A wonderful school district BCBA emailed us the other day and asked if we had some resources for potty training. In looking through our resources, there were so many different ideas and strategies out there. So after working on potty training with our clients so often, we decided to write about our general approach to potty training.
First, you need to ensure the child is ready for potty training. It is great to potty train early, but the child needs to be physiologically ready.
The first question I ask parents and teachers that inquire about potty training is if the child can withhold their urine for 2 hours. If the answer is "no" and the child is wet often, they are likely not physiologically ready for potty training. And if they are wet often as they approach school age (5 and 6 years old), we then may recommend a medical consultation.
Second, we ask if the child knows what the toilet is for and if they sit on the toilet without issues. If a child is not yet interested in their parents going to the bathroom or flushing the toilet, there may need to be some pre-teaching. That pre-teaching can involve identifying the potty in pictures and practicing the potty routine, such as pulling down pants, sitting, and then flushing. Other pre-teaching activities can include social stories and books about going to the bathroom. Visuals are useful to teach the routine at any age. Additionally, if the child hates sitting on the potty, then trying to start potty training is going to be difficult, and possibly traumatic. Working on the issues that are preventing sitting on the potty, such as fears or sitting on an uneasy surface, should be worked on first.
Lastly, it is important that the child is familiar with cause and effect in regard to following directions and getting positive feedback. That could be positive praise or a small treat. If a therapist or teacher is just starting to work with the child, we don't recommend starting with potty training right away. Instead, we recommend developing a positive relationship with the child before starting to potty train.
Once the child is ready, we recommend that the diaper or pull up is removed and the child goes naked (if appropriate for the setting) or in underwear. That way, the adults can try to catch the child going to the bathroom and bring them to the potty as soon as possible. For older children, dignity issues come into play and you may want to do underwear and a dress or baggy shorts. But it is important to move away from the diaper and pull up. If the parents and teachers could move away from the diaper completely, except for bedtime, there is a greater likelihood of success.
Next, we recommend putting the child on the toilet every half an hour, to start. The reason we start with 30 minutes is because the child should be able to withhold for more than 30 minutes and if the child goes during that 30 minutes, they should be quickly redirected to the potty. A portable potty can be put near the child as well. A ton of positive reinforcement is paired with the potty, even if the child start going somewhere else and has to be rushed to the potty. The goal is to pair going in the toilet with big praise!
Each child is different and there are huge gains for some in a short period time and it takes longer for others. However, there are a few cautions to consider. The first is that when there is a negative association with potty training, the child may start to withhold urinating for a long period of time. This negative association may start if the child is required to sit on the toilet too often without enough reinforcement. It is very important, then, to not spend hours in the bathroom and focus too much on the potty training. Another consideration is if the child just is not associating that the toilet with urinating. A troubleshooting strategy for this is to use a wet alarm to alert parents or adults that it is time to quickly get to the toilet to ensure that the child associates the toilet with voiding.
There are many other considerations with potty training that may be needed based on a child's individual needs. Having worked on potty training for people ages 2 to 22, we are happy to provide consultation.