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In learning to use the toilet, the child takes a dramatic step toward control of his own life. This is often the first real opportunity the child is given to independently manage an activity of daily living, one that no one can do for him. It is, however, an activity both emotionally charged and often messy. Not surprisingly, more abuse occurs during toilet training than during any other developmental step. Parents’ expectations often exceed the child’s abilities or understanding, and the child’s frustrations and imperfect attempts at self-control are easily mistaken for willful disobedience.

The pediatrician can help make the parents’ (and thus the child’s) life easier by helping parents properly assess the child’s readiness before beginning the toilet training process. At the very least, the toddler should be able to indicate wants and needs verbally, and should have the motor skills to sit on, and rise from, the potty chair. If an assessment is completed and it is determined that a child is not physically or emotionally ready for toilet training, parents should be encouraged to delay training. Explain to parents that initiating toilet training too early can create stress for the child and ultimately prolong the toilet training process. When they are ready to begin the toilet training process, help parents understand that non-punitive, reward-based techniques are more effective and that their recognition and affection are the best rewards. Remind them that setbacks are common. Caretakers need to understand that the process of learning self-management may not be a quick one, and that occasional relapses need not be seen as failures (on the part of either party), but as a natural step toward success.

As with other teaching challenges, a consistent approach will be most successful. Parents must be reminded to coordinate their efforts with each other and with other caretakers to avoid confusing the child (read more)