4.9: Toilet Learning

Learning to Use the Toilet

As the infant grows into a toddler, toilet learning becomes a major milestone. Although we will talk about it here in physical development, the process involves all the domains. The term most used by caregivers for this process is toilet learning. This is a skill that needs to be learned like any other task. Toileting should never be the cause of discipline.

Fig. 4.9. Child sitting on toilet

Image Source: Toilet Learning. Healthy Living. CaringForKids.csp.ca

Toilet Learning is a Process

It may be helpful to think of toilet learning as a process where both the adult and child each has their own "jobs" to do.

The adult's "job' is to create a supportive learning environment:

• recognize the child is in control of his or her body
• let rhe child decide whether to use the potty or a diaper/pull‐up each day.
• teach the child words for body parts, urine and bowel movements.
• provide the child with the tools they needs to be successful at toileting (such as a small potty chair, potty seat, stool, etc.).
• expect and handle accidents without anger
• avoid both punishment and too much praise

The child’s "job" is to:

• decide whether to use the toilet or a diaper/pull‐up.
• learn their body’s signals for needing to use the toilet.
• use the toilet at his own pace

The Four Stages of Toilet Learning

When it comes to toilet learning, every child is different. Some children are ready as young as 18 months, but most start between 2 and 4 years of age. Be patient and follow the child’s cues through each stage of the process. As a caregiver it is also important to communicate with the child’s family to be consistent.

Stage One: Toilet Play

• pretends to toilet usually with their clothes on
• observes others going to the bathroom
• shows an interest in the toilet by liking books about learning to use the toilet

Stage Two: Toilet Practice

• practices flushing
• practices pulling pants up and down
• practices getting on and off the toilet
• practices squatting and standing
• practices hand washing
• asks whether a diaper is wet or dry, clean or dirty

Stage Three: Toilet Learning Readiness

• is dry in their diaper for several hours in a row
• has regular and predictable bowel movements
• shows interest in wearing “real” underwear
• feels the need to urinate by showing gestures, using facial expressions, or expresses it verbally
• acquires the desire to be clean
• has words for using the toilet, such as "potty"
• tells you when they have to go
• can pull pants up and down for themselves
• stands and sits well on their own
• shows signs of pushing and concentration when they are ready for a bowel movement
• tells you they are soiled or wet and needs to be changed

Stage Four: Independent Toileting

Toilet learning won’t happen overnight. Toileting independence is child directed. Children notice their body signals by themselves, and area able to use the toilet or ask for help using the toilet outside of the. home.

Fig. 4.9.1. Toddler on a toilet chair

Image Source: Tod Morris. Potty training Jaiden. Flickr.com

Make a Plan

A child might be more stable on a toilet chair so that their feet can touch the floor. If you don’t use a toilet chair, you’ll need a toilet seat adapter and a footstool.

• be sure to dress the child in clothes they can pull up and down easily by themselves
• choose words for body fluids, functions and parts
  • use the right words - urine, bowel movement, penis and vagina - to help avoid confusion or embarrassment
  • avoid negative words like “dirty” or “stinky,” which can make the child feel self-conscious
• let the child pretend to help a favorite doll or stuffed animal use the toilet

Always go with the child to the bathroom.

Practice

Develop a routine. Have enough time to patiently help a child every single day.

• have child sit on the toilet at specific times during the day
  • first thing in the morning,
  • after meals or snacks
  • before and after naps.
• help child get used to the toilet.
  • let them sit on the toilet while fully dressed
  • encourage them to sit on it for a few minutes without wearing a diaper
• watch for signs that they need to use the toilet.
  • encourage child to tell you when they need to go.
  • be sure to praise, even if they tell you after the fact
• read to the child while they sit on the toilet to help them to relax
• show child how to wipe properly
  • girls should wipe from front to back. Most
  • an adult will need you to wipe for them, especially after bowel movements, until preschool age
• teach child to wash his hands after using the toilet
• expect accidents – they will happen!
  • be sure not to punish or overreact
  • have a change of clothes on hand.

Boys usually learn to pee sitting down first. This is okay. They can learn to stand up later. When child has used the toilet successfully for at least a week, suggest they try cotton underpants or training pants. Make this a special moment. Typically pull ups are not recommended as a toilet learning tool. The pull up stays too dry and does not indicate to the child that they have urinated and are wet.

What if toilet learning doesn’t work?

If the first try at toilet learning doesn’t work, the child may just not be ready. Don’t be disappointed or upset. Don't rush a child into using the toilet. If child refuses to use the toilet, take a break from the training for about 1 to 3 months.

The child may not want to pass a stool in a toilet, especially if they don’t have good support for their feet. If that happens, let them have bowel movements in a diaper so they don’t get constipated. Constipation can cause bowel movements to be painful. If it hurts, it’s likely to take even longer to learn to use the toilet.

Sometimes a child who has been using the toilet will slip back and start to have accidents. This can be caused by a period of stress, like a new baby or a recent move. If this is the case, it's okay to go back to using a diaper. Watch for signs the child is ready to try again.

Even though a child may be clean and dry all day, it could take several more months or years for them to stay dry during naps or all night.

There may be concerns to refer to a doctor if:

• child is not using the toilet by 4 years old.
• child was using the toilet well for 6 months or more and now seems to be slipping back, without a major stressor
• child is withholding stool, experiences pain when using the toilet, or has blood in the stool
• child develops redness or rash around the vagina or a foul smelling or cloudy urine
• child suddenly seems to need to go more frequently or urgently.

Sources

• All About Potty Training. Child Development and Family Center. Northern Illinois University.
• Hayward, Kristi. The Four Stages of Toilet Learning. Child Development and Family Center. Northern Illinois University.
• Toilet Learning. Healthy Living. CaringForKids.csp.ca