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Ages & Stages

Psychological Readiness and Motor Skills Needed for Toilet Training

All parents are familiar with the routine of feeding breast milk or formula to a baby and then immediately changing her diaper after her meal. At times the diaper-wetting response occurs so quickly that it seems the milk has gone into one end of the baby and straight through to the diaper at the other end. This involuntary elimination process occurs because a baby’s digestive system has not yet fully matured.

While urine fills the baby’s bladder and is released through the urethra, and bowel movements fill the large intestine and are expelled via the rectum, just as with adults, babies cannot yet control the circular sphincter muscles that keep the bladder and rectum closed. As a baby’s stomach fills during a feeding and passes more fluid to the bladder, the sphincter muscles automatically relax, and urination or a bowel movement occurs.

As long as this process remains involuntary, until at least eighteen months in most cases, a baby is unable to consciously delay elimination. If placed on a potty at the right time, she will void into it, but she cannot deliberately wait to use the potty and so cannot be fully toilet-trained.

Awareness of the Need to Go

At around her first birthday, your child will begin for the first time to recognize the sensation of a full rectum or bladder, signaling a need to eliminate. In many cases, your child will show her awareness through her behavior: squatting and grunting when she is about to have a bowel movement or tugging at her diaper when she needs to urinate.

Even though she will still not be able to delay the function she senses taking place, it is a good idea to reinforce this awareness of the link between the inner feeling of fullness and the act of excretion or urination. When you see that she is about to eliminate, comment neutrally: “Oops, I think a poop [or pee] is coming. Do you feel it happening?”

Once she has soiled or wet her diaper, change it right away to reinforce the concept that bowel movements and urine should be removed from the body and discarded. There is no need to comment negatively on this natural process (words such as dirty or messy will only make your child feel bad), but you can certainly say positive things about how good it feels and smells to be clean and dry.

Your goal is to strengthen your child’s awareness of the feeling of needing to go so that she can build on this understanding when the time comes, and to encourage her to see toilet training as a desirable skill.

Motor Skills

In addition to his physiological development, your child’s motor skills must reach a certain level of maturity before he can easily begin toilet training.

The ability to walk (beginning at around twelve months) is an obvious asset in getting to the potty in time to use it. During the early months of learning to walk, your child’s preoccupation with practicing this new skill will probably leave little energy for experimenting with potty use. As he grows more comfortable with getting around on two legs, however (by around eighteen to twenty-four months), he may become interested in acquiring other “grown-up” skills.

The gradual improvement in other gross and fine motor skills, which usually begins at around eighteen months, will support your child’s ability to handle his clothing more efficiently and to engage in activities that may keep him seated on the potty long enough to eliminate successfully.

You can encourage these developments by teaching him to dress and undress himself, making sure that his clothing is easy to remove, and offering him picture books, toys, or crayons and paper to play with while he’s waiting for a bowel movement to occur. The ability to master all of these new skills also greatly enhances young children’s self-esteem—confidence that comes in handy as they meet the toilet-training challenge.

Last Updated
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.
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