Potty Training Problems!

(Or the toilet training power play)

So many parents say to me “Seth, I want him to use the potty!  NOW!!!  How can I make that happen?”  Well, let’s talk about some SCIENCE!!!

Yes, I know I shouted ‘science’ but that’s because I love that stuff!  Not just because it’s interesting, but also because it saves us from making Poor Parenting Choices © (copyright 6,000,000 BC – The Human Race).  Sometimes we just love to make things happen, but we always need to remember that little bodies develop at their own rate and if we try to force things before they’re ready we’ll set ourselves and our kids up for frustration, mistrust and a great big fight that no one can win.  Of course later those little brains will remember how frustrated you became and will know exactly how to make you nuts again (more on that in another post)!

So what’s the science?  Well, I have my friend, and an absolutely amazing Physical Therapist, Dr. Terisa Ashofteh Waterman who I miss working with terribly, to thank for helping me understand the physiological functions of the spine and toilet training.  So a big shout out and thank you to you, Teri!!

The spine is responsible for carrying signals from the brain down to our bodies, and carrying signals from our bodies up to our brain.  Now here is where it gets interesting, and instead of me repeating it all, Medtronics explains the science concisely:  

The messages or impulses sent by the brain to the pelvic area are carried by a system of special fibres called nerves. These signals start in the brain, go through the spinal cord and continue to the nerves located in the sacral area of the back before being sent to the pelvic area.  There are 31 pairs of these nerves in the lower back. Some of these sacral nerves go to the rectum, the bladder’s detrusor muscle, levator ani muscle, and external sphincter muscles, controlling their activities. Two important sacral nerves to the functioning of the bladder and bowel are the pudendal nerve and the pelvic splanchnic nerve. Through a series of reflexes and signals the nerves and the bladder and bowel coordinate with the pelvic floor muscles and external urinary and anal sphincters. This coordination ensures that the sphincters remain closed, opening only during micturition (a term for urination) or defecation. In other words, as the bladder (or rectum) fills, the pressure inside it increases. The nerves sense this pressure and tell the brain about it. The brain then sends signals via the nerves to keep the external sphincter closed. Normally, this prevents leakage. This is called the guarding reflex. When you are ready to go to the toilet, the brain tells the nerves to signal the bladder (or rectum) to empty. You relax the muscles surrounding the urethra (or anus). The bladder (or rectum) empties and urine (or faeces) is expelled.

– Medtronics

So what does this all mean?  Well, let’s break it down simply.  Basically what’s important to you is that the last couple of nerves to develop are the ones which:

1. 

   Let your child feel that he needs to use the bathroom

2. Let your child control holding or releasing his or her bowels and bladder

Whoa!!  That should be a HUGE lightbulb moment for any parent fighting to toilet train a child!  Basically, your child may not be ABLE to control his or her waste or even know if he needs to void it!  Asking him or her to do so is the same as asking you to flap your arms and fly.

You’re just not physiologically capable!

Imagine having a giant person getting madder and madder at you every day because when she tells you to fly…  You don’t!  You love this person and you really want to make them happy and proud but you don’t even know how to fly, much less have the right equipment to make it happen.  Not a fun thought, right?

But Seth, He’s Actively Fighting Me!

So many times I’ve had parents say to me “Seth, I put him on the potty and he sits there forever without going, but as soon as I take him off and put a diaper on him he goes!!  Why is he fighting me on this?!?”  Well, let’s look at what’s often happening:

• We take the diaper off our little guy – He or she gets stressed since it’s not naturally how he or she feels!
• We put the child on a potty – He or she gets even more stressed because it’s a strange situation!
• When he (or anyone) gets stressed, the muscles tense up – His or her rectum, his or her bladder’s detrusor muscle, levator ani muscle, and external sphincter muscles tighten up and he or she doesn’t micturate or defecate.
• You get frustrated and take the child off the potty – His or her stress level decreases a bit…
• You diaper the child – His or her stress level drops to normal and his or her muscles relax…
• The child micturates or defecates – You call me and ask me why he or she is so stubborn!

So he’s not fighting you, his or her body is just responding to changes by tensing or relaxing muscles without him or her even knowing it.  In the same way as when you sit on the couch you don’t urinate even though you’re not sitting there thinking about not urinating.  If we want to get all geeky about it we can talk about the difference between the sympathetic and parasympathetic components of the autonomic nervous system (ANS).  Sympathetic stimulation is predominant during bladder filling, and the parasympathetic causes emptying.  But what really matters is that this isn’t really a fight between you and your child, it’s a fight between you and nature.  I hate to say it, but nature is going to remain pretty solidly in the win category on this one.

So how do we know if our little person has these nerves developed to the point of being ready to toilet train?

When To Start Potty Training

Well, let’s start with whether the child can feel that he or she needs to go, does he or she:

• Wiggle around before having an accident?
• Let you know he or she needs to go?
• Hide before going?
• Hold himself or herself?

Any of these behaviors can show us that the child is feeling that his or her bladder is full, and that one of the two required types of signals are working as needed.  These are the afferent neuronal signals, carrying information from the body to the brain.

Now can the child:

• Sleep through naps of about 2 hours without wetting?
• Urinate a fair amount when he or she does urinate?
• Have well formed bowel movements?
• Have relatively predictable bowel movement times?

If so, he or she probably has the other neural signal working correctly.  These are the efferent neuronal signals, carrying information from the brain to the body.

Often parents ask me at what age potty training will work because these nerves have developed.  Kids’ bodies are highly variable, but most kids will have developed these nerves between about 2 – 3 years of age, though some kids may take longer.  I usually recommend that parents try toilet training a 2 year old, and if that doesn’t work, to try toilet training a 3 year old, but be prepared for toilet training regression if they start young.

So let’s look at some ideas for taking these abilities and successfully turning them into teaching potty training for boys and potty training for girls.

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Nevertheless, these are all my own opinions. I won’t recommend it if I don’t believe in it.

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 Put On Your Big Boy Pants (or pull them down)!

Ok, so as a guy I am a huge fan of potty training urinals like the New Joy Baby Potty Training Urinal for Boys!  Boys want to be like their big brothers, fathers, uncles, and other men they see.  We like to feel focused on a goal, and we like to know immediately whether we have accomplished that goal.  Anything with targets score high on our lists!

We as humans sit down for a variety of reasons, most of which have nothing to do with sitting.  So we often think of other things, look around, read newspapers or poke at iPads, cellphones and other electronic devices while sitting there.  By putting a boy in a standing position in front of a urinal we have effectively given them a purpose, a reason, and a goal.

Also, standing just feels more natural to many boys when urinating.  Regardless of what your husbands, boyfriends, brothers or know-it-all male friends might tell you, there doesn’t appear to be any research showing it’s any better for males with typical bladder and associated anatomy/physiology (Urinating Standing versus Sitting: … A Systematic Review and Meta-Analysis.), but ask men what they prefer and I bet the majority will tell you they prefer to stand.

Everybody Poops…  But not in the urinal!!

So that handles boys and urination, but what about the ol’ number two?  Also, parents have reported to me that about half the kids that are born are girls…  Who would have thought it?  😉  So what do we do about the typical potty seat needs?

Well, there are a few potty training tips to take into account:

• Potties should not be a place to play, we’re there for a purpose.  As Will Smith’s mom said “We go to school to learn, not for a fashion show!”  Well, I say “We go to the bathroom to potty, not for an Elmo show!”  Ok, no rap future for me…
• Potties should as closely as possible mimic adult toilets.
• Kids should see you doing what you want them to do as similarly as possible.
• Nobody likes cleaning out the potty!

So, with this in mind I recommend that parents strongly consider getting an actual toilet seat for their toilet which can accommodate both children and adults, for example the TOPSEAT TinyHiney Potty.  I like these because they’re made of wood instead of plastic, the child portion is magnetic so it sticks to the lid when you lift it and stays out of the way when adults are using the toilet, they’re designed to have a gap between the seats so fingers don’t get pinched, and the Slow Close option (though a little more expensive) helps get rid of the automatic wince we all feel when someone slams the toilet seat down.

There are a couple of things to keep in mind:

1. You need to know how to take off the old toilet seat.
2. You’ll need a potty stool like this Summer Infant Little Looster, Potty Training Stepstool so kids can reach.
3. You need to know if you have a round or elongated toilet, and order the right seat.

With those things met, I feel this is the best option since it satisfies the basic criteria of being:

• Safer – I like things bolted down.  Yes, I’m overly protective, I admit it.
• Cleaner – I don’t even want to THINK about what could be growing in most potties…
• Allows kids to imitate adults as closely as possible
• Helps kids focus on the task at hand instead of playing with attached toys or buttons or looking at cartoon characters.

Books & Videos & Systems, Oh My!

So now we have something to get our kids to put their waste into, but how do we get them to get their waste out in the first place…  On command, and in the correct receptacle?

Well, I have to be absolutely honest.  I have found that until a child is ready nothing really works, and when a child is ready just about anything works.  There’s no one system I can recommend because every child is different.  There are nationally known and renowned books, lesser known systems, video series, DVDs, games, experts, and all manner of options you can try.  Although I don’t necessarily think there’s one correct system, book, DVD, etc., I do think it’s important to have *a* system to which you stick.

So, with that in mind, here are some important potty training system tips:

• Be consistent!
• Be encouraging!
• Get something with a money back guarantee!
• If at first you don’t succeed…  Maybe it’s not yet time.

If you pick something, stick with it, don’t bounce between a bunch of ideas.  It takes anywhere from 3 days to 3 months to change a behavior in a child.  Expecting to potty train in a weekend may be unrealistic.

Kids, and adults for that matter, tend to respond best to positive reenforcement.  We as humans want to know how to make our lives easier and happier, if we show our kids that their lives are easier and happier when they use the potty they will be on board.  If, on the other hand we turn it into a fight then they’ll respond by fighting back and refusing to cooperate.

Nothing works for everyone, and some things don’t work for anyone.  So make sure whatever you buy can be returned in case it doesn’t work for you and your child.

Finally, if it’s not working your child may not be ready.  Give them and yourself a break.  Take some time away from it and come back later.  It may just take a month of growth, emotional and physical, for a child to get ready for potty training.

So what are some systems?  Well, as I said, the possibilities are endless.

A lot of parents really like videos, they’re easy to access, they keep our attention, and for a lot of us it’s easier to learn if someone shows us something instead of just telling us.

It was brought to my attention recently that author Carol Cline is one of the bestselling authors on the internet for parenting and potty training products, and she wrote a Start Potty Training guide.  It states that it has a money back guarantee, so you can return it if you don’t find it useful for your needs.  It includes audio, video and readable versions, and has charts for progress and achievement certificates for your child.  If you buy this system I’d be really appreciative if you let me know how it worked for you.  I’ve read good things so far.

Your Thoughts?

What do you think?  Let me know in the comments section below!