Just because he’s told you he wants to wear “big boy” pants.
Just because she wants the Big Wheel you promised as a reward.
Just because he or she has had some dry days playing on the potty chair. (Many children do this around 18 months of age.)
What Is Readiness?
Age: Your child should be at least 20 months old and preferably 2 years old or older.
Physical readiness: Your child should be able to pick up objects, lower and raise his or her pants, and walk from room to room easily.
Bladder readiness: Your child should already be staying dry for several hours at a time, urinating about four to six times a day, and completely emptying his or her bladder. If your child is still wetting a small amount frequently (7 to 10 times a day), you should wait.
Language readiness: Your child should understand your toileting words, words like "wet," "dry," "pants," and "bathroom." If your child does not understand what you are talking about, you should wait.
Instructional readiness: Your child should be able to understand simple instructions, such as "Come here, please" and "Sit down." Just as important, your child should be following the reasonable instructions you give. If your child opposes you much of the time and has frequent temper tantrums, you will probably have problems with toilet training.
Bladder and bowel awareness: Your child may indicate that he or she is aware of the need to void or eliminate. Children usually indicate this awareness not through words but through actions – making a face, assuming a special posture like squatting, or going to a certain location when they feel the urge to urinate or defecate. This may be a positive sign that your child is ready to begin toilet training.
Getting Your Child Ready
You can take some steps now that will help your child when, at some time in the future, you begin toilet training.
Let your child watch you. Your child can learn a lot about how to use the toilet correctly by watching a parent. Frequently let your child come with you when you go to the bathroom. Use simple words to explain what you are doing (for example, "Mommy is going peepee in the potty.").
Teach your child to raise and lower his or her pants. You can do this gradually when you are dressing or undressing your child. With your daughter, for example, you can first pull down her pants with little or no help from her. Then, do less pulling and let her do more. This process may take many weeks, but it is worthwhile. Later, when you begin toilet training, you will be glad that your child already knows how to pull down his or her pants and that you don’t have to tackle that learning task in addition to toilet training.
Help your child learn to follow your instructions. Make sure you have your child's attention when you give an instruction. Immediately praise your child if he or she does what you ask. If your child does not follow your instruction right away, gently guide him or her through what should be done, and do not give another instruction until the first one has been followed. If your child starts to cry, ignore the crying. When your child has calmed down, repeat your instruction. If you often have trouble getting your child to follow your instructions, ask your health care provider for guidelines on managing your child's behavior, or search the Girls and Boys Town Web site parenting.org for valuable help.
Set out a potty chair. A few weeks, or even months, before you think you will start toilet training, make a potty chair available to your child so that he or she can get used to it. Put it in the bathroom or in another room so your child has a chance to investigate it. Let your child get used to sitting on it, with clothes on. Encourage your son to sit on the potty (instead of standing in front of it) so that he will be used to sitting when you start toilet training. (Later on, when he is well past being toilet trained, he can stand.)
Praise your child. Every time your child does something the right way, be sure to let him or her know. Praise your child with words that are brief and to the point, such as "You did a good job pulling down your pants." Or, give your child a smile, a hug, or a kiss. This attention is how you teach your child what behavior pleases you.
Summary
By forgetting the folklore, following a few guidelines, getting yourself and your child ready, and preparing, toilet training should be easier for everyone involved. Just remember the things you can do before beginning to potty train:
Frequently let your child watch you go to the bathroom.
Teach your child to raise and lower his or her pants.
Teach your child to follow your instructions.
Make sure you are ready before you try to toilet train your child.
Make sure your child is ready.
Wait until your child is at least 2 years old.
Set out a potty chair so your child can get used to it.
Relax.
Praise your child every time he or she does any part of toileting behavior correctly.
We’d like to help you get past these myths and misconceptions and give you some practical, common sense information that can help make potty training your child a more pleasant and satisfying experience.
Forget the Folklore
You can toilet train your child effectively and efficiently if you keep in mind some basic guidelines. Do these four things before you get started with potty training:
Relax. Toilet training is often the first task that parents take a strong stand on. Sure, it is important to you, but adding tension and pressure to the process will not make it any easier for you or your child. Remember, unlike eating, sleeping, and playing, there is no natural, immediate payoff for your child when he or she uses the toilet. Your child may not always cooperate with you during toilet training, but your tension will just make things worse. You know your child eventually will learn to use the toilet, so don't make it a contest of wills. Be calm and patient, and allow your child some time to get the idea.
Wait. Most children are toilet trained when they are 2, 3, or 4 years old. A few children are ready earlier, but just to be on the safe side, wait until your child is at least 2 years old.
Make sure you are ready. Do you really want to find out where the bathroom is in every store and restaurant you go to and on every highway and street you drive? Are you ready for potty interruptions all day long? Have the grandparents let up on their pressure about toilet training? (Remember, toilet training need not be a community affair. If you don't want to, you don't have to mention your child's efforts to anyone else, even grandparents.) Has the crisis at work passed? Is the household relatively stable now, and will it continue to be so for a few weeks? (Having other parts of your life running smoothly will help ease the chore of toilet training.)
Make sure your child is ready. If you are really ready to toilet train, see if your child is ready. Parents and others (grandma, aunt, friends) sometimes push toilet training before there are clear signs that the child is ready. Your child is not ready:
Just because he’s told you he wants to wear “big boy” pants.
Just because she wants the Big Wheel you promised as a reward.
Just because he or she has had some dry days playing on the potty chair. (Many children do this around 18 months of age.)
What Is Readiness?
Age: Your child should be at least 20 months old and preferably 2 years old or older.
Physical readiness: Your child should be able to pick up objects, lower and raise his or her pants, and walk from room to room easily.
Bladder readiness: Your child should already be staying dry for several hours at a time, urinating about four to six times a day, and completely emptying his or her bladder. If your child is still wetting a small amount frequently (7 to 10 times a day), you should wait.
Language readiness: Your child should understand your toileting words, words like "wet," "dry," "pants," and "bathroom." If your child does not understand what you are talking about, you should wait.
Instructional readiness: Your child should be able to understand simple instructions, such as "Come here, please" and "Sit down." Just as important, your child should be following the reasonable instructions you give. If your child opposes you much of the time and has frequent temper tantrums, you will probably have problems with toilet training.
Bladder and bowel awareness: Your child may indicate that he or she is aware of the need to void or eliminate. Children usually indicate this awareness not through words but through actions – making a face, assuming a special posture like squatting, or going to a certain location when they feel the urge to urinate or defecate. This may be a positive sign that your child is ready to begin toilet training.
Getting Your Child Ready
You can take some steps now that will help your child when, at some time in the future, you begin toilet training.
Let your child watch you. Your child can learn a lot about how to use the toilet correctly by watching a parent. Frequently let your child come with you when you go to the bathroom. Use simple words to explain what you are doing (for example, "Mommy is going peepee in the potty.").
Teach your child to raise and lower his or her pants. You can do this gradually when you are dressing or undressing your child. With your daughter, for example, you can first pull down her pants with little or no help from her. Then, do less pulling and let her do more. This process may take many weeks, but it is worthwhile. Later, when you begin toilet training, you will be glad that your child already knows how to pull down his or her pants and that you don’t have to tackle that learning task in addition to toilet training.
Help your child learn to follow your instructions. Make sure you have your child's attention when you give an instruction. Immediately praise your child if he or she does what you ask. If your child does not follow your instruction right away, gently guide him or her through what should be done, and do not give another instruction until the first one has been followed. If your child starts to cry, ignore the crying. When your child has calmed down, repeat your instruction. If you often have trouble getting your child to follow your instructions, ask your health care provider for guidelines on managing your child's behavior, or search the Girls and Boys Town Web site parenting.org for valuable help.
Set out a potty chair. A few weeks, or even months, before you think you will start toilet training, make a potty chair available to your child so that he or she can get used to it. Put it in the bathroom or in another room so your child has a chance to investigate it. Let your child get used to sitting on it, with clothes on. Encourage your son to sit on the potty (instead of standing in front of it) so that he will be used to sitting when you start toilet training. (Later on, when he is well past being toilet trained, he can stand.)
Praise your child. Every time your child does something the right way, be sure to let him or her know. Praise your child with words that are brief and to the point, such as "You did a good job pulling down your pants." Or, give your child a smile, a hug, or a kiss. This attention is how you teach your child what behavior pleases you.
Summary
By forgetting the folklore, following a few guidelines, getting yourself and your child ready, and preparing, toilet training should be easier for everyone involved. Just remember the things you can do before beginning to potty train:
Frequently let your child watch you go to the bathroom.
Teach your child to raise and lower his or her pants.
Teach your child to follow your instructions.
Make sure you are ready before you try to toilet train your child.
Make sure your child is ready.
Wait until your child is at least 2 years old.
Set out a potty chair so your child can get used to it.
Relax.
Praise your child every time he or she does any part of toileting behavior correctly.
Abdominal Pain
Abdominal pain is very common in children, and it can be acute pain, meaning it happened all of a sudden, or it can be chronic or long term. You should not force a child with abdominal pain to eat, but you may encourage him to drink plenty of clear fluids. You should call your physician if pain lasts longer than three hours and is not improving or if you suspect that he may have appendicitis, an intestinal obstruction, strangulated hernia, or urinary tract infection.
Among the associated factors that can help determine the cause of abdominal pain include the presence of diarrhea, constipation, fever, and weight loss. The exact location of the pain can also be helpful, as well as how long the pain lasts, what makes it better (especially if you have been using over the counter medications) and what makes it worse.
Although often not necessary for most children with abdominal pain, testing may include plain xray (KUB), abdominal (and/or pelvic) ultrasound or CT scan, stool cultures (for parasites and bacteria), stool test for blood.
gastroenteritis: pain usually also accompanied by diarrhea and or vomiting.
appendicitis: continuous abdominal pain that moves to the lower right side and is followed by vomiting.
constipation: cramping lower abdominal pain, usually in a child with a history of having infrequent bowel movements
intestinal obstruction: a blockage of the intestines can cause severe pain and vomiting. Your child's vomiting may be bilious (dark green or yellow) and he will probably not be having bowel movements or passing gas. This is a medical emergency.
nonspecific or functional abdominal pain: chronic or recurrent abdominal pain in children without diarrhea, vomiting, constipation or weight loss. Pain is usually mild and centered around the belly button. It is usually not know what causes this type of pain, but it may be secondary to stress.
reflux: children with reflux may have a sour taste in their mouth and a burning substernal chest pain. The pain may be worse at night and after meals.
irritable bowel syndrome: Children with IBS have crampy abdominal pain and bowel movements that alternate between normal, constipation and diarrhea.
inguinal hernia: severe pain accompanied by a bulging in your child's groin or scrotum.
urinary tract infection: lower abdominal pain with fever and pain with urination.
food allergy (lactose intolerance): usually chronic pain that follows eating or drinking certain foods and is accompanied by bloating, gas and diarrhea.
ulcers: burning epigastric pain, usually worse before meals, at night and in the early morning. Children with ulcers usually also have vomiting and a family history of ulcers. They may also have blood in their stool. The pain may be relieved by antacids and by eating.
hepatitis: usually caused by viruses that cause inflammation in the liver. There are many viruses that can cause hepatitis, but the most common are Hepatitis A, B, and C. Symptoms include fatigue, pain in the right upper side of the abdomen, vomiting and jaundice.
celiac disease: with gas, chronic diarrhea, bloating, poor weight gain and recurrent abdominal pain
inflammatory bowel disease: Children with ulcerative colitis and Crohn disease diarrhea, usually with bleeding, cramping abdominal pain, obstruction (a blockage of the intestine), malabsorption (failure of the intestines to absorb minerals and nutrients), and weight loss or poor weight gain.
Other causes of abdominal pain can include a lower lobe pneumonia,
Gynecological causes of abdominal or pelvic pain can includ ovarian cysts, torision, ectopic pregnancy, and pelvic inflammatory disease. Also Mittelschmerz is a dull or cramping lower abdominal pain that occurs with ovulation (midcycle) and may last a few minutes to 6-8 hours
Among the associated factors that can help determine the cause of abdominal pain include the presence of diarrhea, constipation, fever, and weight loss. The exact location of the pain can also be helpful, as well as how long the pain lasts, what makes it better (especially if you have been using over the counter medications) and what makes it worse.
Although often not necessary for most children with abdominal pain, testing may include plain xray (KUB), abdominal (and/or pelvic) ultrasound or CT scan, stool cultures (for parasites and bacteria), stool test for blood.
gastroenteritis: pain usually also accompanied by diarrhea and or vomiting.
appendicitis: continuous abdominal pain that moves to the lower right side and is followed by vomiting.
constipation: cramping lower abdominal pain, usually in a child with a history of having infrequent bowel movements
intestinal obstruction: a blockage of the intestines can cause severe pain and vomiting. Your child's vomiting may be bilious (dark green or yellow) and he will probably not be having bowel movements or passing gas. This is a medical emergency.
nonspecific or functional abdominal pain: chronic or recurrent abdominal pain in children without diarrhea, vomiting, constipation or weight loss. Pain is usually mild and centered around the belly button. It is usually not know what causes this type of pain, but it may be secondary to stress.
reflux: children with reflux may have a sour taste in their mouth and a burning substernal chest pain. The pain may be worse at night and after meals.
irritable bowel syndrome: Children with IBS have crampy abdominal pain and bowel movements that alternate between normal, constipation and diarrhea.
inguinal hernia: severe pain accompanied by a bulging in your child's groin or scrotum.
urinary tract infection: lower abdominal pain with fever and pain with urination.
food allergy (lactose intolerance): usually chronic pain that follows eating or drinking certain foods and is accompanied by bloating, gas and diarrhea.
ulcers: burning epigastric pain, usually worse before meals, at night and in the early morning. Children with ulcers usually also have vomiting and a family history of ulcers. They may also have blood in their stool. The pain may be relieved by antacids and by eating.
hepatitis: usually caused by viruses that cause inflammation in the liver. There are many viruses that can cause hepatitis, but the most common are Hepatitis A, B, and C. Symptoms include fatigue, pain in the right upper side of the abdomen, vomiting and jaundice.
celiac disease: with gas, chronic diarrhea, bloating, poor weight gain and recurrent abdominal pain
inflammatory bowel disease: Children with ulcerative colitis and Crohn disease diarrhea, usually with bleeding, cramping abdominal pain, obstruction (a blockage of the intestine), malabsorption (failure of the intestines to absorb minerals and nutrients), and weight loss or poor weight gain.
Other causes of abdominal pain can include a lower lobe pneumonia,
Gynecological causes of abdominal or pelvic pain can includ ovarian cysts, torision, ectopic pregnancy, and pelvic inflammatory disease. Also Mittelschmerz is a dull or cramping lower abdominal pain that occurs with ovulation (midcycle) and may last a few minutes to 6-8 hours
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