Is Your Child Ready for the Potty?

From the Show: Healthy Children
Summary: Using the toilet is one of the first and most significant skills your kids must learn. But, do can you teach them, or are they simply not ready until a certain age?
Air Date: 2/25/15
Duration: 10
Host: Melanie Cole, MS
Guest Bio: Wendy Sue Swanson, MD, MBE, FAAP
Wendy Sue Swanson headshot high resDr. Wendy Sue Swanson is a board certified pediatrician, mother to two young boys and the author of the Seattle Children’s Hospital Mama Doc Blog, the first pediatrician-authored blog for a major children's hospital. 

Dr. Swanson is interested in the intersection of media and medicine and its impact on the physician-patient relationship. Her online presence through her blog and Twitter has touched the lives of hundreds of thousands of parents who would have been beyond her reach without social media. Dr. Swanson works diligently to offer parents relevant, practical, and timely health information in accessible formats and she believes that a growing community of online physicians can empower parents and patients to make informed decisions based on science. Tackling issues from vaccines to potty training to work life balance, Dr. Swanson provides a voice of reason, not only as a pediatrician but also as a parent, helping parents gain clarity and eliminate fear when making decisions for their children. Her book, Mama Doc Medicine, published by The American Academy of Pediatrics, hit bookshelves in early 2014.

Dr. Swanson is the founder and executive director of Digital Health at Seattle Children’s. She is also an executive committee member of the American Academy of Pediatrics Council on Communications and Media. She is also on the Board of Advisors for Parents magazine and is on the board for the Mayo Clinic Center for Social Media. She is a weekly medical contributor with NBC affiliate KING 5 News in Seattle and is a practicing pediatrician with The Everett Clinic. Dr. Swanson is an advocate on the topic of vaccines and was named a CDC Childhood Immunization Champion in 2012. She was named to TIME Magazine's Best Twitter Feeds of 2013.
Is Your Child Ready for the Potty?
Toilet training is an uneven process, but it is an inevitable one in nearly every child’s life.

By three to four years of age, most children have achieved daytime urine control and full bowel control (both day and night).

Your child, too, will move more or less steadily from diapers to underwear, from potty to toilet, and from daytime to full-time management of his elimination processes.

Wendy Sue Swanson, MD, discusses the ins and outs of toilet training your child and how to overcome the challenges.

RadioMD Presents:Healthy Children | Original Air Date: February 25, 2015
Host: Melanie Cole, MS
Guest: Wendy Sue Swanson, MD

This is Healthy Children brought to you by the American Academy of Pediatrics on Here’s Melanie Cole, MS.

MELANIE: As a parent, you’re never quite sure when to start toilet training and you’ve heard about all these psychiatric problems your kids might have if you started toilet training them too early. Is any of that really true? And how do you exactly go about it?

My guest today is Dr. Wendy Sue Swanson. She’s a Board Certified pediatrician, spokesman for the American Academy of Pediatrics and the Seattle Children’s Hospital’s Seattle Mama Doc.

Welcome to the show, Dr. Swanson.

So, toilet training. How do you know when it’s time to start?

DR. SWANSON: Yes. Well, it’s a big milestone because all of us get a bit tired of the diapers no matter if you’re cloth or if you’re buying them and throwing them in the garbage. You know, I think what we have to remember is often the timing and the signs for readiness are really driven by what parents want more than children want and that’s really the thing to remember. When you’re thinking about potty training, are you doing it for you or are you doing it for your child? I really love the early teachings of Dr. Brazelton from way back that really talk about kind of children led potty training, meaning they’re coming to a sense of body awareness or the idea that they start really talking about knowing when they need to pee. They’re developing memory between age 2 and 3 where they’re remembering that they need to pee and what that means. They’re feeling a sense kind of fullness or discomfort and then they kind of know they need to hold it and get somewhere else. So, it’s a combination of kind of that cognitive, “I know that I want to do this and have this goal,” as a child. “I can remember what to do when I have these kind of physical sensations, and then, I can make plans and really follow through and carry them out.” So, typically, kids will be over 2. They’ll be using some good language and words. They’ll be able to hold it or make comments about it, or even after they’ve wet in their diaper, they’ll talk about it and then they’re motivated. I always love to tell parents, “You know, this should never feel like it’s your idea. You should feel like kind of the health coach for your child’s ideas. You’re just the pit crew supporting them and celebrating them as they come about these great milestones of independence around toileting.”

MELANIE: So, they’ve got their pull-on diapers at this point or pull-up pants, disposable underpants. I remember my son actually said, “Mom, can I please stop wearing these? I want to use the toilet. I want to use the potty. Please let me do that.” I was like, “Okay, buddy. If you’re sure.” So, he did voice it to me. Do you like those little plastic seats that you set on the actual potty so that they hop up on there or those little things you set on the floor that you have to empty and clean out?

DR. SWANSON: No, you bring up a good point. How do you kind of support your child and give them the right tools so that they can be really independent. Around 18 months of age, 15-18 months, I usually recommend that families get one of those little potties that just sits in the bathroom that kids can reach easily without feeling they’re going to fall or they don’t need any assistance. Or, you get one of those seats that fits in the toilet. My preference is usually the ones that sit off the toilet because they don’t require a child climbing onto a stool that may get pushed out of the way or they won’t have an episode where their hand slips and they literally fall in the toilet water. I mean, that happens. So, the little ones that don’t have water in them tend to be great because when you’re peeing, your child can sit in the same room with you and do the same thing, right? You know, parenting is governed by love, but it’s certainly run by modeling. So, they’re watching you and listening to you. So, at 18 months, get one of those little potties that your child can reach all on their own, not get themselves into trouble or have any falls without you, so that even if you’re in the kitchen making dinner and you child has a sense of “Gosh, my bladder’s full. I’m going to go sit and try to see if I can pee and have control of my bladder,” they can do it without you even watching. And too, so that the exploration and modeling can occur and then the exploration independently can occur. That is a really key part of potty training since between age 2 and 3, that’s the typical time that kids really live into potty training and independence. It’s also the time the terrible 2’s is the way where kids are really struggling and learning and fighting for independence and autonomy. The last thing you want is conflict—a feeling where a child knows you want them to do something and they’re in some way letting you down or unable to do it. That’s why you want this to be very child-led so that little potty in the room makes it really possible for them to do that.

MELANIE: Okay. So, some common problems of toilet training? Certainly the wiping is always an issue. They can’t reach, so if they do learn to poop in the potty, you have to be right there, ready to wipe for them because they really can’t reach. But, for little boys, do you teach them standing and peeing? You know, heading towards or do you teach them to sit down and push their little weenies down in?

DR. SWANSON: I think it can go either way. Because of modeling, right, if dad’s around and they’re watching dad pee, standing up might be something they’re really eager to do. That being said, when a child sits on the toilet, it does allow them to relax their perineum, the part of your body where there are lot of muscles around your bladder. Then, that can allow the brain-bladder connection to relax and release the sphincter so the pee comes out. So, sometimes if kids are really having a hard time standing, then I’ll say, “Oh, just have them sit and model some sitting for them, too, so that they can understand that.” So, I think tinkering around, but, again, whatever your child wants to do is probably the right first approach because you’re the pit crew and you’re there just supporting the child who’s eager and excited about this new, very big kid milestone that they’re about to have.

You know, some people criticize the…You’ve probably heard of the Cheerios? You know, you put Cheerios in the toilet…

MELANIE: Of course.

DR. SWANSON: …and have the boys aim. I’ve heard pediatricians criticize that in the past because it’s making urinating a game, which it’s not. I don’t really think there’s a lot of data to go either way. I think, again, if it enlivens and excites your child about feeling independent, in control, and excited about this new skill, great. If it puts it and pits them up for some sense of failure, that’s problematic. I mean, when it comes to toilet training, too, one thing we can’t forget to talk about is, you never want this to be negative reinforcement.

MELANIE: You don’t force them.

DR. SWANSON: You don’t force them, but you certainly don’t punish them, meaning that the brain-bladder connection, just like other neurologic connections, develops over time. So, nighttime bed wetting, for example, is never a child’s fault that they wet the bed. It’s really their brain and their bladder are not yet fully mature. So, when we’re thinking about potty training, we have to think like anytime we have a great success, we celebrate it. When we have a failure, we almost ignore it, move right past it, grab a new pair of undies, grab a new pair of pull-ups and move forward on to the next thing. I remember I’ve seen patients in clinic that talked one time about putting Tobasco sauce on their kids’ tongue after having an accident. I thought, “Oh, God.”

MELANIE: Oh, my God.

DR. SWANSON: That’s the last think you want to do, right? Because then shame, disappointment, conflict, resentment, that all comes in and potty training’s just supposed to be a delightful time in life. You know, I think we always are thinking about timing and success, too. Just know, there is some data from 2010 that talked about the best time for potty training around about 2 ½, but we do know girls tend to potty train a bit earlier than boys, particularly firstborn boys, so it’s really going to be led by what is your child’s body awareness, how verbal are they? What’s their memory like? And, how interested and engaged are they? If they’re really distracted by other things going on in life, a new baby at home, a parent’s new job or stress, who cares? Let it go a couple more months. You know, they’re going to go to college potty trained.

MELANIE: Okay. So we have about a minute and a little bit less than that left, so wrap it up for us. Your best advice if a parent were to come right to you, Dr. Swanson, into your office and say, “Okay. What do I do? How do I start potty training my child? How do I teach my son not to squirt it all over the bathroom? To target it in. What do I do?”

DR. SWANSON: Number one, this should always be about the timing of your child—not your needs. So, remembering that you’re looking for a child showing interest, excitement and enthusiasm. Make it really easy for your child. If you really want your child to potty train day and night, they can’t be in a crib. They’ve got to be in a toddler bed or a regular bed so they can get themselves up and out on their own and in your presence. So, give them the opportunity to be successful and model after your great behavior and your transparency around going to the bathroom. But, also make sure there’s a place for them to get to a bathroom and to a toilet safely without you around so they can experiment with that body awareness—that physical sensation—and then, the control of holding it and getting there. Then, just make sure you celebrate good successes in potty training. You know, reward your children and kind of cheerlead them along as they have it and blow right past the failures. You never want to bring resentment, frustration or conflict into potty training. It will delay it. If you’re having lots of accidents all of a sudden, don’t ever forget about checking in with your pediatrician. Sometimes constipation can make it a lot harder. So, if constipation’s a part of your child’s life, cleaning up the problem of constipation at the time of potty training can really yield great success.

MELANIE: Awesome information. It’s all about potty training your little one. You can see more about Dr. Swanson. She’s the author of Mama Doc Medicine. It’s an awesome book.

You heard it right here on RadioMD. This show is Healthy Children.

This is Melanie Cole.

Thanks so much for listening and stay well.
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