Smart Potty Training

Why all the chatter about toilet training lately? It seemed like this was one thing everyone agreed on, all the books said pretty much the same thing, and most people were doing it. You were supposed to look for signs your child is ready, introduce a system of positive feedback or rewards, and happily go on with your life.

Now you see headlines all the time about “Infant Training”, “Diaper-Free Babies”, “don’t use too much pressure but don’t wait too long”……….Ugh. Another parenting dilemma, and it feels like just another chance to mess things up before your kid even hits preschool.

The good news, to start with, is that you are not going to mess up your child psychologically based on when you toilet train them. In fact, ALL of the many excellent studies that have been done over the years to establish some sort of a relationship between toilet training methods and the personality development of the child have failed to show any link. Obviously, we are talking in the context of some baseline good parenting. But the specific question of will your child have some sort of psychosexual trauma as a result of the age that you toilet train them has been asked and answered. And, happily, the answer is no.

The first question that you probably have is why have I heard so many people say otherwise? Many fantastic psychologists and Pediatricians (including me!) have been trained that too-early or “pressured” toilet training will lead to refusal, later regression (going back to having accidents), constipation, or even general resentment. The idea seems to make intuitive sense, and of course if you’re talking about traumatizing a child we all want to avoid that. The problem is that this type of thinking was very theoretical when first introduced, and is now being applied literally and generally. Why is it called “pressure” for a toddler to wear cotton instead of a disposable diaper? It’s not, of course, and so there are some important distinctions about what we are talking about and the vocabulary we use.

Before the widespread use of disposables, most kids were trained in the first year of life. Then, throughout the 1950s and 60s in this country, people started waiting until the second year of life, with the general idea that children were trained when they turned two. Dr. Brazelton introduced the idea of “readiness”, and he originally argued that once a child is walking well (around 18 months), they are ready to be trained. That was considered a pretty radical delay at that time (1960s), when toilet training was done much earlier. And it really just caught on as a general idea. Many parents today are being advised to wait until their child has the verbal and motor skills more common in a three year old before they even think about it.

Meanwhile, the rest of the (underdeveloped) world has gone on happily training their babies without disposables and without any undue pressure, punishing, or other psychological ills in the first two years of life (unless you think all of China, India and Africa are doing something wrong here). It is just part of baby care, really just part of life with another little human being, and perhaps that is a little closer to how it should be. When you consider that throughout history, all over the world, in every culture without disposable diapers, children have been and still are trained much earlier, you have to question what is natural, and what is best. Added to this is a huge increase in the number of children with constipation problems and recurrent urinary tract infections that are widely believed by medical experts (including urologists and gastroenterologists) to be DUE to the delayed training.

Another complicating factor is that now there are disposable products available that are so absorbent that kids and parents are really not aware of what is going on with regard to toileting needs. Those gel liners that are capable of holding incredible amounts of fluid have only been around since the 90’s. Before then, even kids who were in disposables could feel when they were wet, and their diapers would leak if not changed regularly. Today’s disposables can easily hold a day’s worth or urine without leaking or even getting too bulky, all held in a petrochemical-based gel matrix right next to your baby’s skin! I’m not totally sure that is a good idea, and the truth is that neither is anyone else! Whenever I hear parents talk about how inconvenient toilet training is (and, of course, it is not convenient!), I think how tough it must be for kids who haven’t even seen the adults that care for them figure out a way to get them dry after they wet. How are they supposed to, just because they happen to turn three?

Finally, it is essential in the world we live in to consider the environmental impact of our decisions. There are materials that are unhealthy and even toxic in many diapering products. The effects on our babies and our planet of how we toilet train in an important part of the discussion.

I know from my practice and experience that it is possible to live in our culture, to have the same sense of cleanliness and hygiene that most Americans share, and to manage to get everyone to school and work and piano and hockey and baseball and church……..without leaving children in diapers until they are three or four. You don’t have to swear off all of your disposables, or let your children pee all over your sofa. It is so much easier than all that, and there is lots of room for compromise. And I think it is totally, completely worth the effort.

Jill Lekovic, MD

For more information on Jill Lekovic's class at The Pump Station & Nurtury click here.