Don’t get upset about the prospect of toilet training your two year old or problems you’re having in the process.
Toilet training, when done from a developmental perspective, is a major developmental task for both parents and toddler that results in emotional benefits far beyond putting urine and BMs in the toilet. Before I describe the toilet training process itself, let me begin with a developmental rationale to explain when to begin the training.
Anna Freud, daughter of Sigmund Freud, was a very wise woman who devoted her life to understanding children. She provided us with a developmental framework for understanding toilet training. Spanning four developmental phases, from birth to elementary school, the formulation is a superb example of the practical and theoretical usefulness of thinking developmentally. The goal of developmentally conceptualized toilet training is not only to help form the ability to comfortably control the elimination processes, but, equally importantly, to stimulate the formation of adaptive mental and emotional attitudes and capabilities which will provide a solid core of strength for the child for the rest of life.
The Four Phases of Toilet Training
Anna Freud’s developmental line (1965) is divided into four phases. Phase One, which begins at birth and continues into the second year of life, is the interval in which the infant and toddler have complete freedom to wet and soil. During these months the infant and toddler gradually develop an increased awareness and control of the lower half of the body, of the actions of retaining and expelling urine and feces, and of the body products themselves. As the nerves to the lower half of the body mature during the second and third years of life, the toddler develops the capacity to consciously open and close the anal and bladder openings. This newfound ability occurs at the same time as the growing awareness of body opening and the products that come from them. Toddlers find the actions and products highly pleasurable. Consequently, urine and feces are to be touched, smelled, tasted, and played with; not reacted to with parental avoidance and disgust.
The Phase Two, active toilet training, begins toward the end of the second year of life when the toddler is mentally and physically prepared to participate in the process. By eighteen to twenty-four months, the toddler possesses the following physical and mental capabilities that allow him or her to be an active participant in the process: namely, to understand what the parents expect, to be able to consciously control the muscles which open and close the bladder and anus, and to communicate with the caregivers about his or her intentions.
The parents also need to be mentally prepared for this important interaction with their child. Miss Freud described the parental attitudes that facilitate the toilet training process as follows: “If she succeeds in remaining sensitive to the child’s needs and as identified with them as she is usually with regard to feeding, she will mediate sympathetically between the environmental demands for cleanliness and the child’s opposite anal and urethral tendencies; in that case toilet training will proceed gradually, uneventfully and without upheavals. (1965, p. 74).”
Although Anna Freud refers to mother as the parent who does the toilet training, father is equally as capable and indeed, the process is most likely to be successful when both parents are involved from start to finish.
The interaction between parents and child just described is repeated many times over the months and years of active toilet training. Yes, I did say months and years, not days and weeks. When the process proceeds in a positive fashion, Phase Three, the acceptance by the child of the parental demands for controlled urination and defecation, overlaps Phase Two and results in far-reaching mental and emotional changes in the child. During Phase Three, the child accepts and takes over the parental and societal attitudes toward cleanliness and uses the toilet on a consistent basis. This change is stimulated by the toddler’s wish to grow up, and the need for parental love and approval that override the infantile pleasures associated with wetting and soiling. From this point onward, for the rest of life, the child manifests the typical disgust toward urine and feces found in all older children and adults. And, very importantly, he or she demonstrates the increased ability to control powerful feelings, particularly aggression, that accompany the newfound ability to control the body and its products.
But this is not the end of the story. That occurs in Phase Four. Sometime during the elementary school years, bowel and bladder control becomes completely secure and unrelated to parental involvement. Lapses do not occur, even at times of stress, and the use of the toilet is completely disconnected from parental knowledge, dictates, or support. In the physically and psychologically healthy individual, this state continues for the remainder of life or until some point in old age when physical infirmity undermines the long-standing autonomy and competence of bowel and bladder function.
With some children, toilet training becomes a battle of wills. With others, it is a piece of cake. Temperament - inborn attitudes toward the world which become evident soon after birth and continue throughout life - have a lot to do with how much of a battle occurs. In either event, armed with the knowledge in this book, you, the parent, will prevail. Not just prevail, but toilet train your child with sensitivity and understanding. That doesn’t mean that there won’t be difficult moments or that you will never become frustrated and impatient.
The Right Equipment
So now let’s get to the practical stuff and begin with equipment. All you need to toilet train your child is a potty chair and plenty of clean underpants. The potty chair is a chair with a chamber pot in the middle. The potty chair sits on the floor and allows the toddler to sit comfortably in a seat designed for his or her body with both feet firmly planted on the floor. Watching a toddler precariously balance on the edge of an adult toilet, with a distinct chance of falling in or off, is not the way to encourage cooperation and start the process. Notice that I did not say diapers or pull-ups; I said underpants. When you ask a toddler to only deposit his or her urine and feces in the potty chair and at the same time keep them in diapers or pull-ups (which are simply modified diapers,) you are sending a very mixed message. That mixed message will prolong the toilet training process and, in some instances, undermine it almost completely.
I can hear the groans now. “If I take away all the diapers I’ll be cleaning up urine on the rug and have BMs smelling up the house, to say nothing of wet beds.” I should have added earlier that a rubber sheet is also an essential part of the equipment. Yes, you will have wet sheets to wash for a while. But the result will be worth the extra effort required.
How To Go About Toilet Training
“Mary, It’s time to be a big girl and use the potty like your big brother and Mommy and Daddy. So in a couple of days, we won’t use diapers anymore. And you’ll have big girl pants just like Mommy.” Mary had been curious about her brother’s and parents’ use of the toilet and was noticed observing attentively. Most children respond to the start of toilet training with excitement about the idea of being a big girl or a big boy. One of the major reasons why toddlers eventually cooperate in the toilet training process is because they want to grow up. Repeating the message for a few days before removing all diapers (yes, both day and night) will increase the toddler’s understanding of what is coming.
“Mommy bought these new big girl pants for you. Aren’t they pretty? When you have to go pee-pee or poo-poo (or whatever words you use for urine and feces), you tell Mommy or Daddy, and we’ll go to your potty chair.” The usual pattern is for some compliance and some resistance. Remember, before toilet training begins and the environment places restrictions on urinating and bowel movements, the acts of elimination are pleasurable (as they are for all older humans as well), and toddlers do not share the disgust for the sight and smell of urine and feces that exists with post-toilet trained children and adults.
When Mary uses the potty successfully, the response is “Good girl! Now you’re being a big girl.” But there will be days when Mary will sit happily on the potty chair, maybe even depositing some urine, then stand up and five minutes later have a BM behind the couch. You’ll know because she will quietly disappear for a few minutes. And if you’re listening, you’ll hear a not-too-loud grunt. And then, of course, there is the smell. When Mary resists in this fashion, quietly clean her up, put on a new pair of underpants and calmly tell her to try and use the potty next time.
In regard to wetting at night, when Mary comes into your bedroom in the middle of the night and wakes you up by tugging on the sheets (How inconsiderate of her!) do your best to calmly get out of bed, change her underpants, pajamas, and the sheets. Then put her back to bed, reminding her that big girls use the potty chair and to try hard not to wet the bed.
I know it sounds like a lot of work. “Can’t we just let her train herself?” Not a good idea. Remember, we’re trying to help Mary develop a comfortable sense of control of her body and to internalize core adaptive attitudes toward the world such as orderliness, tidiness, dislike of dirty hands, punctuality, conscientiousness and reliability. All of these traits are positive outcomes of a sensitive toilet training process.
Temporary Delays along the Way
Ideally, the toilet training process takes place in the presence of physical health and environmental stability. Delays or the regressive loss of control can be expected during times of illness and environment instability, such as the birth of a sibling or parental separation. Back off at these times for a few days before returning to a consistent expectation of cooperation and control. In most instances, consistent control of bowel and bladder function, day and night, will be achieved between ages three and four (completion of Phase Three) and complete autonomy by ages seven or eight (completion of Phase Four).
Problematic Parental Attitudes
Problems occur when parents fail to actively train the toddler, usually out of a fear of their own anger when the toddler resists, or when the parent is unusually controlling and severe. Continued wetting and soiling may result from either extreme. Difficulties in toilet training are usually associated with parental inconsistencies or extremes in other areas such as weaning and establishing a consistent bedtime. Children who are not actively trained at an appropriate age often have difficulty in social relationships with peers and adults and are frequently observed to be self-centered and immature. Severe toilet training may be associated with continued bedwetting, soiling or withholding of feces. Clear expectation, patience, understanding of the toddler’s resistance, and knowledge of the developmental thinking behind the toilet training approach described above, will allow parent and child to engage this developmental task without undue stress on either and will result in a child who has comfortable control of his or her body and attitudes and capabilities which will serve them well for the rest of their lives.
Some Examples of Easy and Difficult Toilet Training
An easy child: Joe seemed to be born with a happy, compliant attitude. As an infant, he rarely cried and went back to sleep when he had enough to eat. In the second year of life, he rarely had a temper tantrum and always seemed content. Mom and Dad began toilet training Joe when he was twenty months of age. He was speaking in short sentences by that time and was very curious about his big brother’s toilet habits. He also seemed to have BMs at the same time every day, disliked being in a dirty diaper, and was dry most nights. He was ready.
Joe liked sitting on the potty chair proudly repeating over and over “Big boy pants!” When he did wet his pants or have a BM in them during the first few weeks of the toilet training process, Joe didn’t like the sensations of urine running down his leg or a BM in his pants. He experienced anxiety and cried at those times. He responded well to reassuring words from his parents that he would use the potty next time. Within two months, Joe was using the potty chair most of the time, often announcing that he had to do “pee pee” or “poo poo” as he hurried to the potty chair. Within six months, he was “trained”. I put trained in quotes because I want to emphasize that, although Joe was consistently using the potty chair and was dry at night, he would not reach the fourth stage of complete autonomy in regard to bowel and bladder control for several years.
Would that every child was so easy, so compliant, and so easily trained. But unfortunately, that’s not the case with every child, as we shall see.
Moderate difficulty due to parental inaction: Bill and Sally were busy professionals who deeply loved their first born, Alex, and tended to avoid setting limits. Consequently, Alex wasn’t weaned until he was nearly two, and toilet training wasn’t started until nearly three (after a consultation with me), when Bill and Sally discovered that Alex could not be accepted in their preferred preschool unless he was toilet trained. Bill and Sally listened carefully to the need to actively train Alex and readily agreed to accept my suggestions about how to proceed. Because Alex was nearly three when his parents set a limit on his freedom to wet and soil, he was quite resistant to the idea of using the potty chair. After six months of trying, Alex was urinating in the potty most of the time, but continued to have BMs in his pants.
Further inquiry on my part lead to the discovery that when Alex was at day care, the kindly mother who took care of him continued to put Alex in diapers during the seven or eight hours he spent at her house five days each week. The child was getting very mixed signals from the adults in his life that bolstered his resistance to becoming fully trained. When all diapers were removed, at home and daycare, and all three adults began conveying the same message, Alex began to use the potty for both urine and feces on a more regular basis. But as he neared age four, he was still struggling to obtain mastery of bowel and bladder.
With continued, consistent efforts on the part of his parents and daycare provider, Alex began to use the toilet on a regular basis. His somewhat moody demeanor, present through the months of struggle and resistance, was gradually replaced by increased self-esteem and a sunnier disposition. Alex did go to pre-school, and during the first few months of attendance, he proudly announced every evening that he had used the toilet at school. He also got sadistic pleasure out of telling his parents about classmates who had wet their pants.
The moral of the story—start toilet training at about age two. Actively toilet train your child in the manner described above. If your child is in a daycare setting during your working hours, be sure that the daycare person, who is often a very active participant in the toilet training process, is on the same page as you are.
An extreme case: Bruce and Esther were referred to me by Esther’s therapist because their nearly 3-year-old daughter Amanda was having severe temper tantrums and totally disrupting the household day and night. Esther was a hard- working professional, and Bruce was a stay-at home dad who managed his part-time business from home. He had the primary responsibility for Amanda Monday through Friday.
During the first session with the parents, I listened to this professional woman and six feet two inch hulk of a man describe with anxiety and disbelief how this tiny little girl dominated them and controlled their lives. Amanda was terrible during the day and at night. She had multiple temper tantrums every day, some lasting an hour or more, and demanded a bottle in the middle of the night, thus interrupting her parents’ sleep. No attempt had been made to wean Amanda, and toilet training wasn’t even being considered. Clearly, parents and therapist had a lot of work to do.
Before we could approach the subject of toilet training, Amanda needed to be weaned from the bottle, something that should have happened nearly two years earlier. Both parents looked at me askance, terrified of their daughter’s response, when I outlined the path ahead—gradually wean Amanda and then begin the toilet training process.
Bruce and Esther approached the first task, weaning, as though they were going to war against an army of 10,000. Amanda would never agree, they declared. It took a while to persuade them that Amanda was a very young child without any power that they didn’t grant her. After all, they were the intelligent, competent, physically stronger adults, not Amanda. Amanda would be weaned and toilet trained if they consistently and actively intervened.
Bruce was the biggest problem. He loved the intimacy of holding his daughter while she drank from her bottle. He particularly enjoyed the closeness during the night when Ester was asleep and the house was quiet. My explanation that the infantile connection signified by the continued use of a bottle at age three would not help Amanda grow and mature was begrudgingly accepted by Bruce. But he didn’t fully accept the idea for several months.
Bruce skeptically agreed that we would gradually, over a month or so, reduce the amount of milk in Amanda’s bottle (from eight to six to four to two ounces) and then eliminate the bottle entirely. Amanda had an easier time of it than her father. And within two months, the bottles were gone and Amanda was sleeping through the night most of the time. Father was more prepared to tackle toilet training after the surprisingly easy success with eliminating the bottle.
Once again, Bruce had more difficulty with the toilet training process than his daughter or his wife. At age three and one half, Amanda was more than ready physically and mentally to be toilet trained. Bruce took her to a gymnastic class for toddlers once a week. When she went into the children’s bathroom, Amanda became aware that the other girls there were not wearing diapers. She mentioned this to her father.
Amanda was excited to get big girl pants and wore them happily. She stopped wetting at night over approximately two months but continued to insist on having BMs in her pants. The first success in that area took about three to four months, and another five to six months passed before Amanda was consistently using the potty for both urine and feces.
There was some backsliding along the way. Since I had seen the pattern many times, I inquired if Mom (unlikely) or Dad had put Amanda in diapers. After some prodding by his wife, Bruce admitted that he was afraid to take Amanda to gymnastics in underpants. He worried that she would have an accident, and he would be embarrassed. The second time she went in underpants, Amanda did wet them, but quietly asked her father to change her pants and returned to the gymnastic activities. After that, she neither wet nor soiled at gymnastics or any other public place. Amanda had caught up with the other children her age.
Most surprising to her parents, but not to me, Amanda’s temper tantrums diminished significantly in frequency and intensity. Amanda was developing greater control of her feelings as she mastered control of her body. I ended my treatment of Amanda and her parents at this point. They heaped praise on me as they left. But being the skeptical professional that I am, and knowing Bruce’s desire to hang on to his little girl, I wouldn’t be surprised if they returned when Amanda had trouble separating from her Dad to go to day-long kindergarten and first grade or when she became angry and demanding with her elementary school peers.
So there you have it - a thoughtful plan of why, when and how to toilet train your toddler. Here are the key points.
In the course of my many years of practice, I’ve successfully, through parental coaching and intervention, trained hundreds of young children. I hope this book will result in many more children developing a healthy attitude toward their body and its products.
Reference: Anna Freud, 1965. Normality and Pathology in Childhood: Assessments of Development. New York: International Universities Press.