by Brianna Dillon, MD (’24)
Medical residents often get asked for advice from parents on how to approach toilet training their toddler. It can be a stressful experience for parents but our role as medical providers is to encourage this process to be as stress free as possible. There are many ways to approach toilet training and different advice that can be given to families.
Most children in the United States are toilet trained by 4 years of age. The average age for girls to obtain this skill is between 32-35 months and the average age for boys is between 35-59 months. Generally, between 18-24 months, a child is at an appropriate developmental stage to tackle toilet training. It can take up to 3 months for daytime toilet training to be achieved and it generally takes a few more months after that for nighttime control to be achieved.
It is important that parents understand that most toddlers and young children are very deep sleepers, and it is hard for their bladder to communicate to their brain that it is time to wake up and use the restroom. It is important to assess the developmental signs of readiness of a child before embarking on their toilet training journey. Language skills, cognitive skills, emotional skills, motor skills and body awareness are all key components to a successful toilet training journey.
The child should generally be able to do the following things:
- Follow 2 step commands
- Use 2 word phrases
- Understand cause and effect
- Imitate caregivers
- Show a desire to please caregivers and be independent
- Show behavior improvement (decrease in oppositional behaviors and power struggles)
- Show a sense of pride towards themselves and their belongings
- Ambulate independently
- Sit still for at least 5 minutes without help
- Show an awareness of when their clothes may be soiled
- Show signs of discomfort when they need to urinate/defecate
It is important that parents are armed with the information that they should not push their child if their child is not developmentally ready. They should empower their child to take responsibility of achieving this milestone. Lastly, they should anticipate that there will be setbacks and should use those setbacks as opportunities to improve.
Families can consider the use of a separate potty chair when embarking on this journey. Creating a toileting plan can also be helpful for families who have children that spend time with multiple caregivers. Examples of what can be included in a toileting plan are below:
- How often the child should go to the bathroom in a day (15 minutes before and after a meal/drink)
- How long they should spend trying to use the bathroom with each visit(child sits on toilet for 3 minutes each time)
- Language used to indicate it is time to use the bathroom (time to pee-pee, poo-poo)
- Tools that can be helpful (a child’s favorite book, having a white noise machine if it makes the child more comfortable etc.)
- Rewards (child gets to use the ipad for 10 minutes if able to complete their goal each day etc.)
There are different approaches to toilet training. Some of the common approaches include a child-oriented approach, fast and targeted approach, and behavior shaping approach.
The child-oriented approach includes first allowing your child to sit and explore the potty chair. When they start showing interest, parents are encouraged to let them sit on the potty chair bare bottomed throughout the day (for example, at bath time). When the child defecates in their diaper, parents should take their child to the bathroom to empty the stool from their diaper into the potty. Parents should have the child go diaper less for short periods of time while they are in the house. Parents should be encouraged to give their child praise whenever the child expresses interest in the toilet or makes an attempt to use the toilet.
The fast and targeted approach includes scheduling 3-4 days in a row where the child is informed and shown that they will need to start using the toilet. Parents place the child in underwear vs. diapers and increase the fluid intake of the child. Whenever the child seems like they need to use the bathroom, parents should take them. Parents may find it helpful to take the child every 2 hours or have a timed schedule where the child is prompted to go to the bathroom. Parents should avoid forcing the child to sit on the toilet/potty chair.
The behavior shaping approach follows the child’s lead and interest in potty training. When the child expresses they need to urinate or pass stool, they are given praise for verbally expressing their desire to use the bathroom. Next, parents walk with their child to the bathroom when they express they want to use the bathroom. Finally, parents have their child sit on the toilet/potty chair. Regardless of whether the child is successful in using the bathroom or not, they should be given praise. Continue this process until the child is consistent and able to use the bathroom on their own.
Toilet training is a marathon and not a sprint for many families. It is important that families understand that they should delay this toilet training process if the child is not developmentally ready or if there are any new family stressors (moving homes, arrival of a new baby, parental divorce etc.)
Ultimately, the majority of children obtain the skill of bladder control and are able to use the bathroom on their own. Parents should be informed this should not be a stressful process in order to maintain the parent-child relationship. Consistency and patience are key!
*Of note, this article refers to advice that can be given to parents of children who do not have medical conditions that would impair their ability to use the toilet independently. There are children who may need to continue using diapers into their older ages and in these cases, parents should be informed there is nothing differently that can be done, and this should not be a source of tension between parent and child. Their child is operating in the capacity that their body allows them to and that is ok!
Augustyn, M., & Zuckerman, B. S. (2019). Zuckerman Parker handbook of developmental and
behavioral pediatrics for primary care. Wolters Kluwer.
Mount Sinai Parenting Center. Keystones of Development Curriculum (2022). https://parenting.mountsinai.org/providers/
Parent’s Guide to Toilet Training Children with Autism – Autism Speaks. Autism Speaks. (2018).
Null. (2023, April 6). When to start potty training: What age should kids start (and do boys really take longer) https://health.ucdavis.edu/news/headlines/when-to-start-potty-training-what-age-should-kids-start-and-do-boys-really-take longer/2021/03#:~:text=Allow%20your%20child%20to%20play,three%20months%20before%20boys%20do.
Robinson, K. (2011, October 12). 5 myths and 5 facts about potty training. 5 Myths and 5 Facts About Potty Training | Parenting Squad. http://parentingsquad.com/5-myths-and-5-facts-about-potty-training
Stanford Medicine Children’s health. Stanford Medicine Children’s Health – Lucile Packard Children’s Hospital Stanford. (n.d.). https://www.stanfordchildrens.org/en/topic/default?id=urinary-tract-infections-uti-90-P03117#:~:text=A%20child%20with%20a%20part,risky%20after%20a%20bowel%20movement.
Team, T. T. P. (2022, November 29). Is Nighttime Potty Training Possible?. Parenting Now. https://parentingnow.org/is-nighttime-potty-training-possible/