Tuesday, November 16, 2010

A preschooler and a potty- warning: poop references ahead



As children grow, there are many sweet or funny moments that make parents wish for a “pause” button to enjoy their children at that fleeting stage of life. And there are other milestones that we’d like to “fast-forward” through… which brings me to today’s topic: toilet-training. I have a dear friend who is understandably stressed about the issue. She has wonderful 3 1/2 year-old triplets; while 2 of her kids are happily and successfully using the potty, her remaining daughter, despite prior successes, has been refusing the potty in a classic display of 3 year-old power.

Toilet-training is a huge subject to which entire books are devoted. Consider today’s post a drop in the ocean (or toilet, as it were) of the large, encompassing subject matter. For further information on the basics, such as when and how to begin, you can check out American Academy of Pediatrics advice here. In addition, my book Raising Twins, has a section of the toddler chapter devoted to toilet-training multiples. Today’s blog post is focused on the so-called “late trainer.” (I’m not a big fan of the term “late,” as often both the child and parents can be embarrassed and frustrated– I believe the label only makes matters more stressful for families, which doesn’t help anyone.) Regardless of the term used, know that toilet-training is a whole different ballgame once a child is over the age of 3 years.

3 year-old kids are smart, have a better sense of how the world works, and continue to realize that their actions have an impact on their caregivers and environment. 24 month-old kids are no strangers to the concept of power struggles, but it is quite different to deal with a 3 1/2 year-old’s efforts to assert her independence and control over her own body. As always, every child is different, and you know your kids best. If you have specific concerns about your child, or are worried about underlying problems, consult with your pediatrician.

A special note for parents of twins or triplets: all too often, toilet-training advice found in books and parenting magazines can be geared towards situations where a caregiver and child are one-on-one in some sort of magical bubble with no interference from the real world, family and work schedules, or even siblings. Most of us live in homes full of little people and action. For any family, but especially when training twins or triplets, there are many factors at play that can have a big impact on the progress of training. So, parents of multiples, cut yourself some slack. And remember that the age at which toilet-training is achieved has no bearing on a child’s intelligence or future success. There also seem to be many different definitions among parents of what it means to be “toilet-trained” so don’t get stressed if you share notes with your neighbors. True toilet success is not caregiver-driven; it is achieved when a child pees and poops on the potty without reminders from Mom or Dad.

Ultimately, a 3 year-old child is in control of her own body, and she needs to be the one making the decision to toilet properly– she cannot be forced (the phrase “you can lead a horse to water…” comes to mind). There is no quick, overnight fix– toilet-training is a process. But parents of 3 year-olds should remove the use of disposable pull-ups during daytime hours. Many mistakenly think of pull-ups as “training pants,” however let’s be honest: they are simply a disposable absorbent diaper in pull-up form. And too often, they prolong the course of a child’s learning to use the toilet because they are an “out”– the child doesn’t need to run to the toilet when he feels the natural sensations to pee or poop, he can simply do the deed in the convenience of the pull-up he is already wearing. (That being said, a pull-up for overnight sleep, until nighttime dryness is consistent, is perfectly fine.)

The ultimate goal is for your child to wear clean, dry underwear. To reach that goal, your child needs practice wearing actual cotton underwear in increasing stretches of time over the course of a day, and will learn what happens if they do not make it to the potty in time. Yes, this means accidents for 2 or more kids. But mistakes are a part of life and are part of the learning process. Your child should also be sitting on the toilet or potty seat at regular times each day, regardless of result (examples: 1st thing in the morning, after lunch).

Parents of twins and triplets can preserve some sanity by having systems in place to simplify cleaning up the inevitable accidents. 3 year-olds are developmentally ready to become active participants in self-care, so they can (and should) help when accidents occur. When a child is an active helper with accidents, she’ll see that peeing and pooping in the toilet is much simpler (and more rewarding with positive reinforcement) than all the cleanup. Whenever a child has an accident, caregivers should keep their “poker face” on (more on this later) and direct the child straight to the potty: "Oops, you need to pee, let's go to the potty." Even if nothing else will come out, you need to help your child make the connection that the sensation of needing to pee/poop is associated with sitting on the toilet. Keep wet wipes by the toilet to simplify cleanup, but do not flush the wipes. After sitting on the toilet for a bit, help remove the wet/soiled clothing, and have your child take the wet clothing to the laundry area herself. (To minimize stress over laundry, we used to keep a bucket in our utility sink in the laundry area to streamline the eventual laundering- place a kid-friendly stepstool in front to help your 3 year-old reach the bucket). Then, your child should be the one to get fresh underwear and clothes and put them on. Now, onto the floor: when toilet-training all 4 of our kids, we kept a huge stack of absorbable cloths handy in a cabinet in a central location of our home. The adult caregiver will perform the bulk of the “real” cleaning of the floor, wet-vac, etc. but your child should go get a couple cloths from the stack and come “help” clean the mess (meaning an honest, 3 year-old effort) and bring the dirty cloths to the laundry bucket to be dealt with later.

When you deal with the inevitable toileting accidents, you may feel quite angry and frustrated, but do your best to keep your cool. Even negative attention is attention, and when you have twins or triplets who share a caregiver most of the time, the desire for attention can complicate matters. Throughout the toilet-training process (and always), make sure each of your kids is getting plenty of one-on-one time on a weekly basis, helping them feel valued and loved, and lessening any desire for them to “act-out” in undesirable ways. Also, be mindful in your language. Many of us instinctively say, “Don’t you want to pee on the potty like a big kid?” however coaxing your child with this phrase is not always helpful. To a 3 year-old, the idea of being a big kid with all the added expectations and responsibilities may not actually sound so desirable. Your 3 year-old may think that life as a baby, with the cuddling and oodles of caregiver attention, sounds like a pretty good arrangement, thank you very much.

An additional note about pull-ups, specifically during naptime, daycare, or preschool hours: talk with your daycare providers to make sure everyone is on the same page. Preschools often ask for pull-ups during school hours, however this can complicate matters– some kids save up their daily poop for that 2 hour stretch when they know they're going to wear pull-ups. Similarly, many kids over 3 years who wear pull-ups for naps may poop specifically at nap time. Depending on your child’s age and progress, talk with your child’s caregivers at school and work together towards a plan. A 2 week winter break without travel plans would be an example of a good time to focus on wearing normal underwear for increasing stretches of time without any interruptions from a school schedule. Ultimately, map out a timeline for “raising the bar” for your child to rise to the occasion and make good progress.

If you find yourself feeling overwhelmed by the process, reach out for help. For more information on the nuts and bolts of toilet-training, when and how to begin the process, positive reinforcement, and other troubleshooting topics, please refer to my book, Raising Twins, or the AAP’s website for parents, HealthyChildren.org.


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