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Early Toilet Training

By: Alla Gordina, MD, FAAP

The whole purpose of early training is to show the child WHERE to do it, rather than to give him a responsibility of making a decision TO DO OR NOT TO DO, like it is done here in the States. Both systems do work and both have their pluses and minuses. I will be talking here about healthy adjusted children, who are at least able to crawl and about lucky families, who are able to provide conditions for such training.

It is very important to understand, that timing of toilet training is mostly a cultural decision. And yes, as with everything else, we have to “train parents” before they will train their kids. Doctors from Children’s Hospital of Philadelphia did publish in 2003 an interesting study, where they compared the age of the complete toilet training (child is willingly dry and clean) in early and late trained children.

Researchers used the age of 2 years as a cut-off between the age of toilet training initiation and they did not find any difference between two groups in the age of complete toilet training (3 years) BUT - they found that the younger age at initiation of toilet training was associated with less cases constipation, stool withholding, or stool toileting refusal to compare with the training, initiated after the age of 2.

Control of defecation and urination is the same body function as eating, sleeping, walking and talking. Eventually, every healthy person learns to do it. Control of defecation and urination is at the same level of the spinal cord as lower leg control, therefore at 9-15 months any child will be trained – it is another question would this child be toilet trained (will know where to do it) or diaper trained (would not mind being in a dirty/wet diaper).

Toddlers and young children have some very powerful ways to control adults. The major three are behavior (temper tantrums), feeding (picky toddlers), and toilet training. The same way children can refuse to eat just to make mom upset and to get cookies instead of carrots or refuse to behave in public or a home or both, they can manipulate with toilet training too. Very often during "late" toilet training children can refuse to use the toilet and will "hold" urine and/or stool until placed in the diaper again or until becoming completely constipated.

So, anatomically and physiologically children are ready to begin toilet training at the time they start crawling and are ready to be successfully trained by the time they are steadily walking. The whole point in early toilet training is to show the child WHERE to do it. The good thing about early training is that small children are not showing as much negativism as toddlers and the probability of a power struggle is much smaller. Infants and young toddlers want to please you and do not mind trying new things. If your child resists sitting on the potty - don't fight, don't push - she wants to do it later, let her do it, - this is a free country!;-)

If your baby is as able to sit unassisted, you can create a routine of putting your baby on a potty for 2-3 min (note the time!) - as long as your baby agrees to sit there with a diaper off. When to do it? If you have opportunity to do it - at least 6-8 times a day: after waking up in the morning and after naps, after each meal, before sleep, before leaving the house and when the stretch between visits to the bathroom is longer than 2 hours. If you are unable to be with your child all the time – you can introduce potty once or twice per day, but in the same setting (for example - first thing in the morning). Always go to the bathroom before leaving any place - home, hotel, restaurant, etc. (That is a good tip for adults too). Having loose stools actually helps with toilet training - every time you put your baby on the potty they will have higher probability of success! Praise your baby for succeeding and do not notice failures. You can continue to use diapers or you can use underwear.
 
The purpose of diapers is your convenience. Use them when you have to go out, when you don't want to mess your furniture, but keep changing those diapers as frequently as possible - do not let your child to be in a wet or dirty diaper for too long. Modern diapers can hold incredible amount of urine and some parents are cheating on diaper changes in older infants in order to keep amount of used diapers down - they can be costly! Let your child to get used to the clean and dry diaper only.

Pull-ups are just expensive diapers, and, unless your day care requires them - your child does not need pull-ups. For training sake use the cheapest, the least absorbent diapers, so your child will feel wetness immediately. For added effect you can put a piece of soft paper towel or gauze in the diaper - so it would be not as absorbent. For a child with the frequent loose stools diapers are more appropriate than underwear. When traveling, for pure security, use highly absorbent diapers, but keep changing them frequently.

It is better to use underwear when your child has formed stools, walking steadily, using potty without hesitation and you are able to provide easy access to the potty at any moment. In a child, who is not completely toilet-trained, underwear can be used in controlled setting, when a little accident would not create a big problem. For example, when you will have to spend some time in the kitchen cooking or during summer, when you can let your child to "fertilize" your lawn. Keeping your child without underwear would not help with or speed the process of toilet training.
NEVER ask your child - "Do you want to go potty?" Believe me, the answer most of the time will be big time “NO!” - kids have more important things to do. Be assertive – “IT IS TIME TO GO POTTY”. But, if your child is asking to do it – calmly respond immediately, even if you suspect that she is faking.

Toilet training in boys (both early and late) can be a little bit tricky - it is better for small boys to urinate in a sitting position until they are completely trained for both defecation and urination. This way they would not have to separate urge for defecation and urination until they are mature enough to do it. Make sure that during such training all males around your son are urinating in the same sitting position.

Usually with the early toilet-training children are achieving bowel control first and bladder control second, as opposed to the "late" training, when bladder control comes first.

What to use - toilet or potty? For early toilet training potty is more appropriate. In any way, child has to sit with his feet firmly on the floor, enabling him to push. Those pictures with children sitting on the toilet seat with their legs swinging in the air are very misleading. Just imagine yourself trying to push using a toilet seat, which is as high as an exam table in the doctor's office. Potties also can be convenient if you don't have easy access to the bathroom. Most of 3-4 year olds (depending on the height) can easily use a regular toilet seat with or without a footstool to help with pushing.

Please remember that in any type of toilet training your child’s success - is his victory, but if an accident happens - it is usually not his fault.
 
This educational project is one of the many community-oriented initiatives of doctor Alla Gordina. Dr. Gordina is a Board Certified pediatrician, Fellow of the American Academy of Pediatrics, and a member of its Section on Adoption and Foster Care.

Dr. Gordina graduated from Moscow Medical School, and practiced pediatrics and pediatric dermatology in Moscow, Russia for several years. While practicing in Russia, Dr. Gordina also worked in Moscow pre-schools and nursery schools.

Since 1994, Dr. Gordina has been practicing general pediatrics and adolescent medicine in Central New Jersey. She has special interests in routine pediatric care, adoption and foster care, developmental pediatrics, and conditions such as Attention Deficit Disorder (ADD) and bronchial asthma.

Dr. Gordina has presented her research at sessions of the American Academy of Pediatrics and other meetings. Dr. Gordina has both participated in and organized several humanitarian missions to the Former Soviet Union. There she provided clinical and educational assistance to pediatric clinics, orphanages, and physician training seminars in Russia and Ukraine.

In 2006 the Congressional Coalition on Adoption named Dr. Gordina “Angel in Adoption”. The same year WMGO-Magic 98.3 recognized Dr. Gordina as “Woman Who Make Magic”