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Special Topics in Development:
The politically correct term may be "toilet learning", but nearly every parent that we know still says "potty training". Which just emphasizes that our outlook on this subject often borrows more from other parents than from the rigid philosophies of the "experts". It seems to be a characteristic of humans (especially moms) that we read everything we can, but then poll all our friends with the question "how did that work for you?" Our pragmatic side knows that the way to wade through all the conflicting theories out there is to find out how it really works in actual practice -- for moms like us and for kids like ours. (Read more about potty training.) Bedwetting meanwhile is one of the few problems parents don't commonly discuss with one another. The conspiracy begins in the toddler years with all the anxious discussions between parents (most often moms) about whose child is potty trained and whose child was "dry all night". The "dry all night" and the "completely potty trained" parents are congratulated and admired. The "not there yets" are consoled and encouraged. And those "odd ball" parents whose children are "not even in pull ups yet" at 2 1/2 and 3 are quietly gossiped about as though they, surely, are doing something insidiously wrong. It's a hot issue, getting our children successfully potty trained. Made hotter by the preschools and childcare facilities that require potty training by age 3 -- implying that of course, it should all be over and done with by then. (Not so, for many children the process is only beginning at this time). Little wonder then that parents feel awkward bringing up the subject that their child is still having frequent accidents at night -- at 3, at 4... or 8. But the truth is that childhood bedwetting is a very common problem. And it is a problem which -- other than laundry hassles -- could be no big deal at all, were it not for all the fear and misinformation attached to it. The only real harm in the whole bed wetting issue, is the psychological harm done to children who feel that they "are the only ones" and that there is something "wrong" with them. (Read more about bed wetting.) Knowledge in these subjects areas can bring such a sense of relief, and help restore our sense of perspective (not to mention our sense of humor). And so, in the interests of lightening things up a bit in families everywhere, we present the following links and information.
Toilet Training
101: An Introduction These days there is a dizzying array of advice in the area of potty training. Expert philosophies on the subject range from the gentle "child-centered" philosophies of T. Barry Brazelton and Penelope Leach who advise patience and mutual respect... all the way to the opposite extreme, the so-called "parent-centered" approach of Garry and Anne Marie Ezzo which advises swatting and spanking young children several times a day to gain compliance. (Read more.) Meanwhile even pediatricians can give well-meaning but despairingly vague advice. So let's stick to the facts: your child makes pee and poo (urinates and has a bowel movement, or B.M.), your child must learn that he or she will eventually transition to doing this in a potty, and some day, well before he or she goes off to kindergarten, your child will achieve the willingness and ability to accomplish this feat. How exactly all this plays out, and by when it is accomplished, is something that is not so clear cut. The reason is that, much as we would like to reduce child-rearing to some exact mechanical science where the same applied action will produce the same predictable outcomes, this simply isn't the case. Children are human beings, not robots or computerized machines. They have complex minds, individual personalities, and wildly varying emotional responses. And the same is true of their parents. Take for example the fact that my first two children were both potty trained by about two and a half. Or rather, "B.M."s were all in the potty, while pull-ups were still needed a while longer at preschool for the occasional "oops I forgot I had to go". Child number three however had it all figured out about a year earlier and was all excited to start using the potty like the big people. Then, he realized that most public restrooms were proportioned for giants, like Mom and Dad, and that no provision had been made for him. After this he refused to use public bathrooms and refused to use his potty chair at home. No amount of potty training savvy or even the use of rewards could make him budge. (Perhaps if Mom had been bright enough to bring a portable potty topper to go over the toilet seat, this might all have been avoided. But sadly that ship had already sailed.) Faced with feeling under equipped in a world of big people he became stubbornly uncooperative and wanted to wait, using the potty chair only sporadically. The moral of the story is, read the tips below on readiness and routines, but realize that your child is a unique human being too. Even offering praise and rewards will only going to go so far if your child is not emotionally or physically ready. And so whether potty training at an early age is important enough to bring out the "big guns" of mild threats and punishing consequences, is something you will have to decide for yourself. CAUTION: We can only say we are firmly opposed to frightening, shaming, and physically punishing (spanking, etc.) in order to get results. Such actions often do more harm than good in the potty training process and inevitably generate additional problems as well such as power struggles, stool withholding, and permanent psychological scarring. As the parent, you must ask yourself: is it really worth damaging your child's confidence in himself, his trust in you, and his sense of self worth just so you can keep up with Suzy Perfect at Playgroup and her performing seal of a child who was somehow "perfectly potty trained" by age two? You have no idea what goes on in private at Suzy's home, or how many accidents her child secretly has there. Beware too the well meaning advice of grandparents. For most it has been a long, long time since they coped with potty training and the odds are their memories have long since edited out the ugly scenes, tear streaked faces, and wet pants in public that accompanied their efforts at early potty training. In short, take it easy on yourself, and your child. Unless your child is severely developmentally disabled, he or she WILL master potty training. Just remember to be consistent -- sit them on the potty before you go out, scope out the public restrooms when you are out, and don't slack off when your child is showing genuine interest and enthusiasm. Be ready when they are ready!
How To Tell When Your Child Is Ready
As with everything in parenting, have an open mind
about when your child will be ready. We recommend buying a potty
chair
and some picture books when your child is about 20 to 24 months.
But bear in mind that most children are not ready to begin until
sometime between 24 to 36 months. Children who begin earlier do
not finish any earlier and sometimes will finish later, due to added
emotional issues brought on by pressure and power struggles.
In short "late bloomers" tend to have fewer accidents. That means
less soppy pee pants and squishy shoes while you're standing in line at
the supermarket. Signs your child is ready include:
Signs your child is NOT ready include:
Laying the Groundwork Like so many other things in life, especially where young children are involved, things will go so much more smoothly if we can introduce positive motivation and the element of fun. Why make potty training into your personal Mt. Everest, to conquer or die trying? Instead let's start with setting up a comfortable and appealing environment. Select a potty that's easy to clean, comfortable, and stable (won't tip or wobble). Be sure there's nothing on the new potty that pinches and no lids that tend to fall down. If your child is male, be sure there is some kind of urine guard included. It is best if it is smooth and not too rigid, to prevent painful incidents while getting on and off the potty. Remove all the little temptations out of the bathroom (it can be much more fun to dump all the shampoos into the sink than to sit on the potty), and child proof the medicine cabinet and anything else you don't want your child to get into. In the short term you may get called out of the bathroom on an emergency, and eventually using the potty will become more of an independent activity. Also, in addition to toilet paper, make sure you have a supply of wipes on hand, preferably flushable, for when things get messy. If the wipes are not flushable, have small trash bags stored near by in a child-proofed cupboard (to avoid suffocation dangers). To eliminate the danger of your young child accidentally locking himself in the bathroom alone, buy one of those door safety devices that fits over the top of the door to prevent it from closing (designed to prevent pinched fingers). Lay in a supply of fun story books just for "potty time". We have especially found it helpful to have books about using the potty, to reinforce helpful concepts and promote the value of sitting on the potty in the first place. Discuss with your spouse or other primary caregiver what words you will use to talk about going potty. What will you call the body parts? This will help you be more calm when explaining things to your child. And your consistency will head off confusion. Show your child the new potty and talk about what it is for. Keep the discussion light and low pressure. From this point on, find other opportunities to discuss the topic. Usually it is best to tackle the issues a little at a time. Keep it simple, then build on more concepts in later discussions. Look over the books together. Invite your child to try out the potty, just to see how it feels. You might even offer to sit on the big potty to keep him "company". (This works best if you aren't too shy to do it for real.) If your child seems frightened about this, try to make a game of it. Be prepared to back off for a bit.
Some children find it more natural to try the potty at bath time, when they are already undressed. Talk about how they can use the potty to make poo poo instead of going in the bath tub. During the bath, especially if you see tell-tale squatting and grunting, suggest using the potty "so that the bath water stays clean and nice to play in". Remember to always treat urination and bowel movements in a relaxed, matter-of-fact way. This can be hard if you've never had to deal with someone else's toilet before. But at least you've had months of changing diapers to warm you up to it! Above all, don't panic. If your child has an accident on the rug, don't laugh and be silly about it (because anything fun is worth doing again). But don't shriek and pull your hair out either. "Oh dear. Well, this is messy. We'll just have to clean it up. Next time let's get it in the potty. Then the rug will stay clean."
Because a child has used a diaper all his/her life for dealing with urine and B.M.s, this whole business of doing it on the potty is likely to seem a little mystifying. After all, "why fix what ain't broke?" So it can help talk about the way big kids go potty. But better still is to let your child observe other children using the potty (siblings, cousins, other kids in child care, etc.). This makes a much bigger impression that seeing parents use the toilet since a small child sees parents do all kinds of things that he knows he is not allowed, or able, to do. Next, think about incorporating doll play, or puppets. Some experts recommend a doll that can drink from a bottle and make "pee pee" in a potty. But we realize that this is probably a good idea for some children and a source of distraction for others! ("Why is the dolly in the toilet, sweetie?") Nonetheless, using a doll allows you to pretend about sitting on the potty as well as abandoning diapers for cloth underpants -- with all the imagined joys and pitfalls that go with this transition. As with books and videos, doll play takes the discussion to a more visual level. But another value is that it allows you to talk about potty issues without your child feeling that it is all directed at him. This takes the stress level down a notch. Happily you don't need to run out and spend lots of money on a wetting doll only to find out that this method holds no interest for you own child. Try it out first with his favorite teddy bear or etc. If it seems like a fun game, you can take it to the next level. If not, save yourself some money, and don't worry about it.
Creating a Daily Routine
Getting Your Child to "Go" We've already talked about the value of encouraging potty use during bath time. Another way to introduce successful potty use is to get your child to sit down when you suspect it's time for a B.M. If your child is pretty regular then you should have some sense of how long after a meal he or she will have to "go". Some families find that it works best to tackle bowel movements first, as it's so much easier for the parent to detect and predict a B.M. than to guess when a child is about to urinate. But if your child is recovering from complications due to serious chronic constipation, this may not be the approach for you as it may put too much emphasis on a body function that your child associates with pain and anxiety. Discuss this with your pediatrician. Still other parents prefer to let their child run around naked (or at least from the waist down), because although most children don't mind making poo and pee in a diaper, they do dislike the feeling of it sliding down their legs. Clearly this method only works if you can clean up the mess easily. Don't try this approach if you have wall to wall carpeting. Another possible way to tackle the potty training routine is to use a timer of some sort. Start out with setting the timer for 2 hours. When it goes off, tell your child it's time to try the potty. (Certainly you can have them go sooner if you suspect they need to go, or if they tell you they need to go.) Remember this method doesn't work for everyone. Don't make such a big "to do" when the timer goes off that it becomes a thing to be feared by your child. If they won't go, they won't go. Which means they are not ready. Above all, remember that the goal here is to get your child to start noticing what it feels like to have a full bladder, or bowels, and to realize that the sensation of pressure and discomfort means its time to head for the potty -- quick! Even using the timer method is about having them get to the potty before "going", so that the feeling of going in the pants without thinking becomes less familiar. But if your child is not ready to take notice of that sensation of fullness.... then they just aren't ready for potty training. No matter if they are age 2 or age 4. Be patient. It is normal for children to lag behind in some developmental areas and zoom ahead in others. If your child seems like the potty training "dunce", then he or she is probably really gifted in some other area. For some reason a developing child rarely scores 100% in all areas at the same time. But once they master whatever area they are focused on, then they work on bringing the rest up to speed. Unless we've turned it into a power struggle...
How Long to Sit on the Potty Meanwhile, whichever approach or combination of approaches you decide to use, remember to have your child sit on the potty for a few minutes only. More than five and it will soon seem like a big chore every time it must be done, to both of you. And then your child will balk that much more. Also, stay with your child at first. Look at books. Sing songs. Or, just sit quietly if your child can do so without getting "antsy". Don't worry if nothing happens. Just praise the effort. Over time you will be able to transition your child from needing you to sit with him/her...to being able to spend part of the time in the bathroom without you (perhaps you are still needed for getting pants down, or for wiping B.M.s) ... to eventually doing more and more of the process without your aid.
Rewards & Other ReinforcementsSome parents find it helps to keep a chart and put stickers on for each time the child sits. This provides a visual record of all your child's great effort, and gives you a way to point out progress. As your child becomes really successful with actually "going", you may want to use a different color star to track this. If this works with your child and you like it, great! If this method doesn't appeal to your child, let it go. No big deal. Meanwhile, bear in mind however that we never want to imply that NOT going potty or not sitting is "BAD". Just smile and shrug and say, "Oh well. Maybe next time!" Above all we want to reinforce the idea that this is an ongoing process, part of growing up. You can even tell your child at some point, "You're growing up. You can do things now that you couldn't before." And talk about what it will be like to be potty trained. This helps your child get the idea that diapers were just a passing phase.
Some parents also like to try...
Important Things To Remember!!
Articles on Toilet Training
From inflatable potties, to bring along seat toppers, to fold and go seats that your child can carry himself.
Potty Training a Child in Daycare Some helpful tips that hold true whether your child is in a daycare center or spending the occasional afternoon at Grandma's house.
A Child's View of Toilet Training Every parent should read this article! A good reminder of what it's like to be small and faced with The Potty. (Does anyone remember the fear of falling in?) Sensitive and humorous. From the Pampers Institute.
Daytime Wetting: Steps To Save Embarrassment Explains the typical causes behind daytime wetting accidents and offers excellent practical tips to avoid or lessen incidences. Also explains when wetting problems are cause for special concern.
Step By Step Toilet Training
Excellent, straight-forward advice from one of the best known experts in child development. Be sure to check out the important companion article ...
Toilet Training Do's And Don'ts Brazelton is well-known for his (well-researched) opinion that children who are rushed and forced into potty-training experience more behavior problems than children allowed to develop at their own pace. Bottom line: if the preschool you're checking out demands potty-training before admittance, find another preschool!
Toilet Training Step By Step
A nice article. Sensible, compassionate, and complete. Parent's will want to make up their own mind whether to use rewards to reinforce potty training. We are opposed to giving children food rewards. But we liked her idea of giving stickers "just for trying" -- plus extra ones for "going" in the potty. (As opposed to rewarding only for "going".)
Helping the Child That Won't Go Oftentimes, children might be physically unable, or outright refuse, to use the potty. Here are some tips on helping the child that won't go. Read more...
How Do We Treat Chronic Constipation? Children's Medical Center, University of Virginia.
Part of a series of highly informative
articles on this frustrating (and painful) problem. See also:
What Is Constipation?
and
Why Do Children Become Constipated?
Stool
Withholding and Constipation in Children Practical help on dealing with this fairly common childhood problem. Dr. Stoll also offers his perspective on why your doctor may not have been as helpful as you had hoped. Especially useful for those looking for a method that does not involve prescription medication or "allopathy".
Once your child has mastered daytime dryness, it may still be a while before he or she has the ability to stay dry at night. Nighttime dryness presents its own challenges, including being able to hold urine for such a prolonged period, being able to wake in the middle of the night to use the potty, getting to the potty "in time", and so on. Here are some tips from various experts that may help:
Medical doctors says that one of the most common causes of night time wetting is a bladder that simply hasn't caught up with the growth spurt that the rest of the body has undergone. As soon as the bladder grows to a larger capacity, the problem will disappear. Sometimes too the problem is that the sphincter muscle that holds in the urine hasn't developed enough strength, and this too usually improves with time. Some experts recommend having the child try holding their urine a bit longer a few times during the day, to strengthen these muscles. (Just be sure to do this at home where a change of clothes is possible!)Another culprit may be the body's ability to manufacture Antidiuretic Hormone (ADH). ADH regulates the bodies urine production, preventing the need to urinate as much at night. Studies show that kid's with chronic bedwetting problems are much more likely to to have low levels of ADH. On the other hand diabetes and chronic Urinary tract infections can also cause bed wetting, and so it is critical that the first step in addressing the issue is to contact your pediatrician for an evaluation.
Meanwhile, it's important to remember that while the body will outgrow problems like bladder size and sphincter strength, there will be lingering emotional difficulties if we turn the problem into a source of shame and conflict. So do the whole household a favor, cover the children's beds with plastic mattress protectors. These can be purchased very cheaply at departments stores like Wal-Mart, Kmart, and Target. While you are there, pick up an extra bed pad, or maybe two, so that when you strip the sheets, you can just strip the absorbent bed pad along with it. If the problem occurs more than a couple times a week, you should consider investing in some "Good Nights". These are similar to "Pull-Ups" but are made for older children and provide greater absorbency. Wearing Good Nights will eliminate the need for you to get up in the night, and also eliminate the number of times your child wakes up soaked in urine -- an unnecessary torment if the source of the problem is lagging bladder size. Also, being up in the night with wet pajamas and bedding can cut into your child's ability to be rested and ready for school. It addition to the conditions listed above, medical experts on bedwetting explain that there are two other physical components that should be addressed: the kind and quantity of fluids consumed before bedtime, and constipation. Most parents, and even kids, realize that drinking a large amount of fluids within 1 to 2 hours of bedtime is likely to up the chances of wetting the bed. (Similarly, late meal times may cause problems for some kids.) If the beverages consumed contain caffeine, this adds another troublesome component in that caffeine (present in many sodas as well as chocolate products) actually causes the body to release more urine. Note that it is important to remember that milk too qualifies as a "fluid", and should be limited before bedtime. Finally, constipation is often the unsuspected culprit in bedwetting problems. What happens is that the child who does not consume enough liquids (i.e. early in the day) and fresh fruits and veggies and high fiber grains develops constipation. The child may become so used to having some level of constipation that he or she no longer notices. But at night, the more rigid, heavy, and certainly full lower intestine of the constipated child will press against the bladder as the bladder expands. The result is that the bladder cannot expand to full capacity. It reacts as if it is "full", and it empties. So another tactic to try is making sure your child starts the day with a full 8 ounce glass of water. Encourage more at mid-morning, and early and late afternoon. This should also help quench their thirst and so cut down on whining for fluids near bedtime. Be sure to also increase your child's intake of fruits and vegetables. (In small children, constipation can also be helped by fruit juice intake, as the added sugar acts as a stool softener.)
Once you have cleared your child's health with
his or her doctor, and while you are waiting to see if tackling
constipation helps, remind yourself to be patient. Taking a
relaxed, matter of fact attitude to the situation will help both you
and your child to get through this trying situation.
Be sure that you explain to your child about the physical causes of bedwetting, as explained above. Understanding that it is a physical problem and not a failure of character will ease the child's mind greatly. Above all, avoid punishment or harsh words. It may seem like your child is being "lazy" or slovenly, but this is simply not so. And if in fact there is an emotional component behind the problem (as when it starts after an unsettling or traumatic incident), then hurtfulness is certainly not going to heal the source of the problem. If you feel there is some emotional reason for the bedwetting, then ask your pediatrician to refer you to a counselor who has experience in this area. Together you can review your family life and your child's personal life for sources of stress or trauma. Be aware as a parent that bedwetting is often associated with childhood molestation. So if your child develops this problem after having no prior difficulties, be sure to address this possibility. As with any of the challenges we deal with as parents, it's important to seek out support. Talk to someone who can offer a listening ear without criticism or a need to take over and "fix" things. Use a journal to vent some of your emotions and to help sort things out. And if need be, share your feelings with a counselor; there job, and in fact purpose in life, is to help you get through tough times with a lot less hardship and misery. Be kind to yourself! You'll have a lot more to offer your child. In our bookshop you will find a selection of books that address this troublesome issue and delve into its causes and solutions with greater depth. (You may need to scroll the book display panel downward.)
Although we have not included them for promotion on this website there are also "alarm" devices that help condition children to the awareness of their bladder emptying. Opinions on these alarms is mixed, with some families viewing them as a godsend while others call them useless. But many experts feel that alarms are of benefit to those children whose biggest trouble is waking up when their bladder is full. A study done in Canada in the mid 90s showed that a large number of bed-wetting children really are harder to wake during the night than other children the same age. So if the other actions described above do not work, we advise you to discuss bedwetting alarms with your pediatrician to get his/her recommendation for one that really works. When all else has failed and your child is approaching an age where night time wetting is just too humiliating, another possibility you should discuss with your doctor is medication. DDAVP and Imiprimine are commonly prescribed. DDAVP is now available in a form that does not require refrigeration, making it more useful for sleepovers and summer camp situations. Desmopressin is used to treat those who have low levels of Antidiuretic Hormone. Medication is a last resort because it only masks the problem, rather than resolving it. And of course, we always advise caution about medicating children as their bodies are so much more sensitive to long term effects. (And children are not as well studied by drug companies as adults.)Finally, never underestimate the usefulness of prayer and other spiritual practices. Spiritual beliefs aside, everyone needs a constructive outlet for powerful emotions and desires! Asking one's higher power for guidance is an excellent tool for coping with difficult situations.
Articles on Bedwetting
Bed Wetting A nice article from Today's Parent that covers the whys and what-to-do's of this common problem. From FamilyDoctor.org A brief, straightforward fact sheet about bed wetting -- what causes it, the ages at which most children outgrow it, and what kind of treatment is available when a child has not outgrown it by the expected age. What Parents Need To Know About Bed Wetting From KidsHealth "Every night across America, 5 to 7 million children are turning off the lights, going to sleep, and wetting their beds. The medical name for bedwetting is enuresis - "the involuntary voiding of urine beyond the age of anticipated control" - and it's a common condition in children. It's also a very stressful one for parents and children alike." Read More... "ONLY 38 percent of parents correctly identified bed-wetting as a health condition rather than a behavioral problem the child can control, according to a survey of 745 parents of children ages 3 to 14." Read More... .
Helpful Links from the U.S. National Library of Medicine's Online Medical Encyclopedia
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Have your child always "try" one last time before bed.
Let going potty become one more element in
the bedtime routine. Brush teeth, put on pajamas, go potty.
If story time is prolonged, then have them go one last time before
you tuck them in and turn down the lights. 
If your family is working on the issue of night
time dryness, it's important to do whatever can be done to whittle
the problem down to size. This means, number one, taking
the shame out of the issue. Bed wetting is a normal
problem that happens to most kids to one degree or another.
