Module 4: Promoting Mental Health in Early Childhood

Toilet TrainingToilet Learning

A Milestone in Independence

Toilet training is most effective if it is delayed until the child can control much of the process.Learning to use the toilet is a process that affects the relationship between parent and child. Because parents are often intensely invested in the results, toilet learning can become an area of child-parent power struggles and conflict.

Questions to Ask

  • Do you know the signs of toilet-learning readiness?
  • Do you think your child is ready for toilet training? What makes you think so?
  • Do you feel pressure to toilet train her?
  • Do you have a potty chair, potty training seat, or step stool for your child?
  • How is your child’s toilet training progressing?

Provider Tips

  • Help parents recognize the signs of toilet-learning readiness.
  • Using the guidance listed below, describe the steps parents can take to help their child learn how to use the toilet.

Guidance for Parents

  • It is best to delay toilet training your child until she is ready. Begin toilet training when your child:
    • Is dry for about 2 hours at a time
    • Knows the difference between wet and dry
    • Can pull her pants up and down
    • Wants to learn
    • Can tell you when she is about to have a bowel movement
  • The following tips will help toilet training go more smoothly:
    • Use a potty chair that sits on the floor
    • Dress your child in easy-to-remove pants
    • Establish a daily routine
    • Be relaxed and read or sing songs while she is on the potty
  • Children need to use the toilet more often than adults—up to 10 times a day. Place your child on the potty every 1 to 2 hours. Plan for frequent toilet breaks when you’re traveling with your child, even if you are out for just a short time.
  • Accept the fact that your child will have accidents while she is learning. Don’t make her feel bad or punish her when she makes a mistake. Praise her each time she uses the toilet.
  • It’s hard to start toilet training during times of change or high stress. Wait a while to start training if you have a new baby in your home, if there’s been a change in your child care situation, or if your family is in the process of moving.
Resources for Providers and Families

For the Provider

Area of Concern: Resisting Toilet Learning more information

Simple techniques can encourage most children 2 1/2 years of age and older who are resisting toilet learning. Pressure can be removed by returning the child to diapers and offering “big kid” underwear as an incentive. Disposable pull-up training pants can delay toilet learning.

Independent toileting symbolizes growing up and some loss of intimate caregiving. Acknowledging this and helping the parent and child create alternative intimate moments such as “cuddle time” can further toilet learning progress.

Assess for the possibility of physical or sexual abuse in cases of extreme fears or significant delays or regression associated with toilet learning.

Area of Concern: Toileting Fears more information

Toileting fears, such as fears of falling into the toilet or losing genitalia, are common in early childhood. These fears can result in withholding or toilet refusal. Suggest use of a potty chair or toilet insert or allowing children to sit backward on the toilet for security. Tell children that their genitalia are “theirs forever.” Suggest exploration of the toilet and its pipes to desensitize children to their fears.

Assess for the possibility of physical or sexual abuse in cases of extreme fears or significant delays or regression associated with toilet learning.

Area of Concern: Stool Refusal more information

In cases of stool refusal, help ensure that children produce one or two soft, nonpainful stools per day by recommending a high-fiber diet and sufficient fluids and, if necessary, regularly giving the child mineral oil, laxatives, or fiber supplements before stool has a chance to build up.

Address parental control issues and the child’s fears while allowing the child to use a diaper. In persistent cases (i.e., those lasting more than 6 months), consider other interventions, including referral to a mental health professional or developmental-behavioral pediatrician.

Assess for the possibility of physical or sexual abuse in cases of extreme fears or significant delays or regression associated with toilet learning.

For the Family

Psychological Readiness and Motor Skills Needed for Toilet Training

Increasing Confidence and Self-Esteem During Toilet Training

Problems With Soiling and Bowel Control

Frankel A. 2007. Once Upon a Potty-Boy. and Once Upon a Potty-Girl. Buffalo, NY: Firefly Books Ltd.

Learning Through Entertainment. 1996. It’s Potty Time. Dallas, TX: Learning Through Entertainment.

It’s Potty Time. 2000. Duke Family Series. 60 min. DVD. Learning Through Entertainment.

Rogers F. 1997. Going to the Potty. New York, NY: Putnam & Grosset Group.

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