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Perfect Potty Training

Potty training is one of the most challenging aspects of parenthood, and it can cause major frustration for both parents and kids.

However, the one thing all parents must maintain is patience - and the knowledge that, eventually, it will happen.

Dr. Larry Kutner is a child psychologist and the co-director of the Harvard Medical School Center for Mental Health and Media.

On Monday's The Early Show, he offers the following advice about toilet training - when to start, how to start, how to encourage kids and how long it will take.

The underlying message, when it comes to toilet training, is not to have a deadline for the child. You need to put it into perspective. It feels like such a big deal at the moment when you're going through it, and one loses perspective. There are situations for parents where you do have to get them trained - if their pre-school requires it, or if they're 16. You want to work with the child's age and development.

Toddlers and preschoolers control both ends of their gastrointestinal track - they control what goes in their mouth and what comes out the other end. And if you're fighting with them about that, you're going to lose.

Things To Remember
Things parents need to know about toilet training:
1.) It will happen. Don't lose perspective on it.
2.) You cannot rush biology. No matter how smart they are or how motivated you are, until the child is biologically ready it's not going to happen. The same thing goes for walking.
3.) Don't expect it to be a single episode of learning. It takes time. Expect slip-ups, the occasional bedwetting or soiling. It's to be expected and it's normal.

The "Right" Age
Parents want to know what the "right" age is for their child to be toilet trained, but the honest truth is that there is no one specific age for every kid. And it's different with boys and girls: girls usually get trained earlier than boys. It's going to happen somewhere between the ages of 1 and 4-1/2. There is concern if the child is too young, because that reflects that the parents are putting too much pressure on them. As with so many stages of development, it's more important that the child goes though it rather than them going through it at a specific age. You don't get bonus points for your child being toilet trained at 12 months rather than 24 months. It's also not an "Aha!" moment - they'll be day trained but not night trained, or bladder trained but not bowel trained. The obstacle of getting it done by a certain date is putting an inappropriate amount of pressure on people.

Some specific techniques parents can use
1) Reward successive approximations - the attempts not the results. If you're waiting for your child to do it right before you've said, "Great job!", it's never going to happen. Just sitting on the potty is a great thing.
2) Be sure the child's feet are not dangling. It sounds funny, but this is actually a very common problem. The child will push down with their feet, and if the feet aren't on a stool or on the ground, then they're not concentrating on what they're doing.

Some things you should never do when toilet training
1) Never get upset for failure because it will make things worse.
2) Never shame your child for failing by saying things like "I'm disappointed in you" or "your sister did this at your age and why can't you?"

Signs Your Child Is Ready
Start looking for signs that your child is ready and work with those particular skills that are needed. Like pulling up and down training pants. A lot of children are actually afraid of the toilet, so if that's the case then you need to work with them on that. There are other things you can't work with, like neurological readiness. But there are things that can help, like if they're a little wet they can associate what was going on inside - full bladder, the urge to urinate, etc. - so they can anticipate when to use the potty. Pampers has a new kind of training pants that does allow the child to feel some wetness for this purpose. One of the problems with today's diapers is that they absorb so much the kid can walk around for hours feeling dry, so they don't necessarily know what the feeling is when they have to go.

The other thing that's really important is not to turn this into a battle. If you dig in your heels any self-respecting toddler is going to dig in their heels and they'll win. If it's not working, back off. Your child isn't ready.

You have to remember that this is about the natural maturation of the neurological system. Often, with preschools and childcare centers, they can be rational about it even if they tell you that your child must be trained. But you want to be sure you're working on the same approach as them because if you're not it can be confusing for the child and it will delay things.

You want to really look for the signs that indicate that your child is ready to be toilet trained. If a child lets you know that he or she has a dirty diaper, that's a great sign. Some of the other signs that they're ready are they'll tell you the diaper is wet or point to it or go to a corner. Parents are smart. They know their kids better than anyone else, so you'll see a behavioral difference and figure out that they're letting you know that something's different. Then, it's a matter of watching what precedes that (going in the corner, looking uncomfortable) and then you bring them to the potty. This stuff isn't brain surgery.

The First Step
The very first step in toilet training is called successive approximations. This means: Before they're ready to be trained, you want to get them comfortable with the potty seat. You may leave it in the bathroom or in the den, so that they see it and become comfortable with it. You want to get stories - and there are all sorts of books with stories about the potty. And you want to praise them once they get closer and closer to what you want. You want them to watch you or watch the older kids in your house. For most kids, they're reluctant to have this go down the toilet - it can be upsetting to them. Get it so that going to the bathroom is a natural part of their life and get them interested in going in the potty.

Once you've started the successive approximations, you try to anticipate when they're likely to need to use the potty and plop them down. And if you're wrong, it's not a big deal. If you're right, great! Again, one needs perspective - we're not electing a president here.

Rewards For Success
As for rewarding your child for going to the potty - the best reward is attention. Kids are smart and will go for whatever they can get. But the great thing about attention is that it's highly rewarding, it's not expensive, you never run out of it, and it comes in all the sizes and flavors you need, so go with it. Small rewards are much more powerful than big rewards because kids focus on the behavior you want and not on the reward. Also fast rewards are much more powerful than delayed awards - you want to reward the behavior and not the result. So the behavior you want is the child sitting on the potty and trying to use it. That's when you want to say to them, "You're such a big boy, I'm so proud of you," and so on. It doesn't matter if they actually go or not in the beginning - as long as they're trying.

If Potty Training Is Not Working
If you're trying to toilet train your child and it's not working and you're kid can't do it, then you're just too early. It's as easy as that.

Bowel Training
There are many kids who can get the hang of peeing in the potty, but not releasing their bowels on it. You're not going to be able to have a rational discussion about why they pee on the potty but not poop on it. That's a more complex thing for them to do. If this is happening, you want to make sure that they're not constipated. Are they going in the diaper regularly and what's the consistency? If you have hard stools it will be aversive to the kid.

It's often just a matter of timing and you don't want to make it too big a deal because you'll just make the child anxious. Sometimes, kids won't move their bowels on the potty because they're attached to it - it sounds crazy but don't forget that children are proud of everything they make. If that's the case, then try saying something like, "Let's take what's in the diaper and dump it in the toilet together. Now let's see if you can do it in the potty yourself." You're helping the child understand that this is where it goes and they don't have to be afraid.

But no matter what, keep trying and keep reading the stories and praising your child for trying.

Switching To Underwear
If your kid is getting consistent and wants to wear real underwear, then err on the side of doing that fairly early. That can often be used as a reward, "Do you want to wear big boy underpants?" And it's no big deal if your child wets them. It's the effort that counts.

Part of the idea is if you're in regular underwear it'll be uncomfortable if it's wet. When the child pretty much has the knack of it then expect some accidents, but that also gives feedback. Some parents may say "but my child gets lazy and won't get up to go to the potty if he's playing." If kids are in the middle of playing, switching to something else like lunch or going to the potty is more difficult for them than it is for us. But if you get angry, all the child will hear is "daddy is angry" and they have trouble distinguishing doing something bad and being someone bad. You're not going to help things from your end, and you'll make the child feel rotten if you aren't supportive.

Parents who are going through this stage blow it out of proportion because it feels so important at the time, and it feels like a measure of your skill and competence as a parent. It's not. All children will eventually be toilet trained.

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