toilet training

IS A CHILD READY FOR TOILET TRAINING?

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
IS A CHILD READY FOR TOILET TRAINING?
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Around her second birthday, a child may show initial interest in the potty or training seat. Often this interest soon vanishes, especially if eager parents seize on it. Don’t be fooled by these early indications. Let the first steps be the child’s.

Before age 2, your child isn’t likely to be ready for toilet training. But it’s time to watch for seven new behaviors – usually not all present until then – as the earliest expressions of a child’s readiness.

When one or two signs appear, parents are bound to want to start toilet training. But they need to wait for the others to appear.

  1. She’s not as excited about walking and being on her feet all the time. At 18 months (and often older), she’s ready to sit still and learn a new task, like using her fingers for complex activities.
  2. She has “receptive language” – the ability to understand the words she hears: for example, a parent’s wishes. She can remember what she is told and translate it into action. She can even carry out a two-step command: “Go to your bedroom and bring me a book for us to read together.” And she’s so proud of herself when she succeeds.
  3. She can say, “No!” Don’t push her before she knows how to tell you whether she’s ready. She needs to decide for herself. A child may comply with toilet training for a while, as if to please the parent. Then she may stop, as if she’s realized, “This wasn’t my idea.” Once she can protest with words, she can make toilet training her own job.
  4. She starts putting things where they belong. She may even begin to pick up her toys. Some children this age amuse themselves by lining up toy cars or doll furniture. I’m always amazed at this orderliness that crops up sometime after a second birthday. She is getting ready to use her potty as an appropriate place for her “products.”
  5. She imitates your behavior. A girl wants to wear her mother’s shoes. A boy puts his father’s tie around his neck. This urge to imitate is a precious incentive for a child to use the toilet – “like mommy and daddy.” Children this age are already pressuring themselves to live up to their parents’ behavior. Pressure from parents can make the challenge seem hopeless.
  6. The child starts to urinate and move her bowels more predictably. Her urinary and digestive systems are maturing. She may remain dry for up to two hours at a time. Toward the end of this year, a child may even be dry throughout a nap. These patterns are a real tease for waiting parents who may mistake them as a sign of readiness.
  7. She becomes aware of her body. She points to her wet diaper. She grunts when she’s trying to have a bowel movement. Her awareness helps her train herself. She also starts labeling her body parts and functions. Your own words, or hers, are probably the best. All can alert her to her bodily functions.

When I share these developmental steps with parents, they say, “But this process may take forever!” I assure them that these skills come in a predictable way, and that toilet training is much easier and more successful if they wait for all the signs.

(This article is adapted from “Toilet Training: The Brazelton Way,” by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D., published by Da Capo Press, a member of The Perseus Books Group.)

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.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, 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 currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

IN TOILET TRAINING, A PREMIUM ON PATIENCE

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
IN TOILET TRAINING, A PREMIUM ON PATIENCE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Problems in toilet training nearly always arise because of an imbalance in the parent-child relationship. Children usually show signs of readiness between age 2 and 3. When parents can’t wait until then, and impose toilet training as their idea, the child will feel the pressure as an invasion.

All parents, of course, want their child to grow up and cross this threshold. Preschools often insist that a child be “trained” before he comes to school.

Other parents may offer advice and condescending comfort when their children are already trained. Grandparents may imply that toilet training is a measure of effective parenting and of a child’s overall competence. Some families may see the child’s entire second year as preparation for success in this area.

A toddler for whom independence is a passionate issue anyway will have his own struggles. He may stand in front of a potty, screaming with indecision. Or, he may crawl into a corner to hide as he performs a bowel movement, watching his parents out of the corner of his eye.

It’s a rare parent who won’t feel that such a child needs help to get his priorities straight.

When a parent steps in to sort out the guilt and confusion, the child’s yearning for autonomy becomes a power struggle between them. Then the scene is set for failure.

In bedwetting, as in many of the problems encountered with toilet training, a child’s need to become independent at his own speed is at stake. When a child’s need for control is neglected, he may see himself as a failure: immature, guilty and hopeless. The effect of this damaged self-image on his future will be greater than the symptoms themselves.

Given that toilet training is a developmental process that the child will ultimately master at his own speed, why do parents feel they must control it? My experience has led me to the conclusion that it’s very hard for parents to be objective about toilet training.

The child becomes a pawn – to be “trained.” It may take us another generation before we can see toilet training as the child’s own learning process – to be achieved by him in accord with the maturation of his own bladder and central nervous system.

When Problems Exist:

A.) Discuss the problem openly with your child. Apologize and admit you’ve been too involved.

B.) Remember your own struggles, and your eventual successes, so that you can let the child see that there is hope ahead.

C.) State clearly that toilet training is up to the child. “We’ll stay out of it. You’re just great, and you’ll do it when you’re ready.”

D.) Let the child know that many children are late in gaining control, for good reasons. Then, let him alone. Don’t mention it again.

E.) Keep the child in diapers or protective clothing, not as a punishment, but to take away the fuss and anxiety.

F.) Don’t have a child under age 5 tested unless the pediatrician sees signs of a physical problem. A urinalysis can be done harmlessly, but invasive tests and procedures – enemas, catheters, X-rays and so on – should be reserved for children who clearly need them.

G.) Make clear to the child that when he achieves control, it will be his own success and not yours.

(This article is adapted from “Touchpoints: Birth to Three,” by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D., published by Da Capo Press, a member of The Perseus Books Group.)

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.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, 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 currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

CHALLENGES OF TOILET-TRAINING

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
CHALLENGES OF TOILET-TRAINING
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My 3-year-old daughter is fully potty-trained for urination – no diaper at night or naps. She refuses to use the toilet for a bowel movement, however. She doesn’t seem to be afraid of the toilet and gives nonsense answers to our questions about why she won’t go or what would help.

A. For many parents, successful potty training doesn’t merely mark the end of diaper mess and expense. It is a reassuring sign that their child’s development is moving forward.

But the age range for potty learning varies widely. A child’s readiness often begins only after she has mastered walking and gotten over her excitement about it. Then she can sit down and stay still.

Potty learning also depends on the child’s willing participation. She will need to learn to sense when her body is ready to have a bowel movement. She will have to get herself to the potty on her own and sit there, though far more exciting things beckon.

She must also learn to part with her bowel movement – a major challenge for a child old enough to have questions about her body but too young to understand many of the answers. What happens when something that seems to be a part of her body comes out?

A number of children’s books help explore these mysteries. But it is best to read them to the child without saying anything about her potty progress. She’ll figure out the connections on her own.

Pressure from parents may add to her confusion. A struggle distracts the child from her task and gives her a certain power over her parents. This is one of those struggles that parents can’t win. Potty learning just won’t happen without the child’s cooperation.

A child who urinates in the potty and knows when she needs a diaper for her bowel movement is almost ready to complete the process. If parents can feel reassured by her progress and relax, the child will relax too.

If – without making a fuss – they can convey their confidence to her that she will use the potty when she is ready, sooner or later she will do so.

The accomplishment is a point of pride not only for the parents but also for the child. She needs to know that using the potty is her job – and that when she accomplishes it, the success will be hers, not yours.

For more information: “Toilet Training: the Brazelton Way,” by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D., published by Da Capo Press, a member of The Perseus Books Group.

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.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, 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 currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.