When Toilet Training is not Simple

Toilet training is not simple for all children. Some continue to have accidents after they are 4 years old, others are constipated or soil themselves. These issues can have a major impact on family dynamics, schooling and of course on the child’s self-esteem.

Often parents are told “don’t worry they will grow out of it”. But when will they finally grow out of bladder and bowel issues? And at what point should you seek help?

Normal toilet training should be complete by 3 years of age. It can be started any time after a child learns to sit independently. Having a few accidents while toilet training is normal, however by preschool a child should be able to recognize the urge to go to the toilet and hold on until they get there.

Bowels should be regular, with the stool (poo) being a soft sausage shape. Hard poos looking like rocks and pebbles are not normal and can cause pain and fear of the toilet. Any child with ongoing toilet fears, with pain or with refusal to go to the toilet should be seen by a continence therapist.

Help, my child starts pre-school next February and is not toilet trained yet!

It is not uncommon to get this call late November or December. While there are children who manage to get toilet trained in 3 days, this is not often the case. Starting to think about toilet training early will make the process much easier.

Before you start toilet training, have a look at your toilet or bathroom. Is it child friendly? Ensure you have a toilet seat that will fit your child’s bottom. The fear of falling in is very real when you are under 6. Pictures on the wall may make it more child friendly in there and removing chemical smells or deodorants may also help

When should I start?

Many parents and all grandparents would have been toilet trained before their second birthday. There is no right time to start.

  • Some simple rules do apply:
  • A child should be able to sit independently (on a potty for example).
  • Toilet training when the home is in a major state of change (moving house, new baby due, major renovations) is adding to a very stressful time and often unsuccessful.
  • The child should be healthy both physically and emotionally.
  • Parents should avoid starting toilet training when they are really stressed.

How do I start?

Young children like to please their caregiver. Starting toilet training before they develop a strong willpower (commonly known as a ‘won’t’ power) helps to make it easier. Model the behaviour you want, let the child see you go to the toilet, tell him/her where you are going (“my bladder is telling me it is full and I have to go to the toilet now”) let boys watch their father and girls their mother.

Encourage your child to sit on the potty or toilet for a few minutes at regular intervals 4-6 times per day. No longer than 1 minute per year of age. If they do a wee or a poo congratulate them, throw high 5’s and make sure they know the right thing has happened. If they don’t produce then tell them well done for sitting well and try again later.

It may take a few days or a few weeks but being consistent will pay off. Don’t stress and don’t make it a chore for your child. If the process is too stressful, have a break and try again later.

What to do when children still have accidents at school?

5 to 20% of children still have accidents when they are at school. While some will grow out of it, many do not. Fear of being found out by parents, teachers or care givers lead many to learn how to hide evidence of accidents or pretend it never happens. For parents the fear that their child becomes the victim of bullying, teasing or exclusion will cause much stress.

What causes day time wetting or soiling?

The cause of bladder and bowel incontinence is complex and varied.

  • Some common factors include:
  • Poor fluid intake – children should drink 6-7 glasses of fluid every day.
  • Poor fibre intake – 2 fruit and 5 veg serves per day.
  • Just- in-case toileting – children (and adults) should learn to go when they feel the urge.
  • Being too busy – kids need to learn they their play, toys, friends will all still be there when they come back from the toilet.

Some children have over active bladders. These bladders do not give any warning that emptying is about to happen. They are not ‘lazy’ or ‘naughty’ or forget to go to the toilet, they get no warning.

Getting an assessment by a doctor or a continence therapist specialising in children’s bladders and bowels is the first step in finding a solution for these children.