Potty Training Question

Parent Question: By this point, my child has the hang of peeing in the potty. She still sometimes goes in her pull-up but more so on the toilet. We're continuing to have two issues I'm hoping you can advise on:
1) Very rarely does she ask to go to the potty. She's not good at vocalizing her need to go. Does this come with more practice and maturity or is there something I can do to help get her to realize she needs to go and then tell us (before the fact)?
2) She has only pooped in the potty a few times since we started potty training in the beginning of September. Most of the time, she goes in her pull-up. Any advice?

Answer: For both issues I would start with the language of ownership. For the first concern something like, "Do you know that feeling in your tummy/that pressure in your tummy when you need to pee? You are the only one in the whole wide world who knows when you feel that. It is your job to tell me when you need to pee." or "Let me know when you need to pee. Remember I can't do that for you." For the second concert, "You are so potty trained for peepee! I know when you are ready, you will put your poop in the potty too." I know this language can feel awkward and it is supposed to be delivered in an upbeat (no discipline) way. Also not around accidents or on the potty as it can feel like discipline. More a peptalk as you are tucking her in or while driving home from preschool, out of the blue.
Yes, the first concern should also settle with age and practice.
Have her at least be in the bathroom for the second concern. "The place to be when you need to poop is in the bathroom. I know you're not ready to sit on the potty for that, but everyone poops in the bathroom." Don't force this, just encourage. If she is willing to do that you might have her sit (starting with pullup on and even dressed) on the potty.
I know this can be a long process.

Going Poop a Little at a Time

Hi Dr. Rene,
My son is 3 years and 8 months old. He has been totally potty trained for pee for six months but refuses to poop on the potty. He was constipated but that resolved. He holds it in and poops a little at a time in his pull-ups. When he does, he immediately wants me to change him which ends up being five or six times a day. He has only gone poop in the potty three times. Each time, we had a parade in the living room to celebrate. I have tried just letting go, rewards, stickers and a coin jar. What else can I do?
Sincerely,
LeighAnne
Mother of two, ages 3 and 10 years old

Hi LeighAnne,
I would argue that you are still dealing with constipation or at least the withholding that can follow a bout of constipation. Children who have been constipated often hold their poop so they won't again have the pain they felt from pooping. Unfortunately this just starts a negative cycle. The more they hold, the worse it can hurt and so on. The general idea is that this needs to move at their pace and without pressure.

There are many things you can do. Let's start with the easy, general ones

• Play the videos and read the books - There are so many good potty books and videos available. Mix them in with your other story or tv times.
• When you do change him, let him watch you empty his poop into the potty. Help him make that connection "the potty is where poop belongs."
• Change all diapers in or just outside the bathroom. Again sending the message about place and letting him know we have to stop and go to the potty each time.

Next let's address the ones related to the constipation

• Increase fluids, particularly water.
• Increase exercise, particularly walking.
• Check his diet. Think fiber, fruits and vegetables. Make fruit smoothies and add in a few prunes. Add raisens to all snacks.
• Avoid white bread, rice, bananas and too much milk.
• Talk to the pediatrician but you might try an over-the-counter remedy such as mineral oil.

Now for the specifics

• Let him know it's okay to poop in a pull-up but encourage him to at least stand in the bathroom while he does this.
• Once he is comfortable, encourage him to sit for poop. This can be with his pull-up on sitting on the floor or on the closed lid of the potty.
• Once he is comfortable, you could have him try on the open potty and then on the open potty with no pull-up.

All of your language and efforts should be encouraging him to take ownership. Out of the moment and maybe once a day say things like "You know you are the only one in the whole world who knows when you need to potty," or "You know that feeling in your tummy when you need to poop? I can't feel that, just you!" The idea here is to make it their job, to encourage ownership without pressure.

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Increase Interest in Potty Training

Are you thinking about potty training in the near future? Have you been at it a while but stalled in the process? Is your child "just not interested"? These tips may help.

*Let Them Observe*
If you are at all comfortable with the idea, let them observe. Children learn best through modeling and taking them in with you provides this opportunity. Let them watch and answer any questions they have. By all means, if this is uncomfortable don't do it.

*Talk Them Through*
Talking them through the process can start while you are still changing diapers. You can talk about how they poop and pee and you can label bodyparts. You can talk about how someday they will go on the potty. When they observe you in the bathroom, you can talk about all that you are doing includng flushing and washing. Once you are making the transition you can add language about "that feeling in their tummy that means they need to go."

*Read the Books & Watch the Videos*
There are many good potty training books and videos on the market. The idea is to casually mix in the books with your other story times and the videos with your viewing time.

*Change All Diapers In or Just Outside the Bathroom*
Stop changing diapers all over the house. The first benefit is that children who hadn't already may start associating the bathroom with going potty. The second benefit is that children who just don't want to stop playing to go potty have to whether they make it or not. This goes for when you are out running errands as well, find a bathroom.

*Dump or Hold Over Their Potty*
This idea also helps children to make the potty connection. Whenever you change a poopie diaper walk with the child into the bathroom and dump the poop into their potty saying "the poop goes in the potty" and then flush or clean as you would have. If it is a wet diaper, you can just hold the diaper over their potty saying "the peepee goes in the potty." I know this may create an extra step but may be helpful in the process.

*Sit and Relax*
Some children are too nervous to have success if the push is to "sit and try." If this is the case, it may be best to shift the focus to "sit and relax," sit together and talk or sing or read books or put on finger plays.

*Presenting the Potty OR Making It Their Own*
This means make the initial presenting of the potty fun. Maybe take a special shopping trip to pick out a potty or let them help choose which potty seat they like. If the potty is already out, you've been trying for a while already or they have older siblings, have a potty decorating day. You might let them put stickers on the (cleaned) lid or make a poster for the wall behind the potty, something to celebrate that the potty is now theirs.

*Descriptive Praise*
Descriptive praise works to build intrinsic motivation for behavior. In the case of potty training it sounds like, "You knew you had to go!" "You got there so fast!" and "Look, you put your poop right in the potty!" You are describing back their behavior, focused on effort and progress. This helps to give them ownership of the process.

*Underwear as an Under Layer*
For some children, diapers and pull-ups may work too well. Because these products are so absorbent children may not recognize that they are wet. If this seems to be the case, you might have them wear underwear under their pull-up or diaper. This way they get wet just not the floor.

*Take a Tour of Potties*
Start pointing out potties everywhere you go. Talk about how there are potties in restaurants, stores and in other people's homes. If there is time, you might visit the potties. We took the tour at relatives' and close family friends' houses.

refuses to poop on potty

Dear Dr. Hackney,

My 3 ½ year-old son is consistently potty-trained for pee but continues to want diapers for poop. If we refuse diapers, he soils his underwear. What do we do to help him along?

Sincerely,
Maya
Mother of one, three years old

Dear Maya,

First, realize this is NOT an uncommon problem.

Second, relax a little. The “potties without pressure” approach, which is currently supported by the American Academy of Pediatrics, suggests that potty-training progress at the child’s pace. This means if the child expresses he is not ready to move forward, then the parent slows the process.

Following this approach, the average age for successful potty-training is three years old. Three years old is described as “average” as girls tend to be ready earlier (two and a half to three), boys often later (three to three and a half). In this particular case, the child is well within normal limits for potty-training.

It is suggested that children who are otherwise potty-trained but continue to want a diaper for bowel movements be given one and then cleaned and changed as usual. By all means, applaud the successes of the child peeing in the potty but allow for diapers when they are specifically requested with as little negative emotion as possible. If you must comment, say something as mild as, “I am glad you let me know you need a diaper. I know when you are ready, you’ll do that in the potty as well.”

You can gently encourage progress by allowing children to observe you or willing siblings in the bathroom, talking them through the process and mixing in potty oriented storybooks and videos with your other media. You can also take a wet or soiled diaper, with the child in tow, and empty the poop or place the wet diaper into their little potty while saying, “See, this goes in here.” Then empty and clean the potty as you usually would. For some children, this provides a beneficial cognitive connection between their bodily functions and the expectations of potty-training.

The potties without pressure approach defines the parent’s role as recognizing signs of readiness and offering lots of support and encouragement along the way. Signs of readiness include potty talk (“I peed,” or “I go poop.”), potty play (dolls going potty or trucks getting diapers), an awareness of body parts and functions, longer dry times or more predictable bowel movements, increased imitation in play, ability to follow three-step directions (“Go to the kitchen, get your shoes and meet me by the door.”) and an interest in learning the new set of skills.

This approach identifies several signs that children are NOT ready for potty-training. Children who resist the process and protest the practice loudly are likely not ready to proceed. Children who hide to potty are likely not quite ready. It seems to many parents that children must be ready as they are able to recognize they need to go and actually get somewhere to do it. This is seen as a sign that they are physically ready, just not emotionally ready. Children who sit for a while and then stand nearby to poop or pee on the floor may be feeling too tense while sitting on the potty. If this is the case, it is suggested that parents encourage children to “sit and relax” rather than “sit and try.” The language of “sit and try” may make children nervous and when one is nervous and has tight muscles, it is hard to go potty. Once these children get off the potty, they relax and then, unfortunately, void nearby.

Overall, recognize the signs of readiness and provide lots of support and opportunities for success at the child’s pace.
Sincerely,
Rene Hackney, PhD.
Parenting Playgroups, Inc.