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Potty training tips

It's My Potty, and I'll Try if I Want To!

by Laura Nathanson, MD, FAAP
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Potty training is a unique task in which parent and child need to work as a team. Achieving the goal should make trainer and trainee both feel proud, empowered, and closer than ever. As a pediatrician, I've seen this work best when parents choose their approach based on their family's lifestyle, temperament, and values. That means mulling over these questions: Is it better to "condition" a baby to pee or poop into a receptacle, or to wait until toddlerhood or later, and then actively teach potty skills? If not, at what age should a child be potty trained? How can you tell if the child is ready? How do you go about getting child and potty together?

There are three very different opinions about all these questions.

Baby Potty Training Strategies

Strategy 1: Very early potty training. And I do mean early-before four months of age. With this method, you simply assume that any healthy infant is ready. The key is to have the baby go (gasp!) diaperless - the normal state in many cultures, including America in past times. The adult learns to read a baby's subtle behaviors right before a pee or poop is produced. When those cues occur, the alerted adult makes a special sound and holds the baby over the ground or a receptacle. The baby becomes conditioned to empty the bladder or bowel to the sound, the way Pavlov's dog responded to a bell.

For the baby, this method means no diaper rash or sitting in a messy diaper. For the parents, it means no diaper expenses, and not dealing with potty training a toddler or preschooler. And of course, it lessens the ecological burden of disposable diapers in landfills and the effort of laundering cloth diapers.

However, this method requires dedication and focus. Some parents may find that focusing on the baby's output so intensely detracts from taking delight in the baby's other virtues. And, of course, if the baby hears the "special sound" when it isn't intended to produce results - in a crowded elevator, for instance - difficulties may arise.

Finally, there is no "graduation moment" for anyone, no big day when you call Grandma or Big Bird to tell them about a successful potty event. But how important should that be?

Here are some great books on very early potty training:
Early Start Potty Training by Linda Sonna
Infant Potty Training : A Gentle and Primeval Method Adapted to Modern Living by Laurie Boucke

Strategy 2: Toddler toilet training. Toddlerhood is the age from around eighteen months to about two-and-a-half years. For potty training to work, the child needs to be able to understand and cooperate with the process.

It also depends on the ability of adults to handle the project with a positive attitude, consistency, and a tolerance of accidents. When the topic of potty readiness comes up, it's the readiness of the adults that matters even more than that of the toddler.

The toddler should understand the use of a potty (from watching others use the potty or toilet). The potty should be comfortable, easy to clean, and portable, so that it can always be placed close to where the child is. The best potty to learn on is a freestanding, stable one that's portable and has no sharp or rough edges.

Make sure the potty sits low enough to the ground. Nature has designed pooping to work best when the pooper assumes a full squatting position, knees as high as the shoulders. (I recall one child who, at age ten, would still assume this position, perched on top of the adult toilet seat!)

Getting the potty is the easy part. The hard part is gaining the child's cooperation, and reinforcing it. This is a good age to try a modern version of the old "Betsy Wetsy" doll; now there are Boy (Paul) and Girl (Emma) versions.

To find the training method that best suits your family, sample several books on the subject.

Strategy 3: Wait until he or she is ready, however long it takes. This is not so much a strategy as it is a capitulation. If a child hasn't started potty training by age three, chances are that it's not a question of readiness. It's simply that either the child or the parent does not want to give up diapers.

Diaper changing can become a sure way for a preschooler to feel powerful. Very often, the moment the child calls attention to a wet or poopy diaper, the adult drops everything - even hanging up the phone to tend to the matter. What a triumph for the child!

And the process can be very pleasant - the adult pays full attention to the child, often talking to and praising him or her, and making happy eye contact. In a busy household or daycare, diaper changing can be almost the only time the child reliably can reliably count on getting this much undivided attention. Parents may enjoy it just as much as the child.

But delaying potty skills beyond age three can drive adults bananas, and get a child teased - and that's not good for anybody.

Sometimes all it takes to fix potty refusal is to make the diaper changing inconvenient for the child (interrupting him or her in the middle of play, for example), and making it a very businesslike operation without sustained eye contact or chatting.

In contrast, each time the child sits on the potty, the adult interrupts other activities to give approving, playful attention, such as reading aloud one of the many potty books for children. Consider taking your preschooler along with you to choose from the array of encouraging, inspiring, hilarious books, such as: The Potty Book for Boys or For Girls, Where's the Poop?, Potty Train, Even Firefighters Go to the Potty.

And, of course, don't forget those indefatigable potty-user pals: Paul and Emma!  
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Meet Our Expert
Laura W. Nathanson, MD, FAAP
Pediatrician
Pediatrician Laura Nathanson grew up as Laura Jean Walther, in Lakewood, Ohio. She obtained her BA, magna cum laude, from Harvard. After earning her MD from Tufts School of Medicine, she went on to a Residency in Pediatrics at Boston City Hospital.

She completed her Pediatric Residency at Children's Hospital of Michigan, and then a Fellowship in Peri-Neonatalology (the care of premature and high-risk newborns). She is Board Certified in both Pediatrics and Peri-Neonatology.

She, her husband, and their daughter settled in San Diego California in 1981. Over the next twenty years, Dr. Nathanson worked full-time at El Camino Pediatrics in Encinitas, CA. She also wrote a monthly column and occasional features for Parents Magazine and served as contributing editor to Healthy Kids, a publication of the American Academy of Pediatrics. In every year of full-time practice, she was named by her peers as one of the "Best Doctors in America." She is also the author of The Portable Pediatrician.

After her husband died following a tragic misdiagnosis in 2003, she wrote a layperson's guide to reading one's own medical record, What You Don't Know Can Kill You!, in order to catch and correct careless errors before they become fatal.
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Laura W. Nathanson, MD, FAAP
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Laura W. Nathanson, MD, FAAP
Book Cover Image. Title: Portable Pediatrician, Second Edition:  A Practicing Pediatrician's Guide to Your Child's Growth, Development, Health, and Behavior from Birth to A, Author: by Laura W. Nathanson, Laura W. Nathanson

Portable Pediatrician, Second Editionby Laura W. NathansonLaura W. Nathanson

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