The Challenges of Potty Training

Dr. Gwenn O’Keeffe, a pediatrician at North Shore Children’s Hospital, writes a weekly column on child health issues.

Q. For the past few months, my 3-year-old son has been having a problem getting to the toilet in time. If he wets his pants he is very apologetic. We don't want to discipline him with timeouts, and we have explained that he must give himself more time. But it isn't really working. Any suggestions?

A. First, have your pediatrician examine your son. If your son is not circumcised, the foreskin can become constricting and the urine may not flow correctly. Strictures, or narrowings, of the canal in the penis through which the urine passes are also possible. Having his urine checked for infection is also a good idea.

There really is no way to “train” a child to use the potty because the process is biologically driven. Rather, all we can do is look for the cues that he is ready and “guide” him towards success. Some children master using the potty by two years of age, but others when they are closer to four. Without being biologically ready, even the most motivated child with the most supportive parents won’t succeed without frustration.

Let him drive this process, while you rally behind him. Try using Pull-Ups or a similar product until he is using the potty so well that the Pull-Ups are functioning like underwear. If he does wet his Pull-Ups, first tell him it’s “no big deal”, then calmly change him and hug him. When he does use the potty correctly, give him an even bigger hug and perhaps a little treat. By taking a more child-focused approach, your son will master the use of the potty when he is ready.

Q. My almost 5-year-old daughter will use some toilets but not others. She will use her own potty chair and her grandmother’s bathroom. She won’t use the toilet in the bathrooms at home, school or public places. I have told her that the potty is going away after the holidays. She is very shy, but also very stubborn. She will be going to kindergarten in the fall and I'm worried about her not using a public restroom. She tends to keep to herself a lot so I have a hard time getting her to play with other children. – Cindy from Peabody

A. This is less of a problem of stubbornness than a result of shyness and the anxiety it creates in a small child. When children feel anxious, they exert control in the few areas they have control such as using the toilet.

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