• 5 Tips for Creating Good Habits While Toilet Training Your Child

    Toilet training is an important developmental milestone for children, and is one of the first steps to becoming more self-sufficient. However, toilet training can be challenging for both children and their families.

    The following tips will help your child create good, lasting habits and avoid future bowel and bladder problems.

    1. Wait for it!

    Typical bowel and bladder development occurs around 18 months of age. Starting toilet training too early can create frustration and lead to poor habits or avoidance of toilet training all together. It can also lead to bowel and bladder problems such as urinary incontinence, bedwetting, urinary tract infections, and constipation.

    Watch for signs of mental and physical readiness in your child. The following questions can help you determine whether or not your child is ready for successful toilet training:

    • Are they interested in and asking questions about toileting?
    • Can they sense when they need to go?
    • Can they get to and from the toilet?
    • Can they get onto and off of the toilet?
    • Can they help with dressing?

    2. Use positive reinforcement.

    Praising and rewarding your child during this phase is very important. It will keep the interest of the child and encourages them to continue with training. Negative reinforcement or punishment can create anxiety in the child, which can lead to a tightening of muscles involved with voiding and create an inability to pass urine and stool.

    Consider a reward system based on earning; each success (eg, sticker, gummi bears, money) is a small step toward a larger reward (eg, toy, trip).

    3. Maintain a healthy diet.

    Many children struggle with urinary urgency, frequency, and constipation. These symptoms often relate to improper diet. Avoid foods and beverages that are high in salt, sugar, caffeine, and carbonation or that are acidic in content, which can create irritation in the bladder and contribute to urgency and frequent urination. Proper water and fiber intake is also very important for stool regularity and consistency. Softer stools are easier to pass and will decrease constipation.

    4. Use proper toileting posture.

    Proper posture while sitting on the toilet is very important during toilet training because it helps to relax the pelvic floor muscles. The pelvic floor muscles are a group of muscles that attach to the bottom of your pelvis and help with bowel and bladder control. When the pelvic floor is contracted, urine and stool are held within the body. When the pelvic floor relaxes, urine and stool can pass outside the body.

    Sit with the feet flat on a surface (no tippy toes!), knees higher than the hips, leaning forward with a straight back. Many times, training the child on an adult-sized toilet with a toilet ring can avoid aversion to toilets in the future. A foot stool is a great way to keep the knees up and feet supported!

    5. Establish a bedtime routine.

    If bedwetting is an issue for your child, there are 2 important things to remember:

    • Constipation is one of the leading contributors to bedwetting. See #3 about maintaining a healthy diet.
    • A proper bedtime routine allows for the body to regulate other systems to ensure proper sleeping patterns. First, establish a bedtime and stick to it. Second, follow a prebedtime pattern that you and your child enjoy. For example, incorporate bath or story time into your child's routine. Be sure to avoid or limit fluids before bedtime and empty the bladder just before bed. Bed wetting is often self-limiting, meaning that eventually your child will grow out of it.

    Help is out there!

    Some children continue to have issues with urinary urgency, frequency, incontinence, recurrent infection, and constipation even as they get older. These issues may be related to improper toilet training, learned habits, or perhaps a medical abnormality. If you are concerned that your child's bowel and bladder control is not where it should be, discuss this with their pediatrician. A referral to a medical specialist may be required, or the child may benefit from treatment by a pelvic floor physical therapist.

    Bibliography

    Bae SH. Diets for constipation. Pediatr Gastroenterol Hepatol Nutr. 2014;17(4):203–208. Free Article.

    Popkin BM, D'Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010;68(8):439–458. Free Article.

    Macias MM, Roberts KM, Saylor CF, Fussell JJ. Toileting concerns, parenting stress, and behavior problems in children with special health care needs. Clin Pediatr (Phila). 2006;45(5):415–422. Article Summary in PubMed.

    Schmitt BD. Toilet training—getting it right the first time: successful toilet training benefits both parent and childContemp Pediatr. 2004;21(3):105–116.

    De Paepe H, Renson C, Hoebeke P, Raes A, Van Laecke E, Vande Walle J. The role of pelvic-floor therapy in the treatment of lower urinary tract dysfunctions in children. Scand J Urol Nephrol. 2002;36(4):260–267. Article Summary in PubMed.

    Polaha J, Warzak WJ, Dittmer-McMahon K. Toilet training in primary care: current practice and recommendations from behavioral pediatrics. J Dev Behav Pediatr. 2002;23(6):424–429. Article Summary in PubMed.

    De Paepe H, Hoebeke P, Renson C, et al. Pelvic‐floor therapy in girls with recurrent urinary tract infections and dysfunctional voiding. BR J Urol. 1998;81 Suppl 3:109–113. Article Summary in PubMed.

    Authored by Whitney Bartley, PT, DPT

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