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. It takes less time and we don’t have to get all cleaned up after. 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. (And is why I would even avoid using “accident” to describe these incidents as that word in and of itself can feel shaming.) 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—it is paralyzing and leads to less body control, not more. Instead, focus on having your child help take care of her body: “No problem. Here’s a towel to wipe up the pee. Now wash your hands and choose some clean clothes. Great job!” Create a clean-up station in the bathroom with clean bottoms, wipes, etc.
What about when children choose underwear but have repeated accidents? It is reasonable to set clear limits about underwear use. Every family has a different threshold. You might decide that if your child has more than two or three accidents a day, it will be time to change into a pull-up. It is very important to communicate this dispassionately—underwear is not a reward, and pull-ups are not a punishment. You simply explain that underwear is not made for pee and poop. (Recall the experiment from Potty Learning Part 1 which demonstrates for children the difference between how underwear and pull-ups/diapers work.) “If you have three accidents it means you are choosing not to use the potty. No problem. But that means it’s time for a pullup because underwear is not made for pee or poop.” Remind your child that the pullup is great because it can hold the pee and poop. But, if she decides she wants to use the potty, she can always just pull it down like underwear. (The idea is to message that she has lots of choices—it’s all in her hands—while also setting some objective limits. Most parents find it hard to tolerate repeated accidents all day long.)
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.
It is also important to talk with your child’s doctor about how to assess if your child can feel when the poop has to come. Sometimes when children have been withholding for a long time, their colon gets stretched out and the child doesn’t register the sensation of the poop being ready to let go.
Guide your child through their choices and the outcomes of those choices. Reiterate that they are the only ones who control their pee and poop. It is their decision about when to let it out. Then explain that as their helper, you are going to help them think through the outcomes of their choices so they can make the best decision for themselves:
When they choose to let the poop out when their belly gets that feeling that the poop is coming:
The poops are softer and more comfortable to push out. It doesn’t hurt.
Bellies feel better because they can eat more and are not uncomfortable when poop isn’t sitting there for too long.
When they choose to hold the poop in when it has to come out:
The poop gets hard and make is painful to push out.
Bellies feel uncomfortable.
They may have to take some medicine to make sure the poop comes out because that is a “have-to.” (Talk to your doctor about exactly what the regimen will be so you can let you child know exactly what to expect. For example: “We will give you Miralax (Exlax, whatever you are using) every day. That goes in your milk/juice/water. If you haven’t let a poop out in (however many the doctor indicates), then we do a clean out. I know that feels really uncomfortable for you so it’s important to think about what is best for Charlie: to let the poop out when it needs to come and have your belly and poops feel better; or, to hold it in and have to do the clean-outs to get the poop out. That is your choice. You are the only one who controls your pee and poop.
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 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 are peeing on the potty regularly but insisting on using 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 plan where to eliminate it. 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) Explain to 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.
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.
When children are 3 1/2 and older and are not making any progress on giving up the pullups to poop. I find, by-and-large, that at this point, children have made such a strong association with pooping in the pullup that they are unlikely to give it up on their own. They say things like they are scared of sitting on the potty, or they assert “I will poop on the potty when I’m four” to get their parents to back off.
In these cases, families have had success using the following approach:
1) Tell your child you are in big trouble with the pediatrician. (Kids find this very funny and intriguing so they are a captive, not defensive, audience.) The reason is that when kids turn 3, there are no more diapers/pullups. They were supposed to go away a long time ago! You didn’t know that! The doctor explained that just like they had to give up bottles and pacifiers, now it’s time to say goodbye to the diapers. Present it as a fait accompli. Not something that is open for discussion. It’s just a fact. This is very important. If you suggest in any way that this is up for discussion/negotiation, your child is likely to focus all their energy on derailing you from this plan, trying to get you to change your mind.
At the same time, you have to expect and be prepared for protest and push-back. Acknowledge and validate their feelings: “I know, You don’t like this change. I totally understand.” Avoid trying to talk them out of their feelings as that usually leads to children doubling-down to be heard.
2) Remind your child of other things they have had to give up that they managed and grew from. For example, they had to give up the bottle which they didn’t love, but became a champion cup user. They didn’t want to go to school, or change classrooms, but they did it and loved their new friends and teachers. Explain that this is just another one of those changes that happen as they grow and that you have full confidence they will figure this one out, too.
3) Because this is news to all of them—that the diapers have to go away—the doctor said they have a whole week just for practice before the diapers go away. This might be checking out and sitting on different potties, cutting a hole in the diaper/pullup and sitting on the potty, trying out different underwear, etc., if they want. Avoid the temptation to coax your child to take these steps. Remember, often kids are resisting because they sense you are trying to control them and are digging in their heels. Coaxing communicates you have an agenda and a goal which is fodder for defiance.
Show your child on a calendar how many days they have for practice and which day the diapers will go away.
4) On the day you take away the diapers, you do so matter-of-factly. It’s just a “have to.” You communicate to your child that you have total faith they will figure out what to do with their poop. I know it sounds bizarre but you don’t tell them that they have to go on the potty. Why? Because that’s a limit/rule/behavior you have no control over enforcing. You can’t make them choose to use the potty. Dictating it can result in motivation to prove you wrong, making it less likely they will choose to use the potty.
This approach has worked for many families, I believe, because, absent any fodder (adults’ trying to control them or paying a lot of attention to their elimination) children are freed to make the best decision for themselves. If they have accidents, and no one makes a big deal out of it (it’s simply,, “Let’s get you cleaned up” with no annoyance, shaming, or big reaction), they realize that the only outcome of not using the potty is the discomfort of soiling themselves which ultimately motivates them to start using the toilet.
If you have a child who withholds, what I have found most helpful is to first talk to your doctor about how many days it is okay for your child to go without having a bowel movement. Once that is established, you matter-of-factly explain to your child that poop has to come out. That is not a choice. It is unhealthy for it to stay in bodies. (The video mentioned above does a great job of explaining this.) And because your #1 job is to make sure he is healthy, you have to make sure the poop comes out. So their two great choices are to: 1) Let the poop comes out to when it has to; or, 2) If x number of days goes by without their letting a poop out, then they will have to give him medicine that makes sure the poop comes out. (Again, this is something that you establish with your doctor.) This is communicated to your child without any threats or shaming. You are simply telling them exactly what their choices are so they can make the best decision for themselves—whether it’s better to let the poop out when they feel it has to come, or whether they choose to hold it in and take the medication to have the poop come out.
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. Then follow the steps laid out above about what to do when kids insist on using pullups to poop well after they are physically capable of using the potty for bowel movements. The doctor has explained that there are no more diapers at this age and you have total confidence they will figure out how to take care of their pee and poop, which is their job.
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, picking children up mid-pee or poop (which is very intrusive), 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.