I never intended to develop a specialty in potty training or handling urinary and fecal incontinence (e.g., bedwetting or soiling oneself). Before graduating with my Ph.D., I completed a one-year internship at Oregon Health and Science University. I worked at Doernbecher Children’s Hospital. One of my supervisors was Dr. Kurt Freeman, who ran a specialty clinic for toileting issues. Each intern completed a 3-month rotation in his clinic. Every Monday afternoon, all the patients I saw experienced various toileting problems. 

Almost 20 years later, I still consider that rotation one of the more consequential learning experiences of my internship. We have seen many patients for toileting issues at Lamb Behavioral Health Center. I enjoy helping people reduce shame and seeing individuals find success in this area. In several cases, I have seen individuals make enough progress to avoid surgery.

Toilet training is a learning process that requires several developmental steps. Children need to develop awareness of body cues that they need to void waste. Then they learn that the best way to handle those cues is through using the toilet. This post will help you get started with the basics of toilet training including readiness, first steps, and how to handle accidents. I will focus on daytime toilet training as overnight training can be a different challenge.

These procedures are for individuals without underlying health issues or persistent encopresis. For example, persistent encopresis is tied to constipation 90% of the time, and treatment often requires medical intervention, diet changes, and behavioral modification.

Potty Training Starting Points

Know the right time to begin potty training

Many parents want to start potty training at a very young age. Sometimes they set their expectations too high too soon. Please note that the clinical diagnosis of enuresis (urinary incontinence) cannot be given until the child is 5 years old. Encopresis (fecal incontinence) cannot be diagnosed until a child is 4 years old. Furthermore, some children may have other issues (e.g., developmental disabilities) that may delay potty training.

I recommend waiting to begin toilet training until the child shows signs of readiness. Your child should be able to pull their pants up and down. They should dislike being wet/dirty and give physical or verbal signs of voiding. Your child should not be resistant to learning to use the toilet. Important related skills include sitting in one position for 2 to 5 minutes, taking pride in accomplishments, and following simple instructions. Your child does not need to possess all these signs; however, the more signs of readiness your child achieves before beginning toilet training, the higher the likeliness of success.

Introduce the concept of using the toilet

Because Western culture emphasizes privacy, children may not have a concept of the purpose of the toilet. Children’s books, apps, or toys can help introduce the concept in a simple way by telling developmentally appropriate social stories of toileting successfully. One example that has all three modalities is the book Potty Time with Elmo. In addition, parents should convey an enthusiastic, positive attitude toward toilet training throughout the process.

Consider the best time to start potty training

I strongly recommend that you begin potty training when you can spend as much time as possible at home. For example, do not start training 3 days before leaving on vacation or starting school. This skill can require some time to develop.

Ensure the toilet is appropriate for the child

Make sure your child can get onto the toilet independently and not fall in once seated. Many people begin by using a shorter, stand-alone potty chair. In other cases, I have seen people use potty training seats that lay over the toilet with ladders attached. Parents enjoy this option because they avoid emptying the contents of a stand-alone potty chair.

Have the child wear regular underwear

This is probably the most controversial recommendation. By wearing regular underwear, the child can experience the feeling of being wet. The caretaker also tends to catch and respond to accidents more quickly. For convenience, some individuals use underwear at home but a diaper or pull-up when going out.

Have scheduled sits

Every 30 minutes, have your child sit on the toilet for 2-5 minutes to try to void urine or fecal matter. Engage the child in an activity to increase compliance, such as singing, reading a book, or watching a video. At the completion of the timed sit, offer praise and possibly a small reward (e.g., a single chocolate chip), even if nothing came out. At first, the goal is to make sitting on the toilet a positive experience. Focus on rewarding behaviors that will lead to the desired outcome, even if it takes a while.

Encourage going on their own

Allow and encourage your child to go to the toilet outside of scheduled sits. You may give a bigger reward when they do so, especially successfully. Some kids may go to the toilet just to get a treat and “play the system.” This is okay at first because they are developing positive experiences with toilet training.

As your child progresses to going on their own more frequently, gradually increase the time between timed sits. Eventually your child will be able to get through the entire day going to the toilet without being prompted!

Potty Training: Handling Accidents

Expect accidents to happen

Accept the fact that accidents will happen. In fact, I believe each of my 5 children had at least one accident immediately following a timed sit! Over time, you will overcome obstacles by learning through trial and error. For example, I learned to leave the lights on for my own children due to fear of the dark and/or not being tall enough to reach the bathroom light.

Do not punish or shame the child for having accidents

The behaviorist in me will start by saying that attempting to reduce accidents through punishment or shame (a potential punisher) rarely works. A child may try to reduce accidents by holding it in more. This can cause a variety of health problems, including infections and bowel impaction. Hiding behavior can also arise, such as throwing away soiled underwear to avoid punishment. Rather than punishing your child for any of these behaviors, tell them what to do instead.  

Have the child help clean up the mess

One of the most cited responses to an accident is having the child help clean it up. The point of cleaning up is for the child to experience the natural consequence of having an accident. Handle this in a matter-of-fact manner. Do not imply the child did something “bad.” Simply say, “this is what we do when we make a mess,” similar to spilling milk at the dinner table. In some cases, I have recommended that caregivers offer verbal praise or small rewards for helping clean up an accident.

Potty Training: Conclusion

Hopefully these potty training basics can help you and your child experience a successful potty-training adventure! Measure your success by looking for progress over a period of time. Sometimes a child is just not ready yet and may need more time before trying again.

If you see little progress or regression, if toilet training becomes contentious, or if your child develops associated fears, you may need more help. Talk to your child’s doctor to rule out underlying medical conditions. Schedule a therapy appointment to discuss your efforts and receive more personalized support.

If you would like to learn more or schedule an appointment, contact us!

Post written by Dr. Gordon D. Lamb, Licensed Psychologist and Clinical Director

Please note posts are educational in nature and are not intended to replace psychological services when needed.