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My child and toilet training
What I need to know
Information for parents and carers
Community Paediatric Continence Service
Incorporating hospital and community health services, teaching and research
This leaflet provides information about toileting for young children. It also has useful tips for parents/carers who are starting the toilet training process or those well on the way.
What is toilet training? Toilet training or potty training is helping a child learn to develop controlled emptying of the bladder and bowel. Successful toilet training requires a child to anticipate the need to open the bowels or bladder and then pass urine or stool into the toilet.
Is there an age to start toilet training? Most children complete toilet training by about three years old. Control is generally first achieved during the daytime, well before a child stays dry at night. Night-time dryness occurs about ten months after daytime dryness
Average age Dryness
3.5 years Day time
4 years Night time
When can I start toilet training? Toilet training can begin when your child is physiologically and developmentally ready and they demonstrate the behavioural maturity. Physical development - maturity of bladder and bowel function. Most children develop control of the muscles in the bladder and anus (bottom) by 18 months. Children should be able to walk up to and sit on the toilet, pull their clothes up and down, be able to understand instructions and be able to say or indicate they need the toilet.
Behavioural development Children are ready to train when they show an interest, enjoy imitating others, and have a desire to please. At this stage they are showing signs of independence and cooperation.
How do I know if my child is ready to be toilet trained? He/she is ready when they have physiologically developed, mastered the necessary developmental skills and shown a behavioural readiness to toilet train.
How do I know if I am ready to toilet train my child? It is important for you to be psychologically ready to start the process. It can take many weeks to months for some children to train and they will need your time and emotional energy to succeed. Big changes to your child’s everyday life can get in the way of successful potty training. These include: impending sibling birth, moving home/bedroom/bed from crib, new environments like nursery/preschool or when a parent returns to work. Remember accidents are to be expected during potty training and you should think of how you will deal with these. One way is by being understanding and patient. Avoid comparing your child’s progress to others as potty training is a natural developmental process and will differ between children.
How can I help my child? Decide on a vocabulary for body fluids (wee, poop, etc.).
Buy a potty or potty chair
Practice having your child sit on the toilet (fully clothed is fine at first) looking at a favourite book.
This lets him/her get used to the situation without the stress of performing.
Then practice sitting your child on the potty chair without a nappy.
You can put the soiled nappy into the potty to help them understand
the goal. Afterwards, the urine and stool can then be flushed away
in the toilet. Some children are scared by the flushing toilet.
Practising flushing away toilet paper often helps.
Watch for signals that he or she may be about to go, such as a concentrated look, yanking at the nappy, squatting, or grunting.
Often this will happen first thing in the morning, right after a nap, or about 20 minutes after a meal. Give them more practice by developing a routine for times to sit (without nappy) on the potty e.g. just before bath. If you can tell when they usually pass stool, catching the child in the act allows an opportunity for praise and a small.
When your child wants big boy/girl pants and have been
successfully using the potty for one to two weeks, offer them the
chance to spend longer and longer periods out of nappies every
day. If your child loses interest or resists toilet training, stop and go
back to nappies for a few weeks.
Are there any problems? Common problems include painful urination from urinary tract
infection or constipation. Untreated constipation can lead to painful
anal cracks (fissures) or stool soiling accidents (encopresis).
What if my child has a disability or learning needs, can he/ she still be toilet trained? Although many children with disabilities achieve continence (dryness), this may take longer and in some cases, does not develop. Success depends on your child’s disability, special needs and condition.
The guidance and support from a Paediatrician, specialist continence nurse, other trained professionals such as psychologists and support groups are also important. The steps used to assess typically developing children can be used to see whether your child is ready to begin.
For those children who cannot sense when their bladder or bowel is full there are still ways to help. Your child can be seen by specialists. You can help by teaching your child to remove urine through a catheter on a regular basis, and to visit the bathroom for bowel movements on a regular schedule.
What if my trained child regresses? Children can sometimes start wetting or soiling again and generally this is not a cause for alarm. Childhood illness and emotional stress may disrupt the toilet training process. However, if your child experiences repeated daytime wetting or night time wetting after having been dry for more than six months, they should see a doctor. Who can help? For advice and support first contact your local health visitor, nursery nurses, GP/doctor, practice nurse.
For further information or advice please contact the Community Paediatric Continence Service on 0207 014 7111 (voicemail available) or email: [email protected]
Hackney Ark Downs Park Road London E8 2HY
Where can I get more information? Education and Resource for improving childhood continence (ERIC) –
Helpline 0845 370 8008
Autism Speaks: www.autismspeaks.org/science/resources-programs/autism-treatment-network/atn-air-p-toilet-training
Potty training: pottytrainingnetwork.com/
Patient UK: www.patient.co.uk
Patient Advice and Liaison Service (PALS) PALS can provide information and support to patients and carers and will listen to your concerns, suggestion or queries. The service is available between 9am and 5pm Tel: 0208 510 7315 Textphone: 07584 445 400 Email: [email protected]
If you require this information in other languages, large print, audio or Braille please telephone the Patient Information Team on 0208 510 5302 or email: [email protected] Produced by: Specialist Continence Nurse CSDO
Homerton University Hospital NHS Foundation Trust Homerton Row, London E9 6SR T: 0208 510 5555 W: www.homerton.nhs.uk E: [email protected] Date produced: December 2014 Review date: December 2016
