toilet training

THE CHALLENGES OF TOILET TRAINING

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

Q. Our 2-year-9-month-old son was potty trained relatively easy during the day at 2 and 1/2 years old. However, he is still in a diaper at night. He wet his bed for several days in a row when we tried to put him in underwear at night, and now he awakes with a very wet diaper since we’ve switched him back into a diaper at night. How do we try to help him stay dry at night, or wake up to go to the bathroom at night?

A. He may not be ready – yet. Patience and time may be what he needs most for now. But the “very wet diaper” makes us wonder how much he is drinking in the evening before going to bed. As long as he is getting enough fluids during the day, you can cut back on fluids after supper. If he doesn’t mind, ask him to try urinating once at bedtime and then one extra time before going to bed. If he does mind, don’t bother – the struggle will do more harm than good. In my practice, I found that some children would stop wetting at night if their parents roused them at about 10 p.m. just enough to urinate before returning immediately back to bed.

The most important thing you can do right now, though, is to back off, avoid making a big deal of it (which includes holding off on any unwelcome “help”) and let him know that when he’s ready, he’ll manage just fine. (See our book, “Toilet Training: The Brazelton Way,” Da Capo Press, 2004, for more information.)

Q. My 5 and 1/2 year old daughter constantly forgets to wipe, wash, and flush. What advice do you have?

A. Is this a new problem, or is this something she’s never yet mastered? If this is a change in her behavior, we would wonder about what might have prompted it – for example, some physical condition such as a rash or infection that might make wiping painful, or some experience that has frightened her and led her to try to avoid this area as much as possible. In this case, we would encourage you to bring this up with your child’s pediatrician.

If this is the way it’s always been, and otherwise her development has been entirely typical, our guess would be that she will learn to master this – when she is ready and when this really begins to matter to her. In the meantime, if this is one small expression of her overall temperament – a little girl who is under a head of steam, often in a rush, only halfway through one activity and then she’s on to the next before – you’re likely to do better by accepting this and helping her to accept her own temperament. This will help her to know she can turn to you to understand herself and for help when she begins to be bothered by some of her own shortcomings and is ready to work on them. (If she has difficulty following through with a much wider range of tasks in a number of different settings, it might be worth looking into what might be distracting her. Your pediatrician could help.)

She’s already shown you that reminders won’t work. Do they feel like nagging to her? They’re bound to if she hasn’t asked for them. And she won’t until she is able to recognize and accept that she needs help, and that you can offer it to her without embarrassing her. Of course you don’t mean to. But she’ll be more comfortable with your help when she’s ready for it. You might try sitting down with her in a calm moment when this isn’t the immediate issue. Let her know that you know you’ve been bugging her with your reminders and that they haven’t helped. Ask her if she would like your help. If she says no, then let her know you’ll be ready to offer it when she’s ready to ask for it. Then, drop it. If she says yes, then ask her what kind of help would work better for her than your reminders.

Some parents may feel that this approach gives a child too much control – but in areas where no parent can control a child, the best a parent can do is to help a child discover her own motivation, and to harness that motivation for her to be in control of herself. Others might suggest a reward system – some little token for every flush. There’s probably not much harm in that, except that it could still easily become your issue, rather than hers – a setup for struggles that might just reinforce the problem.

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.

Prior to 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.