May 2009

Going Potty

A few weeks back, when I was in the throes of potty training my little girl, I am ashamed to say I was evicted from a local soft play centre for getting her potty out in the cafe area. Looking back I can't quite believe I thought this would be acceptable - in a public area where food was being served! But my potty mania had reached such a peak that my one priority, in fact my only waking thought, was to get the botty to the potty in time and avoid those disheartening accidents. The potty went with us everywhere - the park, the playgroup, the tube. And my daughter spent a week or so parading around pant less with just a skirt to cover her modesty.

I’m happy to say that - with only a few setbacks - my daughter has now joined the proud ranks of toilet users and I am glad to see the back of those nerve racking days of will-she-won't-she, hyper wee-wee alertness. But what should you do if, after several weeks and even months of following all the advice, putting up star charts, reward schemes, cajoling, entreating, bribing and threatening, your youngster just does not seem to be getting it? When days continue to revolve around stressful interludes on the potty and toilet, with repeated changes of soiled and wet clothing?

Well, you may well have been dismayed by the abundance of ‘helpful’ advice along the lines of the 'potty training in a weekend' manuals. Everywhere, 'experts' suggest you should easily get your two-year-old to leave behind nappies and embrace their potty (even pulling down their own pants and wiping) within a week. When this doesn't happen, it can feel like failure. Most potty training advice suggests meeting toddler reluctance with gentle encouragement, offering small rewards for success and not dwelling on failure. But when faced with a child who refuses to sit on the potty, will not do a poo except in their nappy or pants and would rather hold in his stools for days on end than let them go in the toilet, these seem rather inadequate weapons in a parent's arsenal.

Perhaps the best thing a parent should do in this situation is to stop seeing the potty issue as a battle and the possible outcomes as success or failure. Pressure of this kind can only lead to greater anxiety on both sides and anxiety, as health visitor of 17 years standing and mother-of-two Maureen Crawford explains, is the number one enemy of happy potty training.

Parents who are wrangling with a child of over three or even four who is still shunning the toilet may be interested to hear that in Maureen's estimation around 20% of four-year-olds in this country are still in nappies or not effectively potty trained. In fact, in the eyes of the health experts, a child wearing nappies right up to the age of five is not considered a problem and intervention is not advised as a matter of course until a child reaches five. The reason we don't tend to hear of these cases is that parents are only keen to talk of their 'success' stories.

Perhaps then, it’s time that we all backed off, took a deep breath and accepted that each child matures at its own pace and, just as some children take a lot longer to speak or walk than others, some need a lot more time to become aware of their own bodily functions and how to manage them. All well and good in theory, but the reality is that, with many parents working and sharing childcare out, it is often not practical or convenient to have a pre-schooler in nappies. Plus there is the anxiety caused by teasing peers and a child feeling the odd one out, as well as the pressure of many nurseries and pre-schools stipulating that a child must be able to take themselves to the toilet before they enrol. These factors can push many parents into potty training their toddlers before they are showing the signs of being ready.

The more serious issue of clinical constipation can sometimes arise at these points where a child has become anxious about opening their bowels on the potty or toilet and has opted instead to hold their stools in. Clinical constipation is defined as not passing a stool for 7 to 10 days and this can lead to a vicious cycle of painful motions, fear and further withholding with, at the severest end, faecal compaction and the stretching of the bowel that can create problems well into older childhood. Potty expert Maureen says that the best advice is to catch the problem early. If you notice the pattern of your child's bowel movements changing with the onset of potty training, seek help and advice from your health visitor or GP straight away before the issue turns into a serious problem.

If your child does become constipated and fearful of passing stools, your health visitor or GP should be able to offer you all the advice and hands-on support you need to get them back on track. But if you feel you are not being listened to or taken seriously, don't be fobbed off - insist on a second opinion or referral to a community paediatrician – see box below for sources of help.

Maureen's top nine potty training tips:

1. It’s better for the child physically and psychologically if they are able to give indicators that they are ready - it usually happens any time between 18 months and five years but can happen later - up to five-years-old.

2. The important thing is to get ready as a parent. If you are going to lose your temper or show any signs to your child that this is inconvenient or annoying, then you shouldn't be starting to potty train your child.

3. It is very important that your child sees you and your partner using the toilet, passing urine and stools. If they are seeing that it is part of a normal process, they are less likely to be anxious about it.

4. Anxiety and interruption to bowel function can arise from many causes: lack of hydration, wiping a bottom too hard, a general fear of the toilet, or big changes such as a new baby arriving or starting a new school. Try to be alert to these causes and address them. If a child doesn't like the toilet, move the potty to another area and always wipe gently with wet wipes to begin with.

5. If you have got a child who is even slightly anxious it is worth just stopping the process for a couple of weeks and then beginning it again.

6. Between 18 months and five years, it takes approx four weeks to erase memory and put in good memories. So in between times talk to them gently about potty training, put up little pictures of someone using a potty – no pressure!

7. You have to remember you are dealing with a child at a stage when they are manipulative. Be relaxed and don't show them they are able to niggle you. Praise and reassurance that everything is fine, even if they haven't succeeded, can defuse the battle.

8. Some children are afraid of the toilet flush so try to avoid flushing it straight away. If they are reluctant to go on the toilet, then put a potty elsewhere and always carry a potty with you.

9. Once your child is potty trained, try not to take it for granted. Try to instill a good routine of visiting the toilet every two hours and for no longer than five minutes each time to avoid them getting caught short or holding it in. And don't stop praising when they do it right.

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