Potty training techniques:

A evidence-based guide to training methods and their success rates

© 2008 - 2014, Gwen Dewar, all rights reserved

Doing research on potty training techniques?

This article descirbes the major methods and (where such information is available) reviews the scientific evidence in favor of each one.

As you’ll see below, some approaches depend on parent-led practice runs.

Others rely on child-initiated trial-and-error.

But all modern methods share several important points:

  • All methods use praise and affection.
  • All methods are compatible with using rewards--for example, giving your child a sticker for each successful use of the potty.
  • And all training processes should follow certain health and safety guidelines.

The last of these--health and safety guidelines--are described in my article on how to avoid toilet training resistance, infections, and other problems.

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The rest of this article provides you the information you need to create your own, personal potty training plan.

The options include:

  • Infant potty training
  • Child-oriented potty training
  • Toilet training in less than a day and other "fast track" methods
  • Gradual, parent-led toilet training
  • The "bare-bottom" method

As you consider your options, remember that each child is different. Choose potty training techniques that you feel comfortable with, and don’t hesitate to drop techniques that seem to upset your child.

Infant potty training techniques

In many parts of the world, infant training is the norm. The goals differ. Babies are obviously incapable of toileting independently. But research suggests that infant potty training techniques can be safe, gentle, and effective.

For more information, see my article on traditional infant potty training.

In addition, if your baby is old enough to sit up unassisted, you might want to check out this article about self-initiated infant toilet training. It's an approach that's been clinically tested.

The child-oriented approach to toilet training

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

T. Berry Brazelton introduced his child-oriented approach in 1962. A practicing pediatrician, Brazelton had observed an increase in toilet training failures, including toilet refusal, severe constipation, and (shudder!) stool smearing (Brazelton and Sparrow 2004). He reasoned that the prevailing potty training techniques--which emphasized parent-led practice drills--were pushing kids before they were ready. As a remedy, Brazelton designed an approach that is gradual and gentle.


How to apply these potty training techniques

Brazelton’s method is outlined in his book, Toilet training the Brazelton way ( 2004). Brazelton and his coauthor, Sparrow, recommend that you delay toilet training until your child show spontaneous signs of being ready (for a list of signs, see "When to start potty training"). Once you observe these signs, you follow a series of steps. Before beginning each step, you must wait until your child show’s interest. If you child is reacts negatively, you pull back and wait. There is no schedule or timeline to follow. The child sets the pace.

The first step is taking your child to the store to pick out a potty. Step two is encouraging your child to sit, fully clothed, on the potty. Subsequent steps include emptying your child’s soiled diaper into the potty and encouraging her to wash her hands when she visits the bathroom.

The big breakthrough--the day your child sits on the potty chair with a naked bottom and actually voids--is supposed to happen spontaneously. To encourage this, you let your child run around the house without diapers and leave the potty chair out in a conspicuous place. If your child is slow to make the connection, you can ask if he wants you to help him use the potty. But the goal is to let the child think potty training is his idea, not yours. The remaining steps, like emptying the potty chair into the toilet, flushing, and hand-washing, wait until your child show’s interest in them.


Outcomes

Because each child sets her own pace, training times vary. However, it’s safe to say that the Brazelton approach is associated with late training. According to data that Brazelton analyzed in 1962, the average age of initiation was 24 months; the average age of completion, 33 months. More than 50% of his trainees completed training by 27 months (Brazelton 1962). A more recent study (Taubman et al 2003) reports later completion times—around 34-38 months.

Does age at initiation matter? It might. A prospective study of 8000 children found that kids who started training (of any kind) after 24 months were at higher risk for experiencing slow progress and setbacks (Joinson et al 2009). Perhaps children who start later are more likely to resist change.

But hold age constant, and your choice of toilet training methods might not matter. When a retrospective study compared child-led training and gradual, parent-led training, researchers found no differences with respect to long-term outcomes in dysfunctional voiding (Colaco et al 2013).

Toilet training in "less than a day" and other "fast-track" potty training techniques

Azrin NH and Foxx RM. 1974. Toilet training in less than a day.

Crane, T. 2006. Potty Train Your Child in Just One Day: Proven Secrets of the Potty Pro.

Parpia N. 2006. Potty Training in One Day: A Guide for Today's Parents.

Overview

One-day potty training techniques were first introduced in 1974 by psychologists Nathan H. Azrin and Richard M. Foxx. The techniques were designed for kids who are 20 months or older and who have had no previous toilet training experiences.

Other, more recent methods draw on the same potty training techniques, which include

• teaching through pretend play (with a doll that simulates urination)

• positive reinforcement (food rewards)

• practice drills, and

• over-correcting for accidents (making kids perform pretend, practice runs immediately after he or she has peed in her pants)

How to apply these potty training techniques

For details, see this review of "fast track" potty training techniques.

Outcomes

Do these methods work?

Scientific studies suggest that most parents who attempt fast-track potty training techniques will be pretty successful... if the parent follows the instructions closely AND everyone--parent and child--is comfortable with the process.

But being well-prepared and comfortable is the key. For some families, this approach may feel too regimented. For the full story, see this article about fast-track potty training techniques.

Gradual, parent-led toilet training

This approach combines several potty training techniques. Like Azrin and Foxx's approach, the method is parent-led. Like Brazelton’s approach, this method is gentle and gradual. There are several variants of this approach. Here I describe Barton Schmidt’s version. Dr. Schmidt is professor of pediatrics at the University of Colorado School of Medicine (Schmidt 2004b).


How to apply these potty training techniques

Schmidt encourages parents to plan ahead. Months before you plan to begin training, help your child get ready (see my article “How to prepare your child for potty training”). Take your child to the store to pick out a potty chair. At home, leave the chair wherever your child spends most of her time. Encourage her to sit and play on it while fully clothed. After a couple of weeks—when your child is accustomed and comfortable with the potty chair—you can begin training.

Start with practice runs. Make sure your child is wearing minimal, easy-to-remove clothing. If it’s warm enough, have your child wear a diaper only. Then watch your child for signs that he needs to pee or defecate (grunting, making faces, squirming, pulling at the diaper, etc). When he is about to void, remove his diaper and place him on the potty. Encourage him to use the potty (for example, say “try to go pee-pee in the potty”). If he does, reward him with praise, affection, and special treats (stickers or a snack).

If he doesn’t void, allow him to stay on the potty for up to five minutes. If nothing happens by that time, end the practice run. But don’t force the child to sit. If he’s restless, let him off the potty with an encouraging word (“good try”).

Praise your child for cooperating—even if he didn’t urinate or defecate.

When your child has an accident, change her as soon as possible. You want your child to get accustomed to wearing only clean, dry pants. Encourage your child to keep trying to use the potty. Avoid a show of negative emotions. Be patient, affectionate and upbeat.

If you have trouble telling when your child needs to pee, Schmidt suggests that you hold practice runs about 45 minutes after your child has finished a large drink, or after two hours without urinating. If you have trouble detecting defecation, stage a practice run after a large meal or after 24 hours without a bowel movement.

Schmidt warns that parents should ration the number of practice runs—perhaps no more than 100 total. Practicing more than a few times a day may prompt children to resist. Once your child seems to get the hang of things, stop practice runs and replace them with gentle reminders. Like practice runs, reminders should be used sparingly. If you push too much, your child may start to rebel.

Continue to praise your child for using the potty. After your child has peed in the potty 10 times or more on her own initiative, introduce underpants. Portray them as a reward for progress. Let your child pick them out for herself, but make sure they are loose-fitting. You want pants your child can pull up and down herself. Once your child starts wearing underpants, reserve diapers for sleeping and travel.

According to Schmidt, practice runs and reminders should be unnecessary after 1-2 months. Children should be using the potty without prompting. However, it may take up to 6 months for your child to complete training.

If children are slow to make the final transition, Schmidt recommends trying the bare bottom method (below).

Other important potty training techniques that Schmidt recommends include:

• Multiple potty chairs. Your child is more likely to remember to use the potty if he can see it. Put potty chairs in multiple locations.

• Encourage fluid consumption. The more your child drinks, the more frequently your child can practice potty skills.

• Time-ins. Be generous with physical affection and reassurance. Potty training can be discouraging. Let your child know that you love her and have confidence that she will eventually succeed.


Outcomes

As noted above, a retrospective study evaluated the long-term health outcomes associated with this method and with child-led training. The researchers that neither approach was linked with long-term dysfunctional voiding problems (Colacco et al 2013). As of February, 2014, I have no found no other research pertaining to gradual, parent-led potty training.

Bare-bottom method

These potty training techniques are for children over 30 months who have used the potty several times with parental assistance (Schmidt 2004a).

The method is based on the premise that kids dislike wetting themselves. Let them run around naked for a few hours, and they will figure out by themselves when to use the potty.

This potty training method is for children over 30 months who have used the potty several times with parental assistance (Schmidt 2004a). The method is based on the premise that kids dislike wetting themselves. Let them run around naked for a few hours, and they will figure out by themselves when to use the potty.

How to apply these potty training techniques

Before you begin, reserve at least one six-hour block of time (or a weekend) for training. Some children might require several consecutive days.

Remove all distractions, strip your child below the waist and let her play. Offer her lots of fluids to create many opportunities to pee. Keep her within easy access of a potty chair at all times. This is easiest if you confine your child to a room (or even better, a backyard if it’s warm outside). Stay with your child, but do not ask her to sit on the potty. Be cheerful, and let her work things out for herself.

If you are wondering what happens when your child has accidents, the answer is that you get a mess. For this reason, you’ll want to stage your training session in a place that is easy to clean. Ideally, you should hold your training session outside on a warm day. Otherwise, you might try confining your child to the kitchen and other areas of the house that are more easily cleaned. When you do clean up, avoid giving your child any lectures or lessons. Be upbeat and affectionate.

Outcomes

I can’t find any scientific studies testing this method. Dr. Barton Schmidt prescribes this potty training method to patients who have had difficulty making the transition from practice runs to toileting independence. He reports high success rate (Schmidt 2004a).

Other potty training techniques

Elizabeth Pantley has published her own guide to toilet training, The No-Cry Potty Training Solution: Gentle Ways to Help Your Child Say Good-Bye to Diapers (2006). Like Brazelton, Pantley emphasizes the importance of waiting until your child is ready. But she also believes in parental reminders. Her recommended potty training techniques include the use of rewards.

William Sears and Martha Sears have published a child’s picture book to help parents encourage their children to use the potty. Entitled You can go to the potty (2002), the book appears to be compatible with all the approaches to toilet training mentioned here.


References: Potty training techniques

Azrin NH and Foxx RM. 1974. Toilet training in less than a day. New York: Pocket Books.

Brazelton TB 1962. A child oriented approach to toilet training. Pediatrics, 29: 121-128.

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

Colaco M, Johnson K, Schneider D, Barone J. 2013. Toilet training method is not related to dysfunctional voiding. Clin Pediatr (Phila). 52(1):49-53.

Crane, T. 2006. Potty Train Your Child in Just One Day: Proven Secrets of the Potty Pro. Fireside.

Joinson C, Heron J, Von Gontard A, Butler U, Emond A, Golding J. 2009. A prospective study of age at initiation of toilet training and subsequent daytime bladder control in school-age children. J Dev Behav Pediatr. 30(5):385-93.

Pantley E. 2006. The No-Cry Potty Training Solution: Gentle Ways to Help Your Child Say Good-Bye to Diapers. New York: McGraw Hill.

Parpia N. 2006. Potty Training in One Day: A Guide for Today's Parents. Mom Innovations.

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.

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.Taubman B, Blum NJ, and Nemeth N. 2003. Stool toileting refusal: A prospective intervention targeting parental behavior. Archives of Pediatrics and Adolescent Medicine, 157: 1193-2003.

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