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Last week in my clinic, I spoke with a stressed couple about their 2½-year-old daughter. 

Their daughter was doing great overall, however, despite their best efforts, she refused to be toilet trained. They had tried every technique they could think of, to no avail. 

They put her in underwear and she just soiled through them. After six ruined pairs of panties in one weekend, her mom gave up and went back to diapers. 

They let her run around half-naked and she peed everywhere in the house. 

They let her come into the bathroom to watch them go, but when she sat on her potty, she refused to do anything until she was back in her diaper. 

They came to me asking what else could be done for this stubborn potty refuser.

Toilet training can be a rewarding time for families, but it can also become a source of anxiety for parents and kids, especially when things don’t go according to plan. Some kids do well at first, then hit a bump in the road and regress. Some do great at home but not at school or daycare. And some are like that 2½-year old and struggle from the start.

Kids need to reach physical and emotional/social developmental milestones before toilet training can become successful. Babies have no control over bowel or bladder function until at least 1 year old, when they can recognize the sensations of being full. The first sign of awareness is usually ob-vious when kids start squatting or hiding to urinate or move their bowels. Kids also must be able to sit and walk well enough to use the potty. Finally, social development is essential for toilet train-ing: Kids who are delayed in speech/language development will find it harder to communicate their need to use the toilet, thus delaying the process.

Regression is common with toilet training. Variations in the home or school environment or other life changes can cause a previously toilet-trained kid to regress. The most common example is a toddler who was using the potty well, until a new baby sibling is born. Suddenly they are back to soiling their underwear, sometimes asking for diapers instead and refusing to use the potty. Sudden life changes like this, even if they’re for positive events, can cause a child to struggle with maintaining the toilet-training routine.

So with all the potential pitfalls of toilet training, how do we know the right age to start or the right ways to teach our kids? The short answer is that we don’t: There’s no clear-cut right or wrong method to toilet training. 

Some parents choose to lead by imitation, while others like to read toilet-training books with their kids before starting. Making a game out of sitting on the potty can help kids feel more comfortable and reward charts can be useful for older kids. Other kids succeed best through peer pressure. For stubborn children, being around similarly aged kids who are already toilet trained can help motivate them to take that next step.

No matter the technique you try, the most important thing is to establish a plan while allowing for flexibility as needed – and to stay positive despite the ups and downs.

Children are more likely to learn through praise than punishment, making the process more successful and perhaps even enjoyable.

Dr. Laura Shefner writes about pediatric care for the Cleveland Jewish News. She is a pediatrician at The MetroHealth System and practices in Beachwood and Parma. 

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