By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

A reader dissented from our toilet-training advice in a previous column:

Q. Are you serious? A 4-year-old who resists potty-training! Give me a break.
Children need someone to set boundaries and say, “Get your butt in there and use the potty or you are gonna be in trouble. I know you can do it. You know you can do it
Now go!”

How hard is that? The child won’t have to undergo therapy simply because you put your foot down and say, “Your behavior is unacceptable at this juncture of your life.”
In other words,”You’re too big to still be wearing a diaper. It’s over. And it’s time to be a big girl now.”

A. Good luck! And let us – and the many parents who have unsuccessfully tried this – know how it goes!

Way back in the early 1960s I learned that pressing a child to become toilet trained was too often unsuccessful (15 to 18 percent failure rate). Too many children would respond by withholding their bowel movements, causing chronic constipation and enlarged colons. Some would smear their feces in their clothing, or wet the bed long into later childhood.

The incidence of these failures can be reduced by leaving it up to the child in steps that I have outlined in “Toilet Training: The Brazelton Way” ((Da Capo 2004).
Most of the world carries their infants almost nonstop until they are ready to walk. In these places, parents help their babies learn early when and where to go because they can pick up on their bodies’ cues.

But in our culture we are asking children to adapt to our busy lives. Since most of us don’t hold them close in the first year to help condition a physical response to their bladders and bowels (“elimination communication”), we must respect their own timing and wait until they are cognitively ready – which won’t come until at least two years of age.

In the 1960s, when we learned to leave toilet training to the child’s timing, these problems were significantly reduced (2 to 5 percent failure rate). I would be concerned to recommend that we return to the practice you suggest without considering its negative consequences for far too many children.

Q. My 1-year-old granddaughter has some habits I don’t understand! Anything she gets a hold of, she puts behind and around her neck, which is worrisome when
it is something like a cord. She’ll hang a camera by the strap around her neck, and she continuously tugs at her little shirts or tops. What might we do to help?

A. What a fascinating observation – I am not sure I understand your child’s behavior either!

Perhaps she is imitating adults around her as they dress, putting on a scarf or a tie, or as they shoulder a pocket book. Perhaps she tugs on her shirts and tops when the labels at the back of her neck scratch her. Children who are hypersensitive to touch are often bothered by these labels, and even when they are able to speak, they don’t necessarily let anyone know.

Don’t try to stop her in either of these behaviors for your attention to her at these times might just reinforce them. But be sure that she doesn’t have access to anything that she could strangle herself with, especially when in her crib.

Can you offer her a lovey (a special doll or teddy bear) when she begins this behavior, so she can turn to the lovey instead of straps or cords? Or try making a big, loose, paper chain with strips of paper attached at the ends and linked to each other. She can ceremoniously put this special necklace around her neck to replace the dangerous ones she comes across. Make sure that it is easily breakable. She’ll be safe and you’ll be busily employed until she gets wise to your tricks!

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.