My 3 year old is afraid of using the toilet

toilet-paperQ. My three-and-a-half year old son is absolutely petrified at the thought of toilet training. We have tried several times with him. He becomes anxious, aggressive and even gets to the point of becoming sick (he got a bad viral infection the last time we tried). We have taken nappies off him, bribed him, done reward charts, promised him a much sought after toy – all to no avail. I have physically put him on the toilet and he has weed twice – both accidentally.

He was calm afterwards and happy with himself, but back to the same behaviour when the next time comes around. He screams and cries and it is just not worth upsetting him so much. He is back in pull-ups (which he treats as nappies) and is much calmer and happier. We put him back in these on the advice of the local health nurse. Is it possible to start afresh with the training and how should we approach it? He is not allowed into pre-school until he is toilet trained and this worries us as he is in a class in creche for which he is too old.

A. Toilet training is a tricky process to get right and preschoolers frequently resist or develop specific fears about using the toilet. As parents are often under pressure to complete toilet training, the process can easily become a battle of wills which can increase a child’s anxiety which, in turn, makes it harder for the child to relax and use the toilet. As a result I think you are right to take a break from the process and let your son return to pull-ups for a period.

As in the last question, when you do restart toilet training, the key is to approach it gradually. Break the learning process into simple stages which are rewarded and make sure that your child can easily complete the first stages. For example, one child I worked with got his first star on a chart for simply sitting on the toilet while still wearing his nappy, then when he was comfortable with this, he got a star for sitting on the toilet with the nappy half-open, before finally learning to tolerate sitting on the toilet without any nappy at all.

Tune into your child to understand what his specific fears are, so you can understand what the smallest step is for him to learn. It also really helps to think through what rewards your son and what things could make the learning more fun such as playing music in the bathroom, reading books there or being allowed play with a special toy. One parent I worked with put small ping pong balls in the toilet, which her son really enjoyed trying to sink as he did a wee – this simple strategy distracted him from his fears.

Do go back to your public health nurse if problems persist and she may be able to offer more help or make a specialist referral. To take the pressure off, you might also be able to negotiate with the preschool that he could still start even if still using pull-ups (especially if it is short hours and he mostly only needs to be changed at home).

Dr. John Sharry, Irish Times, March 2011. John writes in The Irish Times Health+ every Tuesday.