Toilet Training Tips

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18 months

• Begin identifying toileting with appropriate words: “poop,”“pee,”“potty,” or whatever words you determine fit your family.
• Make diaper-changing a pleasant experience.
• Encourage your child to come to you when the diaper is wet or soiled—this will enforce “staying dry” as good.
• Avoid using negative terms, such as “yucky” or “nasty,” to describe bowel movements. Instead, say, “You are wet, we need to change you,” or “Your pants are soiled, and we need to fix that.”
• Point out that everyone has to potty.
• Model appropriate toileting behavior for your child—letting them see you use the restroom is part of toilet training.

21 months

• Identify an appropriate potty chair, and explain that it belongs to your child and is special.
• Practice sitting on the toilet while your child sits on the potty chair.
• Start to develop the prerequisite skills for toilet training: sitting for up to 2–3 minutes, following directions, getting on and off the toilet, and raising and lowering pants and underwear.

2.5 - 3 years

• Use toileting tools, books, and videos to teach the components of toilet training.
• Have your child potty-train a doll or stuffed animal.
• Begin talking about wearing underwear—it is “special” and a “privilege.”
• Begin practice runs to the potty—do this when you begin to see signs of needing to use the bathroom.
• Encourage sitting on the potty for about 1 minute at a time.
• Dress your child in clothing they can easily pull up and down.
• Optimal practice times are about 30 minutes after meals and after naps
• Most children will need to urinate about every 60–90 minutes.
• Use positive reinforcement for sitting on the potty and using the potty—positive reinforcement can be praise, high fives, stickers, or small treats.
• Accidents happen—deal with them in a nonjudgmental way

General Guidelines for Good Toilet Hygiene

• Toilet training for typically developing children usually occurs between 18 months to 4 years of age.  Each child is different
• Urine training typically occurs before bowel training
• Try to avoid starting toilet training around the time of major life changes (birth of a sibling, death of a loved one, move or relocation, school entry, etc)
• Help discourage obvious retention behaviors (squeezing legs together, clenching buttock, grabbing privates, etc) when they are witnessed
• Use of osmotic laxatives may be needed to keep stools soft if constipation is noted
• The best time to attempt toilet sitting for defecation is within 2 hours of awakening and/or 30 minutes after large snack or meal
• Allow unhurried use of toilet in a calm, non-threatening environment
• For those with toilet aversion, doing pleasurable activities (reading, listening to music, etc) is acceptable to help overcome the fear of sitting on the toilet. However, for those not aversive to toilet sitting and working specifically on defecation, time sitting on the toilet should be spent focusing on defecation, not reading books, using electronic devices, etc
• Try having child blow up party blowers, bubbles, or balloons if no latex allergies (always under direct supervision due to choking hazard risk) to help strengthen and train pelvic floor muscles
• If feet don’t touch the floor, use a footstool for added leverage during defecation
• If behavioral problems or anxiety are impacting toilet training, seek help from a professional
• Make sure your child is getting adequate fiber in diet. To calculate the fiber (grams per day) needed in diet for children over 2 yrs. of age: age in years + 5 = ___ grams per day. (i.e. 4 year old child needs 4 + 5 = 9 grams fiber per day)
• Untreated constipation is likely to delay or complicate toilet training. Limit dairy intake to no more than 16-24 oz a day maximum. Make sure your child is getting the adequate amount of fluids (see guidelines below). Water is optimal

Weight in Pounds/Fluids per day

10 pounds= 16 ounces (2 cups)
20 pounds = 30 ounces (3-3/4 cups)
30 pounds = 40 ounces (5 cups)
40 pounds = 48 ounces (6 cups)
50 pounds= 52 ounces (6 ½ cups)
60 pounds= 55 ounces (7 cups)
80 pounds= 61 ounces (7 ½ cups)
100 pounds= 67 ounces (8 ¼ cups)
120+ pounds= 73-82 ounces (9-10 ¼ cups )

References: Contemporary Pediatrics, Vol. 21, No. 3; American Academy of Pediatrics; HealthyChildren.org; www.GIkids.org; Clinical Handbook of Pediatric Gastroenterology, Second Edition.