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C H I L D H E A L T H
Parent's Bulletin
by Nancy Zerbey
- Is your child ready?
- What's the best method?
- How can you help?
"TOILET TRAINING IS A TERRIBLE TERM", says Dr. Eileen Aicardi, a professor of
pediatrics at the University of California, San Francisco. "It makes the process
sound like boot camp, and if there is one sure prescription for failure in this
area, it's pressure of any kind on the child."
But pressure isn't necessary. Toilet training can be fun!
READY
When left to their own devices, children
spontaneously become interested in toilet training sometime between the ages of
18 and 30 months. They become interested because they want to be grown-up and
in charge of themselves. Like her first step and her first word, a child's first
trip to the potty is part of the larger developmental drive for autonomy.
But before a child can be toilet trained, he must be able to regulate the muscles
responsible for elimination. Such control usually comes at the end of the second
year, when the child is between 18 and 24 months old. Children are usually thrilled
to discover that urine and feces are under their control, but it is still hard
work for them to take responsibility for bathroom routines. That's because physical
control is not the only issue. There is also the issue of social
control -- the battleground of the "terrible twos".
As parents everywhere know, toddlers can be balky. They have strong opinions about
everything and they resent parental interference. So while a child beginning toilet
training may be excited by her newfound physical control, she will want to exercise
that control in her own way and on her own schedule. Unless parents are relaxed
and flexible about toilet training, it can easily turn into a power struggle between
parent and child.
"With a two-year-old, you need to choose your battlegrounds carefully", says Dr.
Aicardi. "There are certain battles you can win, but toileting isn't one of them."
No amount of haranguing, pleading, punishment, or reward can
make a child go to the bathroom. The child must want to go.
IS YOUR CHILD READY?
When the time is right, your child will
show signs of readiness. Here are some common signals.
- The child regularly lets you know when a bowel movement is coming.
- He stays dry for several hours at a time.
- He can hold back his urine for a minute or two even on a full bladder.
- He has learned the family's basic bathroom vocabulary and uses it correctly.
- He complains about wet or dirty diapers.
- He becomes curious about the toilet and asks for his own special potty.
Children vary greatly in the age at which they are ready to begin toilet training
-- and the speed with which they achieve it. Intelligence has nothing to do with
it, but a lot depends on temperament. Like all bathroom matters, toilet training
is a very individual business, but you can look for signs of readiness around
the second birthday.
SET . . .
How you teach toilet training will depend
on when you start. Some families begin at the first sign of readiness -- as early,
sometimes, as 18 months old. Success at this age usually comes from a combination
of close parental attention and intensive behavior modification including frequent
trips to the bathroom, enforced potty sits, repeated reminders, lavish praise,
and regular rewards. As parents often say, "The younger the child, the more training
there is of the parent. "
In the last 25 years, professional opinion in the United States has come to discourage
early toilet training in favor of a more developmental approach that lets a toddler's
own drive for autonomy do more of the work. The goal is to get the child training
herself.
"Don't be in a hurry to start", says Dr. Penelope Leach, the British psychologist
whose book Your Baby and Child has become a handbook of child
development for parents worldwide. "Toilet training is not a question of making
the child do something for you. It is a matter of helping him
to do something for himself. " Parents can help by offering
friendly encouragement and by supplying training gear that helps to build the
child's confidence.
Be especially choosy about your child's potty. Most children feel more secure
sitting on a floor potty than on a seat that attaches to the toilet; it's also
easier for them to push when their feet are on the floor. Be sure the potty won't
tip over, and choose a portable model so your child can go visiting without breaking
her routine. Potties decorated with cartoon characters often appeal to children,
as do potties that play music. Since the potty will soon come to symbolize your
child's pride in toilet training, it pays to get one she will like.
Also pay attention to your toddler's clothing; don't let it get in the way. Banish
buttons for the time being -- also belts, zippered flies, overalls, tight waistbands,
and diaper pins. Some parents let their children go naked during training; others
favor long, loose T-shirts or nightgowns. Many children love training pants, because
they look so grown-up, but others prefer the security of a diaper.
Whenever you can, let your child choose his own training style and equipment.
"The more he feels that the whole business is within his own control", says Dr.
Leach, "the less likely he is to resent it". Dr. Aicardi agrees. "Follow your
child's lead, not your own agenda", she says, "and you will avoid all kinds of
trouble".
GO !
Once the child is ready and the parents are set, toilet training will go along
smoothly -- if it proceeds at the child's pace and without undue
interference. Keeping training on track is a matter of attention, encouragement,
and confidence.
Timing. Getting to the potty on time is half the battle. At first you
may want to suggest a "try" whenever a bowel movement is expected -- like after
a meal. A couple of minutes is enough time to sit; if nothing is accomplished,
try again another time. Once your child can signal her own need to go, she won't
need these scheduled visits, but she may need occasional reminding.
Down to Business. Training comes easier when you break the job down into
several small tasks that can be separately mastered and rewarded. Start with getting
the pants down. Move on to sitting still. Try for bowel control before bladder
control (but don't insist on it), and teach boys to urinate sitting down before
standing up. Follow the child's lead and praise each success along the way.
Rewards. Well-chosen rewards make toilet training go faster, and the
more immediate the reward the better. Parents have had luck with everything from
candy and stickers to kisses and praise. Rewards that are within the child's
own control and which can only be gotten by getting
down to business -- like hearing the tunes from a musical potty -- are especially
good because they promote the very independence the child is trying to achieve.
Accidents. Accidents will happen. When they do, just clean up matter-of-factly.
Remember, too, that toddlers are ingenious excuse-makers, and more than one child
caught in a dirty diaper has blamed a younger sibling for the mess. By treating
any such announcement as a joke and not a lie, a parent can help the child accept
responsibility for his body without feeling ashamed of himself.
Clean-up. Children must be taught careful wiping before they are allowed
to go it alone. Girls should be taught to wipe from front to back after a bowel
movement to prevent bacteria from entering the urethra and causing infection.
All children should be reminded to wash their hands with soap and water after
every visit to the toilet. Parents helping with training need to wash up, too.
WHAT DO PARENTS SAY?
Doctors and psychologists aren't the only
experts on toilet training. Here is some advice from parents who've been through
it all.
- Kids learn quickly that a potty call will get your attention fast; don't
let it become a game.
- Don't make a wild dash for the toilet or a frantic business of yanking
down pants; that will just make your child anxious.
- Don't overdo the praise; if your child is using the potty just to make
you happy, imagine what will happen on a day when she's mad at you!
- Stay out of your child's way by giving her stickers that she can award
herself or a musical potty that rewards her automatically.
- Toilet training can be stressful; if you feel your temperature rising,
remove yourself from the scene and let someone else take the job for a while.
- Have heart; some days you'll think that toilet training will go on forever,
then all of a sudden it's done!
Regardless of the age at which they start, most children will achieve full bowel
control between 3 and 5 years of age; by age 5, 75-80 percent will also stay dry
through the night. For the parent who will change more than 5,000 diapers for
each child, toilet training certainly comes as a welcome development. More importantly,
it is one of the first milestones on your child's road to becoming grown-up. With
patience, tact, and unflappable confidence, you both will have
reason to be proud.
Nancy Zerbey is a Boston-based
writer and the mother of three preschoolers -- two are toilet trained, one still
to go.
This bulletin is adapted from an article
previously published in the Parent's Health Adviser Home Library, distributed
through pediatricians' offices nationwide. If you have further questions about
toilet training, be sure to discuss them with your child's pediatrician.
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