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Ages & Stages

The child-care center Stephanie was attending for the first time was enormous—like an indoor playground with children of different ages running around her in all directions. Stephanie’s mother had shown her around the room and introduced her to the caregivers before she left, but that seemed a very long time ago, and now Stephanie was all alone. She stood near the wooden sink in the play kitchen, gazing in awe at the unfamiliar plastic dishes, the painted burner on the toy stove, and the bowl full of plastic fruit. Nearby, two boys were fighting for control of a toy train set, and one boy hit the other on the head with the train engine. The noise of the second boy’s crying filled Stephanie’s head, increasing her confusion and anxiety. She looked around for a grown-up. There was a lady across the room. Help! Stephanie thought, but did not know enough to say. That noise is so loud!

Suddenly, Stephanie felt a warm, wet sensation on her inner thighs beneath her jeans. She looked down. Uh-oh. An accident. Vague, undefined feelings of disappointment and shame filled her, crowding out all thoughts of her surroundings. Unable to think of how to fix the situation, Stephanie started to cry. Then, a moment later, a grownup’s arms were around her shoulders and a friendly voice murmured, “Hey, Stephanie, it’s okay. You had an accident. We’ll dry you off and put some clean clothes on you right away.”

As adults, we sometimes forget how intensely young children experience their world, and how easily thrown they are by any change in their daily routine or their surroundings. At ages two, three, and four, our toddlers or preschoolers have come so far in terms of verbal skills and general comprehension that it’s easy to overestimate their ability to focus, prioritize, and remember.

Research has shown, however, that through the entire toddler and preschool period children remain weak in their ability to select and prioritize information from the flood of sensations that reach them. A young child walking along the sidewalk with a parent is as likely to focus on the sounds of birdsong in the trees as on her parent’s voice or the car speeding past a few feet away. A child who finds herself struggling to cope with a wide variety of stimuli in an unfamiliar environment, as Stephanie did in the example above, may easily miss her body signaling the need to eliminate. Even when a toddler is just headed for the bathroom in her own home, she may be sufficiently distracted by the sound of a whistling teapot in the kitchen to forget where she was going.

Parents frequently find that bathroom accidents are more common when their toddlers and preschoolers are playing outside, watching television, playing on the computer, painting pictures, or otherwise focusing so intently on one activity that they fail to notice their physical needs. An inner focus on another aspect of development—acquiring a new skill or coping with an emotional issue—can have the same effect.

Another factor to take into account is that young children’s memories tend to be more situation specific than most adults realize. Your child may use her potty every day without mishap at home but “forget” the necessary sequence of actions at a friend’s house or restaurant, on a day when her ordinary routine has been altered, or even when she is wearing tights or some other new variation on her usual clothes. Young children also have difficulty thinking ahead of time about their bathroom needs, and must be reminded to use the potty before going out even though they don’t urgently need to.

Finally, despite the leaps your child may have taken in verbal ability over the past two or three years, new situations or experiences may still leave him at a loss for words.  He may not know how to tell you that his skin is irritated, causing pain when he urinates, or that he’s constipated and it hurts to poop. Unable to fix this problem, he tries to ignore it until an accident results. Unable to express his confusion about a particular potty-related process or rule, he may even have a few accidents on purpose to solicit your reaction and, he hopes, get the information he needs.

All of these behaviors are perfectly normal and age appropriate for your child. In fact, it is a good rule of thumb to wait for at least six months after your child starts using the potty to consider him fully trained.

By praising him for his progress and teaching him to think ahead, focus, and plan better regarding toilet use, but continuing to keep cleanup aids at hand, you allow him to continue learning at the irregular pace that is appropriate for his age, to experiment with variations on his original routine, and to discard behaviors that clearly don’t work.

Like you, he will have good days and bad days in terms of focus, memory, and performance in all aspects of his behavior. Like you, he will progress more smoothly and quickly in response to praise and patience—along with firm and consistent instruction—than to harsh criticism or ridicule.

 

Last Updated
5/11/2013
Source
Guide to Toilet Training (Copyright © 2003 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.