Potty Training

Many factors come into play when your child decides it’s time to potty train. Be sure you’re prepared when nature calls!

BY DWAIN HEBDA

Being a parent does a lot of things to a person. It can bring you out of your shell, tax your energy and creativity, rob you of sleep and grace you with patience and strength you didn’t know you had. Most of all, it forces you to be comfortable in subject matter that rarely finds a home in polite conservation.

Body waste, for example, is a topic that doesn’t usually find a hospitable place in casual conversation. But for any parent navigating the process of potty training, it’s no problem. In fact, they’ll tell you, at no other time in your life will you celebrate urination as when your toddler finally masters the art of using the toilet.

The reason for this is simple: After the teeth come in and the bottle goes away and walking and talking are old hat, the next landmark on most early childhood horizons is potty training. And, just like those other achievements, many parents obsess over when, how and how fast their little one gets the hang of answering nature’s call, especially if it comes a little later than in other families.

This is generally much ado about nothing, said Stephen Canon, chief of the pediatric urology division and medical director for Arkansas Children’s Medical Group in Little Rock.

“I would say, in general, the age at which kids potty train is probably a little later than it used to be, in part related to the quality of diapers nowadays,” he said. “I think kids don’t sense being wet nearly as much as they did years ago. I think that has an impact. But, in general, around age 2 to 3 would be the right timing.”

According to the Mayo Clinic, parents are generally more uptight about the timing of potty training than the child, which is exactly backward and can actually hinder a child’s learning to use the toilet properly and on time. Kids will indicate their readiness in different ways; maybe they got curious about the potty chair at daycare or perhaps they want “big kid” underwear like an older sibling. Conversely, a disruptive life event such as a move or the arrival of a new baby can delay their wanting to learn. Experts say once the child shows a willingness to learn, it’s important that parents devote the time and special attention necessary to capitalize on that interest, even if that means providing some demonstration. “Once they’ve shown an interest, one thing we encourage that does have probably the greatest impact is the child observing the parent of the same sex urinating, to be able to see how it works,” Canon said. “Then, once they’ve seen that, I tell families if they have a two- or three-day period the most effective way is to take them to the toilet every 20 minutes until they go and when they go, you throw a party. Usually, if they’re ready, that’s when they’ll figure it out.”

Canon cautions that even when such success has been attained, parents should be prepared for sporadic accidents for a time. These are fairly common up through about age 4, so it’s important not to overreact or fail to keep things positive.

“They’ll still continue to void a little more frequently than they will when they’re older, and they’ll have some intermittent accidents depending upon the child,” Canon said. “Some kids are completely dry the first time they go, but I’d say in general that would be the exception. We really have to focus on positive reinforcement and no negative reinforcement.”

All personal differences in children aside, there can be underlying medical conditions that can interfere with successful potty training, Canon said.

“If they reach age 4 and they’re not continent most of the time, then they need to come see us in pediatric urology,” he said. “At that point, it might be an anatomic problem and usually that’s when their primary care doctors are referring them on to us.”

“If a child is not continent at night by age 5, that’s usually when we start calling it enuresis. Nighttime accidents are typically independent of the daytime function, although it can be a byproduct of daytime problems.”

Bedwetting can also be a symptom of larger issues such as stress, being bullied, having difficulty at a new school or, in extreme cases, some kind of abuse. Canon said part of the urologist’s job is to first distinguish between medical cases and those signaling a larger psychological issue.

“When we see kids who are having problems, we first want to figure out whether or not there’s anything going on at daytime,” he said. “For instance, if they have daytime urinary incontinence or if they have significant daytime urinary urgency and frequency, then that can be representative of a different underlying etiology that can spill over into the nighttime. You really have to address that first before addressing the nighttime problems.

“An important distinction to make is if patients have been wet at night for most nights all their life. If you see a child who’s 8 and they were dry for two years and then all of a sudden they’re wet at night again, then we would call that secondary enuresis. That’s an important distinction because secondary enuresis is most often associated with a psychological stress.”

Canon said for medical conditions there are several medicinal and non pharmaceutical treatment options, with the former generally reserved for children older than 6. He said families should not feel self-conscious about seeking help.

“There are great options to help manage the problem for the child’s best interest and the family’s benefit,” he said. “Definitely don’t hesitate to seek the care of your primary care doctor and even a pediatric urology team to get the child some help.”

Get This Potty Started

How do you know if your child is ready for potty training? There’s no universal sign, but the following are some good questions to ask yourself. Remember, there’s really nothing doctors would consider an issue until around age 4. Until then, ask yourself:

Can your child walk to and sit on a toilet?

Can your child pull down his or her pants and pull them up again?

Can your child stay dry for up to two hours?

Can your child understand and follow basic directions?

Can your child communicate when he or she needs to go?

Does your child seem interested in using the toilet or wearing "big-kid" underwear?

Answering mostly “yes” to these questions might suggest your child may be ready to potty train. Answering mostly “no” might suggest you wait, especially if you’re heading into a major life event such as moving or a new baby in the house.

Source: mayoclinic.org