Potty training problems: A evidence-based guide for prevention

© 2006 Gwen Dewar, Ph.D., all rights reserved

Common potty training problems include

• Potty training resistance

• Refusing to sit on the potty (“toileting refusal”)

• Stool withholding

• Refusing to defecate in the potty

• Chronic soiling

Most kids experience one or more of these problems. In some cases, the causes are organic. For instance, when otherwise continent children begin wetting themselves during the day, it’s important to determine if they suffer from urinary tract infections or bubble bath urethritis (see guidelines 11 and 12 below).

However, according to Dr. Barton Schmidt, most potty training problems have behavioral causes (Schmidt 2004). With the right approach, parents can help resolve these problems or avoid them altogether. The guidelines below are based on published studies and the recommendations of pediatricians experienced with potty training problems.


Guidelines for health, safety, and better cooperation

1. Prepare your child for potty training

You may avoid some potty training problems by planning ahead.

2. Avoid direct confrontations

If your child is uncooperative, it’s better to back off and try again later. Coercion can lead to all sorts of potty training problems, including constipation, urinary tract disorders and phobias (Schmidt 2004b).

3. Don't force your child to sit on the potty

Physical coercion tends to backfire. See Guideline #2.

4. Don't restrain your child if she wants to get up

Again, see Guideline #2. Instead, try to make potty-sits entertaining. This may include talking with your child, playing games, reading stories, and providing your child with “potty-time” toys.

5. Don't punish or scold your child for accidents

She may start holding back her urine or stool which can cause health problems and delay training (Schmidt 2004b).

6. Use a potty chair (not a toilet)

Children need stability and leverage when they sit. If their feet are left dangling, kids have more trouble controlling their voiding muscles (Christophersen 1991).

7. Avoid potty chairs with splash guards

Boys can catch their genitals on them when they are moving on or off the potty. If you teach your son to pee sitting down, show him how to hold his penis down so the urine goes into the potty. If your son prefers to stand, let him pee in a bucket (Schmidt 2004a).

8. Take steps to prevent constipation

Constipation increases a child’s risk for developing potty training problems like stool withholding, toileting refusal, and chronic soiling (Taubman 1997; Blum et al 2004). Make sure your child drinks plenty of fluids (at least four cups a day) and consumes plenty of fiber (Sears et al 2002). If your child has a constipation problem, consult your doctor.

9. Don't encourage your child to strain

Straining can cause disorders of the bladder and sphincter muscles (Weiner et al 2000). If your child can’t urinate without straining, report this to your pediatrician.

10. Consider scheduling a few routine potty visits during the day

Some pediatricians (Brazelton and Sparrow 2004) recommend that all potty sessions be child-initiated (no prompting from parents).

However, this approach is a matter of personal preference. Another approach features regularly scheduled potty sessions, such as immediately after waking, after meals, and before bedtime. When potty sessions are treated as a part of the daily routine, kids learn to expect them without being nagged (Lekovic 2006). Scheduled potty sessions may also have health benefits, including the prevention of urinary tract infections (Bakker 2002).

11. Beware of bubble baths and soapy bathwater

The soap can cause an inflammation of the urethra, which makes urination painful. Girls are more likely to develop this problem than are boys.

12. Help your child wipe

Most children don’t master wiping skills until they are 45 months old (Schum et al 2002). Good wiping is especially important for girls. Because the female urethra is shorter than the male urethra, it is easier for bacteria to invade the female urinary tract and cause infection. Teach girls to wipe front-to-back.

If you suspect your child has a urinary tract infection (UTI), seek treatment at once. ANY ONE of the following signs may indicate a UTI:

• Painful urination

• A sense of urgency (even when there is little or no urine to void)

• Odor

• Pink urine or blood in the urine

UTIs can cause potty training problems. But, more importantly, they can cause serious health problems. Untreated UTIs can damage the kidneys.



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References: Preventing potty training problems

For details on coping with potty training problems, see Dr. Barton Schmidt's article in Contemporary Pediatrics (Schmidt 2004b). This, and other articles cited, are listed below.

Bakker W. 2002. Research into the influence of potty training on lower urinary tract dysfunction. Unpublished MD dissertation, Department of urology, University of Antwerp, Belgium.

Blum NJ, Taubman B, and Nemeth N. 2003. During toilet training, constipation occurs before stool toileting refusal. Pediatrics, 113: 520-522.

Brazelton TB and Sparrow JD. 2004. Toilet training the Brazelton way. Cambridge, MA: deCapo Press.

Christopherson ER. 1991. Toileting problems in children. Pediatric Annals, 20: 240-244.

Lekovic JM. 2006. Diaper-Free Before 3: The Healthier Way to Toilet Train and Help Your Child Out of Diapers Sooner. Three Rivers Press.

Schmidt BA. 2004a. Toilet training: Getting it right the first time. Contemporary Pediatrics, 21: 105-119.

Schmidt BA. 2004b. Toilet training problems: Underachievers, refusers, and stool holders. Contemporary Pediatrics, 21: 71-82.

Schum TR, Kolb TM, McAuliffe TL, Simms, MD, Underhill, RL and Lewis M. 2002. Sequential acquisition of toilet-training skills: A descriptive study of gender and age differences in normal children. Pediatrics 109: 48-54.

Sears W, Sears M and Watts Kelly C. 2002. You can go to the potty. Boston, MA Little, Brown and Company.

Taubman B. 1997. Toilet training and toileting refusal for stool only: A prospective study. Pediatrics, 99: 54-58.

Weiner JS, Scales MT, Hamptom J, King LR, Edwards CL. 2000. Longterm efficacy of simple behaviour training for day-wetting children. Journal of Urology, 164: 786-90.

Content last updated 12/6