Toilet Learning in Child Care

When Is a Child Ready?

Every child develops differently, so it’s important to look for the cues that a child is ready for toilet learning. The start of toilet learning should be based on the child’s developmental level rather than age or the adult’s eagerness to start, and should not begin while the child is experiencing major disruptions or transitions such as a new sibling. Attempting toilet learning before a child is ready can create stress and anxiety for the child, and in turn delay the process. While the right time to start toilet learning will differ for every child, it is recommended that the process not be initiated until the child is 24-27 months old.

Signs of toilet learning readiness include an increased awareness of a need to go, curiosity in others’ bathroom habits, demonstrated interest in the toilet, having words for using the toilet, an understanding of “wet” versus “dry,” and imitation of bathroom behavior. In order to start learning to use the toilet, a child also must be able to:

• follow simple instructions
• cooperate with adults
• stay dry for at least two hours at a time during the day or be dry after naps
• understand words about the toileting process
• have regular and predictable bowel movements
• express verbally, through facial expressions or posture the need to eliminate
• get to and from the bathroom area
• help pull diapers or loose pants up and down

The toilet learning process generally takes two weeks to six months. Mastering nighttime dryness may take an additional six months to a year. Since toilet learning is a multi-step process, setbacks are common, should be expected, and do not necessarily mean failure. Remember that the child is taking a temporary step back to a more comfortable place, which helps support later progress.

Parent-Caregiver Partnership

It is best if parents and child care providers approach toileting learning as a team, jointly identifying and responding to the child’s signs of interest and readiness. Children will be more successful when parents and caregivers agree on strategies and techniques, and help support each other to accomplish goals.

• Talk about signs that indicate the child is ready to begin toilet learning.
• Agree on how to work on the toilet learning process together.
• Use normal routines to establish regular toileting times to help make toileting a habit.
• Encourage practice runs to the toilet whenever the child gives a signal (facial expressions, grunting, holding genitals, squirming).
• Help children understand the association between relieving themselves and the bathroom by taking them there for diaper changes and to see the toilet flush.
• Teach proper hygiene habits. Show children how to wipe carefully from front to back, and to always wash their hands after using the toilet.
• Try to keep the child’s daily schedule, routines and rituals consistent between home and child care.
• Use the same words to describe body parts, urine, and bowel movements at home and in child care. It is best to use proper terms that will not offend, confuse or embarrass the child or others.
• Read the same or similar books about using the toilet at home and in child care. Give the child opportunities to ask questions and watch for reactions that will show how the child perceives and feels about using the toilet.
• Use the same method of praise and reinforcement at home and in child care. Rewards such as food or candy aren’t recommended. Verbal praise is best.
• Handle toileting accidents the same at home and in child care. Provide plenty of changes of clothing for the child in care so there is always clean clothing in the event of an accident.
• Try to have similar toilet equipment at home and child care.

Techniques for Success

• Promote toileting skills within the context of helping children develop self-esteem and independence.
• Because toilet learning involves so many steps (discussing, undressing, going, wiping, dressing, flushing, and hand washing), reinforce the child’s success at each step.
• Child care providers should include toilet learning activities as part of the daily curriculum. Read stories, sing songs and play games about using the potty to reinforce toileting skills.
• Occasional accidents are normal. Say “I see you have had an accident. That’s ok. I know you will learn how to use the toilet. You are trying hard. It will be better next time.” Praise the child for successes and downplay accidents. Punishment does not make the process go faster.
• Never force children to sit on the toilet against their will or for long periods of time. It only sets up a power struggle and negative feelings about toileting.
• Dress children in clothes they can easily pull up or down on their own.
• Have children pick out and wear underwear.
• Using potty chairs in child care is not recommended, but if they are used they should be emptied into a toilet, cleaned, and sanitized after each use.
• Make toilet seats feel safer by having a special adaptive seat to make them child-sized.
• Add a secure step stool, so the child can climb onto and off of the toilet and have a place to rest feet while sitting on the toilet.

What if a Child Resists?

If the child shows resistance to learning, he or she may not ready for the process or find it too stressful. Let the child guide the process. If a power struggle emerges, wait a few weeks and try again.

Here are some ideas to help in this situation:

• Transfer responsibility to the child. The child will decide to use the toilet only after realizing there is nothing left to resist. Stop forcing, punishing, criticizing and frequent reminding, which are forms of pressure. Use pleasant reminders like “The poop is trying to get out and go in the toilet. The poop needs your help.” When children stop getting attention for not using the toilet, they will eventually use the toilet for attention.
• Give incentives for using the toilet. If the child stays clean and dry, give her plenty of positive feedback.
• Change soiled clothing immediately. Never keep a child in wet or messy pants as punishment.

Adaptations for Children with Special Needs

A child with special needs may require a unique set of plans and procedures, more time, and more flexibility and patience from adults, but the same toilet learning methods apply. For example, a child with cognitive delays may not be able to understand and remember the many steps involved in toilet learning. A child with mobility limitations may need continuing physical help using the toilet. Children with learning disabilities may not understand what is expected of them. Measure and reward success in smaller steps of progress. Simplify expectations, be persistent, create small, achievable steps and acknowledge progress along the way.

For additional support and resources, contact the Healthline at (800) 333-3212 or www.ucsfchildcarehealth. org.

References

National Network for Child Care. Douglas, R. (1994). Helping children learn to use the toilet. In Todd, C.M. (Ed.), “Family day care connections”, 3(6), pp. 1-3. Urbana-Champaign, IL: University of Illinois Cooperative Extension Service.

PEDIATRICS Vol. 111 No. 4 April 2003, pp. 810-814. Relationship Between Age at Initiation of Toilet Training and Duration of Training: A Prospective Study. Online at: http://pediatrics.aappublications.org/cgi/content/ abstract/111/4/810.

Toilet Training Guidelines for Parents. (1998). American Academy of Pediatrics.