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Column originally published Mar 2, 2004

Toilet-Training Can Be Challenging For Both Children And Parents

Question: I am a first time mother. Our daughter is one year old. I am starting to wonder how to toilet-train her. The books and pamphlets that I have read so far are confusing and sometimes contradictory. I would appreciate some suggestions from you.


Toilet training is an area that many parents struggle with. Virtually all children will achieve complete toilet training sooner or later, during the first few years of their lives. However, something that is totally natural for human existence sometimes can be very difficult for parents and children. I am glad that you are considering it now, even though she is probably a little too young to start.

Toilet training practice varies greatly around the world. It is very much driven by the local culture. For instance, in East Africa, the Digo people begin toilet training during the first few weeks of life. By 4 to 5 months of age, their children are expected to be able to urinate or stool on demand from the caretakers. As a result, someone has to attend to these young infants constantly to watch for cues of urination and bowel movement, and this responsibility is often delegated to the older sisters.

In North America, research has shown that toilet training occurs most often between two to four years of age. There are lots of dirty diapers to change during those years. The advent of disposable diapers has certainly improved the quality of life for numerous parents, and might have made toilet training less of an urgent child-care issue to deal with than previous generations.

Our current approach to toilet training is very much based on the recommendation pioneered by Dr. Brazelton in 1962. Dr. Brazelton suggested a child-directed approach, which takes into account both the physiological development as well as behavioural readiness of the child. This is still the general approach recommended by most health-care professionals, including paediatricians.

In the first year of life, an infant’s bladder empties about 20 times reflexively every day; that means they have virtually no control at all. When the bladder fills to capacity, it will contract automatically until it is almost empty. In a similar fashion, when a baby is fed, it increases the motility of the intestines so that stool in the large intestine is eliminated into the diaper. Voluntary control of bladder and bowel function requires maturation of a part of the central nervous system called extrapyrimidal tract, and this does not happen until the child is between 12 to 18 months of age.

Many parents have asked me this question: How can I tell when my child is ready for toilet training? There are some clues that parents can use to make that determination, and one must remember that not every child will fit into a particular mode. If your daughter is not ready, it is better that you delay attempting to toilet train her instead of making her turned off by the whole idea, or develop complications as a result of toilet training.

The first sign that a child is ready for toilet training is having a dry diaper for several hours, indicating that her bladder is large enough to hold fair amount of urine, and that she has some control of the bladder sphincter. Another important sign is your daughter indicating to you that she needs her diaper changed, either because of urine or stool. This is an important sign of maturity that is essential for successful toilet training. If she has developed verbal skills, you can teach her to tell you whether she has urine or stool in her diaper.

The next step of toilet training would involve sitting at the toilet. This is a very important step, and some children can be turned off or develop problems at this stage. You can prepare her for this step by letting her watch you using the toilet. This may sound odd, and some adults may be uncomfortable about it. The fact is that it is a natural part of parenthood. Many parents would admit that once they have toddlers at home, they lose their bathroom privacy.

The best place to toilet train your daughter is probably in your bathroom. Most likely she would be more comfortable sitting on a small potty instead of on the regular toilet. You can place her sitting at her little potty when you have to use the washroom: the perfect modeling approach. At the beginning, she can sit there with her diaper on. Once she is comfortable with that idea, then you can remove her diaper before sitting her down.

Most likely she will not pass any urine or stool at the potty when you begin toilet training. Do not keep her there until she has done something. After a reasonable period of time, which can be as short as a few minutes, let her get up and praise her for staying there. Again, try to give her positive re-enforcement.

If you have noticed some cues before she passes urine or stool, or if she starts to indicate that to you, it would be a good opportunity to take her to the potty. Even if she has already done it partially in her diaper, she should be praised for trying. If you make the experience a positive one, more than likely she would try to please you, and gradually would able to hold the urine or stool until she gets to the potty.

I should mention here that one should choose carefully what kind of praise or reward that we should give to children. This applies not only to toilet training, but also to the whole area of discipline. Using food as a reward is generally not a good idea. Sweets and candies should not be used at all because they can lead to cavities. Most children love to please their parents; therefore the best reward is your smile, hugs, and kisses. In short, children need the love of parents, and that should be their best reward. If you need to give her something, stickers and stars placed on calendars would be sufficient most of the time.

At the beginning, toilet training is very much a hit-and-miss situation. There will be times that she would be dry all day, and this can be followed by days that she might not tell you until she has done it in her diapers. Do not be upset, and definitely refrain from any kind of physical or verbal punishment. Rather, encourage her to tell you the next time. Be patient. Tender love is what children look for and need. With time, she would do it more and more consistently. Most children are able to control their bladder before they can control their bowel.

After a few weeks of successful toilet training, you can sit down with her and explain about the idea of training pants. Make it a big step in her development. However, also be prepared that accidents are likely going to happen, and it would be messier since she doesn’t have the diaper on. Even if you are quite upset and your furniture is soiled, do not over-react or punish her, because this can lead to regression and more problems down the road.

There are a few things that I should mention here that you probably should not do. If you are very busy and have no time to work on this, it would be better to delay starting toilet-training for a short while. Some mothers decide to toilet-train their children during the summer holidays. Do not use the regular toilet by itself for toilet training. If you want to use it, please get a toilet insert over the toilet seat. This will fit her little buttocks much better. You should also put a footstool in front of the toilet, so that her feet can rest on solid ground. This is very important for her to bear down and push the stool out.

What should you do if your daughter refuses to sit at the potty when you believe she is ready for toilet-training? The best solution is to wait a little while. She is probably not ready emotionally at that time. It has been observed that children with strong temperament require more time to toilet train than others. Back off for a while. Insisting on toilet training when a child is not ready can lead to withholding of stool. This will lead to stool becoming dry in the rectum and pain on defecation, followed by more withholding. The end result is constipation, which can be very difficult to manage.

I should mention here that toilet-training is also a great time to teach your daughter proper personal hygiene. After urination, she should be taught how to wipe herself from the front to back (this is to prevent germs around the anus going to the vulva). As expected, you will have to help her to clean after she uses the potty for quite some time. If it is left to them, many children are frankly unable to keep that area clean after urination or stool. She should also be shown how to wash her hands after going to the bathroom.

Finally, although children can be successfully toilet-trained, a small proportion of them continue to wet the bed at night for many years. This condition is called enuresis. It is beyond the scope of this column to discuss in detail about it. Most of them will finally become dry at night, although this problem may become increasingly distressful for parents and children when they want to invite friends for sleepover.

I hope you have gained some insight as to what you should do and how you should approach toilet-training your daughter. Good luck.