QUESTION
I was wondering if you have any advice or can point me in the direction of help as I am struggling with toilet training my little girl, who is two years and 10 months old. We had a failed attempt in August and decided we wouldn’t try again until she was ready. Last week and this week she has twice instigated using the toilet herself. On the first day of trying she sat on the toilet with no problem and did a pee two out of four times though she had some accidents as well. However, the following day she wouldn’t sit on the toilet at all and freaked out and screamed when it was suggested. She is not bold or anything; just visibly upset. She relaxes only when she’s back in a nappy.

She’ll sit on the toilet in creche no problem and pee occasionally but she still may have one or two accidents a day there, usually just after she goes. In creche she thinks it’s exciting going to the toilet with her friends, and at home she keeps saying “I just don’t want to” even with the offer of reward charts, treats, and so on.

At home it’s all accidents and it has taken five days to get her to even sit on the potty, and that’s only if I’m on the toilet as well. What should I do? I’ve no idea how to reassure her about using the toilet.

ANSWER
While some parents have the experience of toilet training being plain sailing over a short period, for most it is characterised by fits and starts and setbacks. It varies greatly the age at which a child is developmentally ready to learn to use the toilet.

While the expectation might be for a child to be fully toilet trained before their third birthday, in my clinical experience many children are simply not ready until much later to fully master all the skills necessary. Many parents report that their children have learned to use the toilet at a younger age, but these children are not fully toilet trained and have regular accidents and setbacks.

It is easy to become frustrated with toilet-training setbacks and even get into a battle with a child over using the toilet. This can become counter-productive and make the child more resistant or even more fearful about going.

For this reason, toilet training requires a very patient, positive and child-centred approach. In most cases, my advice to parents is to closely observe and tune into where their children are at in learning to use the toilet so they can encourage progress at the child’s pace.

Understanding the stages of toilet training
To successfully use the toilet to do a pee, a child must:
1) be able to consciously do a pee while sitting on the toilet or potty,
2) be aware of when their bladder is full and notice the signals that they need to go, and
3) be able to hold on for a short period as they wait to go to the toilet .
It strikes me that your daughter is able to do step 1 but as yet has not learnt to do step 2 or step 3. This is the reason why she can sit on the toilet and is able to go 50 percent of the time, yet she is still prone to accidents.

To help her, you want her to master step 2 in order to develop an awareness of her bladder becoming full and sensing her urge to go. There are some lovely child-centred books that help children develop this awareness such as Time to Pee by Mo Willems or On your potty by Virginia Miller. The latter tells the story of a little bear having lots of accidents before he finally notices the urge to go and runs to the potty in time (while an encouraging Daddy bear supports him).

Practically, to help your daughter learn, she needs to be comfortable telling you when she pees or is about to pee, without any pressure. For example, you might set up relaxed periods of time at home, when she is in her underwear or wearing training pants.

When a pee comes, you might gently comment “Oh, a pee has come, did you notice?” Or if you spot her wriggling or making movements that might signify a pee is coming, you might gently comment “Is there a pee coming? Shall we run like little bear to the toilet?” The key is to be very relaxed and reassuring.

If she does not go, you simply say “maybe next time” and if she does go, you praise and reward her for being such a big girl.

Motivating your daughter
It is worth reflecting on what made your daughter freak out or get upset when asked to use the toilet. Is it because she feels pressured about going or is there something in particular that she is afraid of? If she currently needs the nappy to feel comfortable, you can let her start by sitting on the toilet with the nappy and take it off gradually.

In most situations, the key is to reduce the pressure on her and simply say, “You let me know when you are ready.” 

It is also worth reflecting on what might motivate your daughter to participate in toilet training. It is interesting that she is motivated by the peer group in creche and by going when you are also going to the toilet with her. You can build on this by setting up a morning routine when she and Mummy go to the toilet together.

Make it a fun relaxed time by maybe reading on the toilet together or even playing music, and so on. Think what would make the experience of being in the toilet fun and relaxing.

I often recommend that parents keep special bubbles in the toilet and you can blow one or two together when she sits down. Bubbles can distract a child from their worries, helping them relax, and the motion of blowing can even help them let go and pee in the toilet.

John Sharry, Irish Times Newspaper, December 2016. John writes in the Irish Times Health+ every Tuesday.
For information on John’s courses for parents visit www.solutiontalk.ie