Learning to Use the Toilet

Toilet training is a process that involves the body and the mind.

• First, children need to be aware of their own bladder and bowel signals. They need to learn when their bodies are signaling them that it's time to urinate or have a movement. In general, children show signs of bladder and bowel control between 18 and 24 months of age.

• Second, children need to learn how to use the toilet. Children must be able to understand instructions and follow them. For instance, they have to be able to sit or stand comfortably. They have to be able to pull down their pants and underpants, as well as pull them back up.

• Third, once children have bladder and bowel control and they know how to use the toilet, they need to be willing to use it. Toilet training struggles happen when children choose not to use the toilet. It's important to remember that children can succeed at using the toilet but in their own time.

When to Start Toilet Training

Toilet training may come up during children's 18-month, 2-year, 2½-year, and 3-year well-child visits. The average age toilet training begins in the United States is between 2 and 3 years of age. Most children in the United States are bowel and bladder trained by 4 years of age. However, toilet training can begin as soon as parents and children want to start.

In general, here are signs a child may be developmentally ready to begin the toilet training process. If you have any questions or concerns, talk with your child's doctor.

• Is dry at least 2 hours at a time during the day or is dry after naps

• Shows signs they are about to pee or poop, like grunting, freezing, or squatting

• Can follow simple instructions

• Can walk to and from the bathroom and help undress themselves

• Does not like to be in wet diapers and wants to be changed

• Asks to use the toilet or potty-chair

• Asks to wear "big-kid" underwear

Toilet Training Tips

Here are toilet training tips to help start the process. Parents can help empower their children to be in control of their own toilet training.

• Keep the process positive. Choose the words your family will use to describe body parts, urine, and bowel movements. Avoid words that are negative, like dirty, naughty, or stinky.

• Pick a potty-chair. A potty-chair is a child-sized seat with an opening in the seat and a removable container underneath to collect pee and poop. Children's feet should be able to reach the floor. Books or toys for "potty time" may help make this time more fun.

• Be a role model. Let your children see you use the toilet and wash your hands afterward.

• Know the signs. When your children feel the urge to poop, you might notice grunting, squatting, or freezing. Children's faces may turn red while pooping. Explain briefly to your children that these signs mean a poop is about to come. If your children tell you about a wet diaper, praise them for "using their words." It may take longer for children to notice the need to pee than the need to poop.

• Think of toilet training as toilet mastery. Invite your child to take over their toileting. Talk with them about how they will now be in charge of their pee and poop. Read children's books about using the toilet to help the process make sense and seem inviting and exciting. When you start the process, try to turn as much of the care of toileting as possible over to your child. Remember, if parents are in charge, there is less room for children to step in and take charge.

• Make trips to the potty-chair a routine. Routines are important, and practicing the steps is helpful. Make a habit of seating your children onto the potty-chair first thing in the morning. Boys can urinate by sitting down first and can stand up to urinate when better at it.

• Expect hesitancy. Taking over toileting is a big step. Many children want their parents to take care of their pee and poop and may seek ways to keep parents involved, such as peeing and pooping into their pants. Gently help them overcome their hesitation. Then help them stay in charge by having them be in charge of the cleanup.

• When toilet training starts, switch to big-kid underwear. Talk with your children about taking control and toileting into the toilet and not their underwear. Some parents may use cloth training pants, which are a little thicker, to protect children's clothing. (Diapers and disposable training pants send a message to children that they are not taking over and do not need to learn to use the toilet.)

• Teach your children proper hygiene habits. Show your children how to wipe carefully. Girls should spread their legs apart when wiping. They should wipe thoroughly from front to back to prevent bringing germs from their rectum to their vagina or bladder. Make sure both boys and girls learn to wash their hands well after using the toilet.

• A word on praise. Taking over toileting is something all healthy children do. Achieving mastery is the best reward for toilet training success. Avoid treats and punishments. Because this is an adventure for your children—a reach for new responsibility— treats and punishments distract rather than encourage. When your children succeed, be specific about why you are proud—"I am so proud you are able to use the toilet so well," for example.

• Avoid a power struggle. Children at toilet training ages are becoming aware of their individuality. They look for ways to test their limits. Some children may do so by holding back bowel movements. Try to stay calm about toilet training. Remember that children control when and where they pee and poop. So power struggles, begging, pleading, rewarding, and punishing keep children from managing their own toileting.

• Understand their fear. Some children believe that their pee and poop are part of their bodies. They may be scared the toilet will flush parts of them away. Some may also fear they will be sucked into the toilet if it is flushed while they are sitting on it. To give your children a feeling of control, let them flush the toilet.

• Watch for a desire to move up. Most of the time, your children will let you know when they are ready to move from the potty-chair to the "big toilet." Provide a stool to brace their feet.

When Toilet Training Should Be Put on Hold

Major changes in the home may make toilet training more difficult. Sometimes it is a good idea to delay toilet training if

• Your family has just moved or will move in the near future.

• You are expecting a baby or have recently had a baby.

• There is a major illness, a recent death, or some other family crisis.

Remember

If any concern comes up before, during, or after toilet training, talk with your child's doctor. Often, the problem is minor and can be resolved quickly. Sometimes, physical or emotional causes will require treatment. Getting professional help can make the process easier. If your child needs additional care, your child's doctor may suggest another pediatric health care specialist who can address the specific pediatric needs of your child.