Go With The Flow, Part 2: How to Address the Typical Challenges That Arise in the Potty-Learning Process

This blog, which addresses how to manage potty learning challenges, is a follow-up to a previous post that focused on guiding principles for how to take a positive approach to helping children learn to use the toilet. I strongly recommend you read Go With the Flow, Part 1 before digging in to this piece as all the guidance below is based on the principles that are outlined in Part 1.  

When it comes to challenges in the potty-learning process, it is important to keep in mind that children are not a monolithic group. They have different temperaments, developmental paths, and life experiences that impact all aspects of their functioning, including learning to use the potty. There is not a one-size-fits-all approach that works for every child and family. When I collaborate with parents to address these challenges, we look at all the factors that might be influencing the process to come up with the best solution for their unique child. For example, in one family in which the child was withholding bowel movements, there was a lot of conflict between the parents that was affecting the child. Once we developed ways to help the parents reduce the tension in the household and combined that with some of the strategies described below, their child stopped holding in his poop.

Problem-Solving Potty Challenges
By and large, the primary reason the children I have worked with get stuck in the potty-learning process is a result of anxiety caused by the pressure they are experiencing to use the toilet. Often, these children are temperamentally more sensitive and cautious. They are fierce about needing to be in control. The more they sense that others are trying to make them do something, the greater their need becomes to take back control. When it comes to potty learning, this often means refusing to use the toilet and sometimes holding in pee and poop.

By the time families come to me for help they have tried everything: rewards and consequences; setting limits around using the potty (i.e., establishing times they have to sit on the potty and try to go); and even shaming or threats. Nothing has worked because these strategies don’t tackle the root of the problem—the child’s resistance to feeling controlled. In fact, the typical strategies parents are using are often inadvertently perpetuating the problem. In many cases, the constant and intense focus on trying to coax their child to use the potty has become an intrusion into family life and a major stressor.

The strategies below are all designed to reduce the tension and give control back to the child, where it belongs:

  • Explain to your child that it is her body and only she controls it, including choosing how to pee and poop. Point out all the positive ways she already controls her body, such as: eating healthy foods to grow big and strong; getting herself to sleep to build her brain and body; running, jumping and climbing which helps her have fun on the playground equipment. The idea is to instill a sense of confidence in your child that she is capable of controlling and taking good care of herself. This is an important first step because the messages she has likely been receiving, inadvertently, are that she doesn’t know her own body.

  • Dial it all back. You might say something along these lines: “Mommy and Daddy have been so silly! We have been trying to get you to use the potty because that’s what we do; it’s what feels good to us. So, we figured it might feel better for you, too. But that was so silly, because only you are in control of your body. It’s your job to take care of it. (Kids love the idea of having a job.) So, when it comes to peeing and pooping, you are the decider about where you let it go—in a diaper/pull-up or the toilet. From now on, it’s all up to you. It doesn’t matter to us as long as you let the pee and poop out. It’s not healthy for it to stay stuck in your body.” This discussion is purposely designed to be lighthearted to ease the tension that is usually pervasive around pottying at this point.

  • Be clear about her choices and show confidence in her ability to make the best decisions for herself. “What’s so awesome is that you’ve got two great choices: since you know how to hold your pee and poop in until you want to let it go, one choice is to use the toilet. Then you can wear underwear. You just let us know what else you need to use the toilet. We are your helpers. If you choose not to use the potty, you wear a pull-up; but the rule is we have to change it when it’s full of pee or poop because it’s not healthy for your body to sit in a full pull-up.” It is critical that the rules are presented matter-of-factly, without any suggestion that one choice is preferable over another. The idea is to make this process a less emotionally-charged experience.

  • Follow through—no talk about going to the potty unless your child brings it up and you are following her lead. While this feels very uncomfortable to many parents—we feel like we have to be doing something to help our children make progress—in most cases it’s our over-involvement that is the root cause of the problem (see Part 1). Children learn to self-regulate when you show that you believe in their ability to make good choices for themselves. When you try to do it for them, you are sending the message that you don’t think they can do it; that you need to do it for them, which only leads to more dependence and missed opportunities for children to take responsibility for themselves.

  • Expect accidents and don’t shame your child for them.  As discussed in Part 1, making children feel bad about accidents doesn’t prevent them, and it can actually increase them. Showing disappointment or annoyance can create a lot of anxiety that may interfere in the learning process, making children less likely to use the toilet. Shaming is not a motivator. Instead, focus on having your child help take care of her body: “Accidents happen. No problem. Here’s a towel to wipe up the pee. Now wash your hands and choose some clean clothes. Great job!”

  • Avoid comparing your child to other children or making threats about the consequences of him not going on the potty: “Your brother was doing this by the time he was 2 ½.” Or, “Do you want to be the only one left in your class who uses pull-ups?”

When parents stick to this approach to the letter, communicating with their words (and body language and facial expressions!) that they couldn’t care less whether their child chooses to use the toilet or pull-ups, usually, within a month children start moving toward independence in using the potty.

Other Common Challenges

Constipation. 
Many children I see are holding in their bowel movements as a way to assert some control over their bodies when they sense that others are trying to manage them. This can lead to constipation which makes pooping painful and adds another layer of stress to the process.

  • Explain to your child very matter-of-factly that letting go of his poop is very important for his health. Holding it in makes the poop hard and painful to push out. Many parents find this video helpful to share with their children. It illustrates why and how we poop and what happens when we hold it in. Be sure to view it in advance as you know your child best and can assess whether you think it will be useful for him. (If you do share it with your child, I suggest starting it at 00:26.) Taking a scientific approach can be very effective for helping children see that they are making choices about how to eliminate and that each choice has an outcome.

  • Talk to your child’s health care provider, who may prescribe a stool softener. As long as your child’s bowel movements are hard, it is unlikely he will feel comfortable letting go. One caution: be sure to work with your provider on establishing a dose that softens your child’s bowel movements but that doesn’t make them so loose that your child can’t control them. This can intensify the problem. Remember, it’s all about control.

  • Once your child’s stools are no longer hard, follow the steps laid out above to make it clear that your child is in control of both his body and the outcome of his choices about how to eliminate.

Children wearing underwear but then asking for a diaper/pull-up to poop. This is very frustrating and confounding for parents. The child clearly has all the skills she needs to use the potty. She is able to hold her pee and poop and then let it go in a planful way. She’s just doing it in a diaper versus the toilet. But she is almost there. Crossing the boundary to try to control your child runs the risk of setting her back. Instead, reinforce the idea that it is your child’s choice, but that there are some rules associated with her decisions: 1) You can tell your child that when kids are 2 ½ or 3 (whatever age you decide), pee and poop are done in the bathroom. By this time, most children have observed many peers using the potty and they see their parents going into the bathroom all the time, so this will make sense to them. Whether your child goes in the toilet or in a diaper, it all happens in the bathroom; and, 2) There is an expectation that she will participate in the process. This conveys that she is capable of doing a lot of her own self-care and you are supporting that. This means using a pull-up versus a diaper because she can put it on herself when she needs to poop. Then you will help her take it off and put the poop in the toilet, wash her hands, and help get herself re-dressed. When children experience the consequences of their choices, it is more likely they will ultimately decide that it’s just easier to go on the potty.

Children who actively resist or seem afraid of using the potty. There are many reasons why this may happen, but the most common I see are:

  • The way they experience their bodily sensations and other stimuli around toileting. Children who are under-responsive to bodily sensations may not be bothered by a full diaper and are less tuned in to the signs of having to pee and poop. Others are over-sensitive to sensory input, for example: sounds, which make the toilet flushing scary (especially the automatic ones); touch/tactile sensations, which may make the feel of pee slashing up onto them or poop coming out, uncomfortable; and smells, like bathroom odors, that can be overwhelming.These are often the kids who say they are afraid of using the potty. If you think the cause of the delay in, or resistance to, potty learning may be in some part due to your child’s sensory experience of the process, I recommend you consult with an occupational therapist (OT). OTs are highly skilled at helping children process sensory input accurately so they can master new skills more readily.

  • Feeling unstable on toilets that are too high to enable their feet to be firmly planted. That’s why I recommend using a “squatty potty” that fits around the base of the toilet where your child can rest his feet.  

  • A major change in your child's world, such as: a new baby, a recent loss, a family move, or a change in child care arrangements: If this is the case, I recommend giving your child time to adapt and get back to his baseline of feeling secure in his world before trying the strategies outlined below. Note that If the change is a new baby in the family, your child may be much less interested in being a “big boy” because he sees the baby getting so much attention for being dependent, including being diapered. In addition to giving him some time to adapt to his new sibling, I would avoid using “that’s what big boys do” to try to coax your child to do something you desire him to do as that can backfire during this stage. It can also be interpreted as shaming—that he’s a baby because he’s not acting like a big boy. Remember, shame is rarely a motivator and can negatively affect a child’s self-esteem.

Children who have turned three and are showing no interest in using the potty. The following strategies have been effective in helping children take steps forward in the process:

  • Use pretend play to give your child a chance to practice and get comfortable with the process. You might build into the story you are creating together the idea that your child’s lovey (or action figure, doll, animal, etc.) needs to learn to use the potty so he can swim in the big kid’s pool or go to the camp he wants to attend. Through the play, encourage your child to be a helper. Have your child take the pretend toy through all the steps of going to the potty. If you have a sense of what the obstacle might be for your child, for example being afraid of the unknown or feeling pressure to “perform”, build that into the play. Have your child be the one who helps the toy get over the fear. This can be very empowering to children, especially those who have expressed being afraid of going on the potty, as it helps them work through whatever anxieties they may have about the process.

  • Have your child pretend to use the potty. Go through all the steps: have her pretend she feels some pee coming; provide whatever help she needs to pull her pants down or lift her skirt/dress up; have her choose which potty to sit on and then she pretends to let the pee and poop out. Having a chance to practice through pretend can ease anxiety and pressure and make children more comfortable with the process. Some children actually end up going during the practice session and they’re on their way.

  • Set a specific date for when there will be no more diapers and pull-ups. Some parents choose a specific age marker, for example when their child turns 3 or 3 ½. It is critical that you communicate this matter-of-factly, just like you might tell a child that she will start going to school every day or that she is going to have a new caregiver. You acknowledge that this is a change and that you are there to help her make this transition. And most importantly, communicate that you have complete confidence that she will adapt. Point out other changes she has faced and mastered. Remind her that she is still in complete control of her body. You are not making her do anything. If she goes on the potty, fine. If she has an accident, no problem, you will clean it up together and move on. This initially feels uncomfortable to parents. But remember, it is strategic; when children sense their parents have an agenda or expectations, it causes anxiety and pressure that interferes in learning. Accidents are part of the process. They should not result in shaming or annoyance. Once children experience that it is all up them, and they don’t have anything to rebel against, they are more likely to make the best decision for themselves which is to use the potty. Few children would prefer to have accidents all day long that they are responsible for helping to clean up. This strategy can also be used with children who are stuck on using a diaper to have a bowel movement even after they have fully mastered peeing on the potty. 

I recognize that this sounds like boot camp, but it’s not. Most boot camps involve constant reminding about using the potty, requirements for sitting on the potty at certain times of day for set periods of time, and rewards for using the toilet. It is adult-driven. The model I am suggesting is quite different in that it entails trusting the child to figure out how to control his body in an age-appropriate way and to master a new challenge for which he already has the skills to achieve.
 
Keep in mind that when your child does pee or poop in the toilet, don’t go overboard with excitement as that can lead to regression (see Part 1.) It can feel intrusive and overwhelming. It also means that when your child doesn’t use the potty, he is disappointing you which makes the whole pottying process fraught with emotion. Instead, acknowledge your child’s success in a way that communicates that it is his accomplishment. Point out the benefits for him of making the choice to use the potty: “You felt the pee coming, got yourself to the potty and let it go. You had total control. Now there’s no need to change a diaper. Back to playing!”

Final Note
Potty-learning challenges can be very complex and confusing. They are often caused by underlying issues your child is struggling with. So, if you are in the midst of a challenge around pottying that you feel is having a negative effect on your child (and family), I encourage you to seek consultation for two important reasons: 1) The way you approach this process has an impact on your child beyond learning to use the potty. You are sending him messages about his capacity to regulate himself which is critical to his overall development; and, 2) Understanding the root cause of the struggles your child is experiencing can be hard to figure out. A trained child development specialist can help you put together the pieces of the puzzle that make up your child’s behavior. This can help you approach the challenge in a positive and effective way that supports your child’s overall development. And, the insight you gain about what makes your child tick can help you anticipate other developmental tasks or experiences that might pose challenges for him as he grows. It can provide a roadmap for how to support him through other challenges he may face.