Tips for Potty Training

by Alan Greene, MD, FAAP

"I have a 3¼-year-old daughter who is not potty trained. She wears pull-ups, enjoys sitting on the toilet, and gets very excited when she urinates. The problem is she has been doing this for months. She has not made the transition to going to the toilet and using it when she has to go. How do I help her to make the transition from an occasional fun thing to do, to using the toilet every time she has to go? I have been very relaxed about the whole potty training situation. I am beginning to think I have been too relaxed, and need to give her a little more guidance and direction, and am not sure how to do this without being too pushy."

Often toilet training seems to be going well, and then the process stalls. When progress comes to a halt, take time to consider the constellation of forces that work together to motivate a child to complete toilet training, and those that oppose completion. Altering the balance of forces will generally get the process rolling again. It sounds like, for your daughter, pull-ups have become a hindrance rather than a help.

I commend you for not being pushy. Pushiness creates and complicates toilet training problems. Trust your instinct, though, that your daughter needs "a little more guidance and direction." From your description, she does need some guidance, and it should be only a little.

For a child to successfully master toilet training, there are two core concepts that must be assimilated. A child needs to learn how to use the potty. This includes recognizing the urge to go, voluntarily using her muscles to hold it in, walking to the potty, and using different muscles to move the waste out. The second core concept is learning to use the potty consistently. This includes overcoming any reason for resistance, and assuming responsibility for her own toilet activities.

Explain to your daughter that every day her body is making pee and poop, and that pee and poop belong in the potty. Explain that since she has already done such a good job peeing in the potty, it's time for her to move to wearing panties throughout the day, instead of diapers or pull-ups. Tell her that when she feels the need to go, she should hold it in just long enough to walk to the potty, sit down, and let it go. It's okay if she has accidents -- they're part of learning.

At first she may need a little help recognizing the urge. When you notice behavior such as tugging at her clothes or shifting from foot to foot, point it out to her, and suggest that this might be a good time for the potty. Every time she comes to you and says she needs to go, smile. If she has already pooped in her pants, help her take it the rest of the way, and put the poop in the potty.

Be excited with her when she gets it right! Be matter-of-fact about accidents. Say something encouraging like, "Soon you'll get it in the potty every time!" Have her take off her dirty clothes and put them in the laundry. Avoid putting her back in pull-ups during the day, unless she seems truly overwhelmed (in which case offer reassurance, use pull-ups for the rest of that day only, and try underpants again in the morning).

Although this time can be a frustrating and messy one, it's a great opportunity for you to model for your daughter how to approach many of life's challenges:

  • When you want to do something, it's easier
  • If you don't want to do something, figure out why
  • Internal motivation is the best motivation
  • Identify what it is that stands between you and completing your goal
  • Sometimes pull-ups slow down your progress
  • Often others see when you are shifting from foot to foot, before you do
  • Continuing to do what you are comfortable with can keep you from growing
  • Poop happens, accidents are part of learning to do it right
  • Don't beat yourself up over mistakes
  • Overcoming a challenge is a process
  • Sometimes you just need to do it
  • Celebrate successes!

Dr. Alan GreeneDr. Alan Greene, author of Raising Baby Green and Feeding Baby Greene, is the founder of and the WhiteOut Movement. He is a frequent guest on such shows as Good Morning America, The Today Show, and the Dr. Oz Show. He is on the Board of Directors of Healthy Child Healthy World and The Lunchbox Project. Dr. Greene is a practicing pediatrician at Stanford University's Packard Children's Hospital.

Copyright © Greene Ink, Inc., all rights reserved. Permission to republish granted to Reviewed by Reviewed By:
Khanh-Van Le-Bucklin M.D. & Rebecca Hicks M.D. April 7, 2009.