Potty Training 101
Toilet Training or Potty Training is such a huge step for both children and parents! This can also be a very confusing time for parents. Trying to determine exactly when your child is ready for this big step can be tricky. It is often easy to just let a child continue in diapers, so that parents and other caregivers do not have to worry about toileting accidents and soiled clothing. This can be directly in conflict with pressure from other parents/caregivers to toilet train a child earlier than the parents/child feel comfortable.
Major life changes such as new siblings, new day care centers, moving houses, etc. can affect whether a parent/child are ready to begin this process. With all of these factors pushing for both earlier AND later toilet training, no wonder parents are stressed and confused! But don’t worry, whereas the final stages of toileting training are a bit more of an “all or nothing” situation, there are many steps that you can work on with your child before either of you are actually ready to get started with toilet training.
Work on dressing skills. Everyday activities like having children help pull on/off clothing and don/doff shoes and socks can help children foster a sense of independence as well as improve fine motor strength and dexterity required for clothing management once a child is actually ready to focus on full toilet training.
Work on language skills. Begin talking to your child about using the toilet in very simple language, using the vocabulary that your family will use during toilet training. Defining words such as “poop, pee, toilet, potty,” etc. will help your child have the vocabulary skills she needs once toilet training begins. It is also important to begin to use the language your family uses for genitals so that your child can understand the basic mechanics of emptying their bowels and bladder. Additionally, it is important to explain in very simple terms the difference between using the toilet vs. using a diaper. For example, “Mommy is a grown up, so she goes pee in the toilet. When you are a big kid, you will go pee in the toilet, too.” There are many different books and social stories for children that help explain and encourage the process of toileting.
Work on location. As they say in real estate, “location, location, location,” This is also true for toilet training. Parents can start as early as 12-18 months with using stand-up diaper changes in the bathroom. By taking your child to the bathroom for diaper changes, having the child help with pants up/down, possibly even briefly sitting on the toilet, flushing, and washing hands, you are teaching your child the sequence of steps for toileting with none of the pressure of actually having to use the toilet. It is also a good idea to start to trial what type of toilet your child will use. Some children are frightened of the large toilet because it is so high, their feet are dangling, and they are worried that they will “fall in.” A potty chair on the ground will often be more comfortable, and you can then transition to a standard toilet when your child is older, taller, and more comfortable with it. Other children prefer the “big kid toilet” and want to start with a standard toilet right away. For these children, it may still be a good idea to use a toilet insert over the top of the toilet seat so that the opening of the toilet is not so big. These toilet inserts often also have handles to further make a child feel more secure.
Parent tip: If using a potty chair on the ground, place a small piece of toilet paper in the bowl of the potty chair before your child uses it. This will help the contents of the bowl dump out into the main toilet when your child is finished voiding.
How do you know if your child is ready for toilet training? According to the Mayo Clinic, some toddlers are ready at 18-24 months. Others are not ready until they are closer to 3 years old. It is important to look to your child for clues that he/she is ready to get started with this process. Some of these readiness indicators include:
- Gets on and off the toilet independently
- Pulls pants up/down
- Stays dry for 2 hours
- Follows basic directions
- Communicates/verbalizes when she needs to go to the bathroom
- Seems bothered when diaper is soiled
- Seems interested in the toilet or wearing “big kid” underwear
According to Johns Hopkins, the average age of toilet training is 27 months. A child younger than 12 months of age does not have control over bladder or bowel movements, and there is very little control between 12-18 months. Most children are unable to obtain bowel and bladder control until around 24-30 months.
But what if a child has some type of developmental delay? As with so many aspects in working with and loving on children with special needs, you accept them where they are developmentally, and then work with and encourage them to move on to the next level, whatever that may be. If your child is over the age of 3 years but has not yet met most of the milestones listed above for potty training readiness, then you will just really focus on meeting those milestones first. This may take some extra time, and that is fine. Don’t get discouraged if your child has a developmental delay and takes longer to complete the toilet training process. Just keep working on it.
Meeting the readiness milestones may also take some problem solving. For example, a child with a significant physical impairment may need a special toilet seat with supports to help the child sit unaided, and parents/caregivers may need to practice helping the child getting on/off the toilet as well. A child with limited verbal skills may need to learn to associate a picture card with “toilet” or to use the sign language sign “toilet” as caregivers perform diaper changes in the bathroom setting, to help the child learn to understand and communicate that bowel/bladder functions need to occur in the bathroom.
Let’s Get Started
Ok, now it is time to get down to the good stuff. You will need:
TIME. Try to start potty training on a 3-day weekend when you can devote 3 entire days to the task. You can stay home and not worry about having “accidents” in public. It is also important to get the timing down so that your child has not recently had any major life changes: new sibling, move, changing daycare/starting daycare, significant illness, etc. (Note that most children will definitely require more than 3 days to become toilet trained, but this 3 days devoted to potty training starts the process off on the right foot.)
Underwear/pants. Accidents WILL happen. Be prepared with LOTS of back-ups. Even better if the pants are loose-fitting, elastic waist pants/leggings. An added bonus if the child has helped pick out underwear that she is proud of, and does not want to soil.
Cleaning supplies. Again, accidents will happen. Have the necessary wipes, mops, rags, buckets, cleaners available to clean ALL the surfaces of your house. (Even better, spend lots of time outside if possible!)
Timer. This can be an old-fashioned kitchen timer, a watch with a timer, or the alarm on your phone. Anything that you can set to ring at given intervals will do.
Plenty of Fluids. No, it is not a good idea to give children a ton of sugary drinks, but now would be an excellent time to make drinking lots of fluids enticing. Bending the rules a bit with favorite juices, buying a few drinks in those fun boxes or pouches, or maybe even finding a cool color-changing cup can all be ways to help encourage your child to drink more. The more she drinks, the more she will need to urinate, which can greatly help toilet training success in these first few days.
Toilet. This one seems like a no-brainer, but hopefully you have had several trial runs with your child in getting ready for training, and your child has a potty chair or toilet cover with which she feels comfortable. If your child prefers some type of potty chair or toilet adaptation, it is a good idea to have more than one, so that the same toilet set up will be present in multiple bathrooms, at grandma’s house, babysitter’s house, etc. as needed.
Reinforcer. Some kids work well for M&M’s or Skittles. Others work well for fun stickers or a set time with a highly preferred toy or game. Some children comprehend a sticker chart and want to work for bigger rewards. Also, be prepared for a lot of singing and silly cheering as a reinforcer as well.
PATIENCE! Emotionally, toilet training can be one of the trickiest developmental milestones. It can be embarrassing. Other parents/caregivers can be judgy. It will definitely be messy! Kids will put up resistance at times. These are some of the reasons that the American Academy of Pediatrics reports that more child abuse occurs during toilet training than during any other developmental step. Make sure you are taking care of yourself as well as your child during this tricky phase in order to make this transition go as smoothly as possible for both of you.
Step-by-Step Guide
Once all of your materials are gathered, and the timing is right, here is your step-by-step guide for toilet training success:
Set up the environment. Make sure reinforcers are in the bathroom and that plenty of liquids are on hand to drink.
Put on underpants. Hopefully the child has chosen underwear that she finds particularly fun! Once you have officially begun toilet training, diapers/pull-ups are ONLY allowed when the child is sleeping (naps & night time). Switching back and forth between a diaper and underwear can be very confusing for a child, because she will have a hard time discerning when it is ok to void in her pants, and when it is necessary to get up and actually go to the toilet.
Set the timer. When first starting, you probably want to set the timer for just 20 minutes at a time. As your child has fewer and fewer accidents, you can lengthen the time to 30 minutes, then 45, then an hour.
Respond to the timer. “Time to go potty!” When the timer buzzes, the caregiver and child immediately stop what they are doing, and the caregiver takes the child to the bathroom. Don’t ask the child if she needs to go. Of course she will say, “No!” What child wants to stop playing to go to the bathroom? It is an automatic cause and effect that when the timer buzzes, it is time to go to the bathroom.
Use the toilet. If the child is resistant, it is perfectly fine to help her with clothing at this stage. The main focus is using the toilet. Have her sit on the toilet (or stand by the toilet if boys prefer) for 1 minute. NO MORE PLAY TIME OCCURS UNTIL THE CHILD HAS SAT/STOOD FOR 1 MINUTE. A visual timer or singing a song that lasts 1 minute can be helpful to let your child know exactly how long they need to sit/stand. However, if the child actually voids in the toilet, then she is free to get up as soon as she is done, which automatically reinforces our goal of using the toilet.
PRAISE!!! Most young children will not have bowel/bladder control right away. Praise the process! If the child sits (stands) for 1 minute, then she has done her part. Simply say, “Great job going potty,” whether the child has actually voided or not. Praise even more if she actually voids. And, if the child’s underwear is still dry when she sits on the toilet, give praise for that as well. Toilet training is often a tricky process for kids, and reinforcing every small step in the right direction is important.
Flush/wash hands. This helps to teach the proper sequence for using the bathroom right from the very start.
REWARD! Make sure the reinforcer (sticker, M&M, toy/game, etc.) is promptly handed over, and don’t forget to heap on even more praise! If a toy/game is used, a time limit will be helpful so that she can gain access to it again the next time she goes to the toilet.
Accidents. Accidents WILL happen. That is part of the process. When there is an accident, there is no scolding involved, just say something simple such as, “Oops, looks like you had an accident. Time to clean up!” Try to say this as cheerfully as possible. Children will not be perfectly toilet trained right away, so it is important to not make them reject the entire process. However, it is also important to teach that having accidents wastes time. It is much more efficient for the child to use the toilet than to have an accident. This is why you make all accidents the child’s responsibility as much as possible. Take the child back to the bathroom, have the child change her clothes with as minimal help as possible, and have the child take the soiled clothes to the proper spot for laundering. Then, have the child wipe up any messes that are on the floor with rags, soap/water, wet wipes, paper towels, etc. Obviously, you don’t want the child handling any harsh chemicals, but having the child clean up is helping her understand that accidents are her responsibility.
Common Problems and Negative Behaviors
Child refuses to go to the bathroom: This is why we use a timer and stop all activities until they at least sit for the designated amount of time. If they refuse, cheerfully pick them up and carry them to the toilet. Even better if while using some type of made up toileting song. Maybe, “Potty Time – Do do do do do do,” to the tune of “Baby Shark”? By singing, (even while carrying the child), parents signal to the child that she is not in trouble, BUT that the timer means it IS time to go to the bathroom. Consistency is key. Also, avoid saying “Do you need to go to the bathroom?” in the beginning stages. This just gives children the opportunity to say “NO!”. And, toddlers love to say NO, and older children appreciate the opportunity to express their autonomy! More appropriate phrasing is “Time to go potty.” You can also remind your child of the reward they will obtain by going to the bathroom. Try using the phrase, “First potty, then sticker/M&M/toy.” If you are at the point of longer times between the timer buzzing and the child is squirming as if she needs to use the bathroom, say, “It looks like you need to go potty. Let’s potty then come back.”
Child ignores accidents: Again, it is important to make the child responsible for any accidents so she will learn it is much easier to use the toilet than deal with the clean up involved with having an accident. However, some children are so engrossed in playing they either do not notice or do not care that they have had an accident. They are too busy playing! In this case, it is once again important to use a cheerful voice (though it can be hard) and simply provide the “help” needed to take responsibility for this problem. In the therapy world, we call this “hand over hand assist.” All playing, TV, etc. is stopped, and the child is directly taken to the bathroom. The parent will verbally talk the child through the steps needed to clean up their clothes as well as the environment. If the child refuses, then the parent will (again, cheerfully) say, “Ok, then let me help you!” and provide hand over hand assistance to the child in order to complete all of the steps for cleaning up. This is NOT the parent simply completing the tasks for the child. Rather, it is the parent placing her hands over the child’s hands in order to get the job done. Most children would rather be independent than have their parents/caregivers provide hand over hand assistance, and will quickly learn that it is faster to just complete these clean up tasks on their own.
Withholding bowel movements: When children withhold bowel movements, it can be a sign they are experiencing other conditions such as hard/painful stools, painful anal fissures, and/or emotional stress. Prolonged withholding leads to constipation and may compromise rectal tone. Increasing fiber in your child’s diet can help. The AAP reports that withholding behaviors can often be improved by an adequate intake of dietary fiber and decreasing milk/dairy intake. (AAP recommends your child’s age +5g of dietary fiber per day to help improve bowel movements.) If you have taken these steps and your child is still withholding bowel movement, the AAP recommends discussing this with your child’s pediatrician.
Refusing to flush/wash hands: This one can be a bit more of a judgement call. Is the child refusing due to sensory sensitivities, or is this a behavioral reaction? If you have a child who is sensitive to a variety of sounds (vacuum cleaner, singing, blender, etc.), then the sound of the flushing toilet may truly be aversive to her. Consider allowing your child to stand just outside the door as the caregiver flushes the toilet. If, however, you have not noticed any other sound defensiveness in your child, you can once again simply provide hand over hand assist for your child to flush and then strongly praise her for flushing.
Similarly, if your child is tactile defensive to a variety of textures and does not like to wash hands or take a bath, then maybe the feeling of soap and splashing water on the hands may be too much, and you might want an alternative such as a wet wipe or hand sanitizer. If, however, your child loves bath time and is inconsistent with refusing hand washing, then again, simply provide hand over hand assist to get the job done.
Bed time/Nap time: It is very common for children to be fully toilet trained during the day, but continue to need to use a diaper/pull-up during nap time and night time. Focus on day time dryness first and don’t hesitate to use a diaper when the child sleeps. Be mindful to take your child to the toilet before sleeping, and avoid excess fluids right before bedtime. If your child is still wetting the bed after her 7th birthday, then parents might want to talk with the pediatrician about alternatives for achieving night dryness.
If you have tried the above tips and are still struggling with toilet training your child, don’t hesitate to discuss with your child’s pediatrician or occupational therapist. Good luck!
RESOURCES:
AAP: Practicing Safety: Toilet Training. (Downloaded Aug. 2019)
AAP: Toilet Training Guidelines: Parents – The Role of the Parents in Toilet Training. (June 1999)
https://pediatrics.aappublications.org/content/103/Supplement_3/1362
Johns Hopkins Medicine: Toilet Training. (Downloaded Aug 2019)
https://www.hopkinsmedicine.org/health/wellness-and-prevention/toilettraining
Healthychildren.org. Toilet Training Children with Special Needs. (Feb 2012)
aap.org. Toilet Training Guidelines: Clinicians – The Role of the Clinician in Toilet Training (Downloaded Sept 2019)
https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/potty-training/art-20045230
About the author
Melissa Foster is a Nationally Board Certified Occupational 
Therapist who received her Masters in Occupational Therapy from University of Central Arkansas in 2004. She came to Children’s Therapy T.E.A.M. in 2013 with a wealth of treatment experience in settings that range from clinical experience in Northwest Arkansas (NWA) to Kansas to New York. Her primary interests are treatment of children on the Autism Spectrum, treatment of children with ADHD and treatment of children with sensory processing and behavioral disorders. Melissa is an active public speaker in the NWA community on topics related to Autism and Sensory Processing Disorder. She has authored several resource materials for parents on topics such as picky eating and toys to promote development. Her blogs address topics of interest to parents and have become a popular resource for families. Melissa loves spending time with her husband and their two children. On warm summer days she enjoys sitting on her patio with a good book and a glass of iced tea.
Reviewed by Children’s Therapy TEAM BCBA, Jordan Bethea and Speech-Language Pathologist, Carmen Shumpert.
last updated March 15, 2021