GONE TO POT
RELIEVE THE STRESS OF TEACHING YOUR LITTLE CHILD TO RELIEVE HIMSELF WITH THESE
DOCTOR-RECOMMENDED SUGGESTIONS

The dreaded task of potty training: it’s enough to make you reconsider that those middle-of-the night feedings were
the worst part of raising your child thus far. If the thought of helping your child make the transition from diapers
to potties is stressing you out, follow these helpful tips from Reva Snow, MD, a pediatrician in Chevy Chase, MD,
to make the job as easy as (number) one, (number) two, three.

THE FAMILY GROOVE: What age range do you recommend parents begin
making the steps toward potty training their child?
Dr. Reva Snow: I usually begin talking about toilet training at the 15-month checkup. However, there are many countries and cultures in which children learn to control elimination earlier. The earlier-timed elimination communication method is gaining momentum here in the U.S., as documented in the October 9, 2005 issue of The New York Times. I think early toddlerhood is a great time to start thinking about toilet training for a number of reasons.  First, it's an age when most children are more communicative than in earlier infancy. Second, they can walk and sit voluntarily. Third, they are interested in mimicking whatever mom and dad are doing. And last, they aren’t quite as contrary as they usually become in later toddlerhood. All that being said, I think the best time to start toilet training is when you're ready and you think your child is ready, which obviously varies from family to family and child to child.

There are plenty of age-appropriate potty books out there to introduce your toddler to the idea of using the toilet. Once Upon a Potty is a classic. The American Academy of Pediatrics has a Guide to Toilet Training for parents as well as a useful information page, which is located at  www.aap.org/healthtopics/toilettraining.cfm.

TFG: Are there any indicators that a child might be ready (or nowhere near ready) to begin the process? 
RS: When your child exhibits a good number of the following skills or behaviors, it’s probably an indicator that he or she is ready:

1. Child has the adequate motor skills for using toilet independently – can walk, sit, pull down pants
2. Child can follow simple instructions
3. Child can imitate parents' behavior
4. Child is interested in the toilet/bathroom/potty chair
5. Child has regular and predictable bowel movements
6. Child wakes up dry from naps or is dry for about two hours at a time during the day
7. Child communicates that he or she is wet/soiled (even if right after the fact ) or the need to pee/poop
8. Child seems uncomfortable in wet or soiled diaper and wants to be changed
9. Child asks to wear underwear

Keep in mind that it’s a good idea to not begin the process of toilet training at same time as major transition or a stressor like the arrival of  a new sibling, starting daycare or nursery school or moving.

TFG: What are the first steps you recommend a parent take when beginning to potty train their kids?
RS: I always recommend that parents take a few preliminary steps like leaving the bathroom door open and talking to their child about pee, poop and the toilet in a matter-of-fact way, that does not include the use any negative language like stinky, gross or dirty.

It’s a good idea to get a potty chair and let your child sit on it when he or she wants, with or without a diaper, for as short a period as they want. Never force a child to stay on the toilet. Let your child know what is supposed to happen when they sit on the potty, and give positive verbal reinforcement if pee or poop comes out while they are sitting there.

Once they've been using the potty comfortably for a while, parents can switch to what I call intensive toilet training. Begin by getting some underwear, and lots of it. Take your child with you to choose which ones she or he wants, and switch from diapers to underwear fairly quickly, knowing there will be accidents. Take your child to the bathroom many times a day ―about every one to two hours for an average two year old. Make it fun, but more or less matter-of-fact. Avoid putting pressure on your child or creating any anxiety about the process.

TFG: Do you have any good products to recommend to aid in the process? What do you recommend a parent keep on hand for emergencies? 
RS: I'm a fan of the potty chairs that sit on the floor because the child can get on it easily and keep his or her feet planted on the ground. If you use a seat that goes over the regular toilet seat, look for a stool high enough for your child's feet to rest on it comfortably. I'd also recommend keeping your child in diapers until they are really dry for a few hours at a time because diapers are more absorbent and will protect the skin better.  Pull-ups are fine for an older child at night or if you might be away from an accessible toilet for a while, while cotton training pants with a thicker, more absorbent pad sewn in can be useful in the transition to underwear.

Make sure your child has plenty of easy-off clothing without buttons, snaps or zippers, and always remember to bring a change of clothes and underwear ―or two― whenever you go out.
 
TFG: About how long does the potty training process usually take?
RS: The answer to this depends in part on what you would consider toilet trained. Total self-sufficiency, which includes doing a decent job at wiping, probably won't happen until they are over four. But keeping dry underwear throughout the day can happen in a matter of days to weeks if the child is helped to remember to use the bathroom and to recognize signs that they have to go.

TFG: Is there an age that you'd consider too old for a child to not be potty-trained?
RS: A child with otherwise age-appropriate development over the age of four who has no bowel or bladder control should be evaluated by a pediatrician.  I would also recommend talking to your doctor or practitioner for some behavioral tips if your typically-developing  four-year-old can control her bowels and bladder but refuses to use the toilet.

TFG: Any final tips?
RS: Yes―if your mostly-toiled trained child asks for a diaper in which to have a BM, give it to him/her. Remember that every child is different―some train earlier, others later; some boys quickly learn to pee standing, others prefer sitting; some gain bowel control first, others bladder control. Always support your child's efforts and help them feel in control of the situation. You can't force toileting. In picking battles with your toddler, this is one to avoid, as you will not win.

TRAINING DAYS
Below, find our favorite potty-training accessories:

Baby Bjorn’s Potty Chair is a sleek, stylish way to toilet-train your child. ($22.99, www. buybuybaby.com)	Baby Bjorn’s Safe Step Stool eases the climb up to the toilet. ($15.99, www.buybuybaby.com)	Pimo’s Folding Potty Seat keeps germs at bay when you’re on the go and your child has to go. ($12, www.egiggle.com)	Alona Frankel’s Once Upon a Potty, which comes in both girl and boy versions, is a time-tested instructional favorite. ($5.99, www.bn.com)