I can’t think of two words that elicit more anxiety and confusion among parents of toddlers than potty training. As the mother of a (still diaper-donning) 26-month-old boy, I am approaching the peak of toilet trepidation, and it isn’t helped by the fact that every piece of information I come across contradicts a recommendation I already filed away. Training pants? No, go diaperless. Praise him for peeing in the potty? Well, if you get too excited you’ll never, ever get him on a toilet again. Prompt him to go? Yes, but be careful not to over-prompt, and whatever you do, don’t “hover within the prompt.”
My usual solution for information overload is to drown myself in even more information, until I come out the other side bearing a nugget of understanding. So that’s what I’ve done with toilet training. I’ve read studies with titles like “Dry Pants: A Rapid Method of Toilet Training Children,” published in journals with names like Neurourology and Urodynamics. I’ve talked to several developmental pediatricians who have spent their careers studying toilet training. And what I’ve discovered is that, although there’s some good information suggesting when parents should potty train, and studies detailing which kids have an easier or harder time doing it, the how best to potty train part has still been largely unanswered. Why? One report put it this way: “Toilet training for healthy children is not a subject that invokes passion among researchers.”
I get it—cure cancer, or watch kids poop all day? I know what I’d choose. But the net result is that parents are bombarded with “best” techniques that have never been backed by much (if any) science. Worse, much of the research that does exist is hard to decipher. (I still don’t know what it means to “hover within the prompt.”)
First, let’s tackle the (relatively) easy stuff. How do you know when your kid is ready to potty train? One review surveyed 23 studies on potty training and identified 21 “signs of readiness” that parents should look for. Some are obvious: Your kid has to be able to sit up, take her pants/diaper off, follow simple commands, and understand potty words. It also helps if she sometimes keeps a diaper dry for at least 90 minutes, a sign that her bladder muscles are under the control of her brain (rather than contracting reflexively—often hourly—as happens in babies), and if she doesn’t poop in the middle of the night anymore. Bonus if your child is showing an interest in the potty. These skills and behaviors come together at the different ages depending on the child, but it’s rarely before the age of 18 months, and—yes, it’s true—boys often train later than girls. Earlier is not necessarily better, either: One study found that when parents started to intensively toilet train their children before the age of 27 months, the training took quite a bit longer than it did for parents who waited until their kids hit the 27 month mark. (Yes, some parents start training much, much earlier—I’ll get to that below.)
As for methods, let me start by saying that the ones parents use today are a lot better—and by that I mean less emotionally scarring—than the ones parents used several generations ago. In 1932, the U.S. Government published a book called Infant Care that recommended that kids be done with toilet training by the age of 8 months. To facilitate the process, parents were told to insert “soap stick” rectal conditioners into their babies’ butts to get them to poop on command in the toilet. This “coercive bowel training,” as it was called, eventually elicited frowns from child psychologists, who linked it to constipation, refusal to poop on toilets (wouldn’t you?), anxiety and rage. In response, Harvard pediatrician Berry Brazelton developed a much more gradual “child-oriented” toilet training approach in the 1950s, which attempted to potty train in a way that “utilized the child’s developmental capacities and interest.” Fewer soap sticks; more praise.
The Brazelton approach still forms the basis for the American Academy of Pediatrics’ toilet training recommendations (in fact, Brazelton co-authored them; the main difference between the two is that the AAP doesn’t recommend rewarding children with food as Brazelton does). The technique has four stages, which go something like this:
1) Kid meets potty and sits on it, fully-clothed.
2) Kid sits on potty with pants and diapers off and is praised—though not TOO heartily, some experts warn, as that can build pressure—if she goes.
3) Kid is put on potty after she soils her diaper and the dirty diaper is emptied into the potty; parent explains that poop and pee go into the potty.
4) Kid goes diaperless for short periods of time and is encouraged to use the potty independently.
(If, during this process, the child ever resists the potty, the parent is supposed to immediately stop training for one to two months and then start it over again.)
The Brazelton approach is easy for doctors to support because it’s simple, safe and it makes sense. “It is consistent with views of positive approaches to parenting and with our increasing understanding of brain development,” says Nathan Blum, a behavioral pediatrician at the Children’s Hospital of Philadelphia, who has studied toilet training. But little research has been done to evaluate how well the Brazelton method actually works. Brazelton himself reviewed the charts of 1,170 of his patients in a 1962 paper and reported that most of the kids were potty trained by 28 months (remember this was back when parents started toilet training much earlier), but the kids weren’t necessarily trained using his method—he sometimes helped parents with other techniques, so it’s impossible to conclude much from these findings. A second study published in 1997 evaluated 482 children who had been toilet trained using the Brazelton approach and found that 88 percent of the kids were toilet trained at 3 ½ and that 98 percent were trained by age 4. But the Brazelton approach doesn’t work overnight—research suggests that it can take five to 10 months from start to finish. And some critics point out that it’s funny that Brazelton advocates gradual training considering that he has also been a paid spokesperson for Pampers diapers—obviously, the longer toilet training takes, the more diapers children wear.