Trouble with toilet training

ASK THE EXPERT: Q:About two months ago, I decided I would try toilet training my two year old. He seems ready for it as he usually tells me when he has wet/soiled his nappy and is interested in using the toilet.

Everything was great for three days, he was excited about wearing “big boy pants” and would sit happily on the toilet regularly. We didn’t manage to actually get him to go in the toilet, but we were making progress.

Unfortunately, on the fourth day he developed balanitis (an inflammation of the tip of the penis). He started to urinate frequently and seemed to be in a bit of pain.

I didn’t quite realise what was going on at the start, and was encouraging him to the toilet and changing his pants all morning, which was quite distressing for him in the end.

The doctor advised me on how to treat the inflammation and to forget about the toilet training until it was gone, which I did.

I would like to start toilet training again now but every time I suggest he tries wearing the pants (or even pull-up pants), he gets upset and insists on wearing a nappy. So far I haven’t pushed the issue and I very quickly say to him, “Okay, we’ll try another day.”

The promise of a treat hasn’t worked either.

I feel like we’re stuck in a stalemate because the more I suggest it, the more entrenched about wearing a nappy he becomes.

How do I move on from here? He still seems interested in using the toilet, but if I just go ahead and start training him at the same time as using nappies, I feel like I’ll confuse him.

A

When toilet training becomes interrupted and your child associates using the toilet with discomfort or anxiety, it can be hard to get the process back on track. Different things can upset the process such as a painful infection in your situation or constipation in other situations or simply a fear of sitting on the toilet.

The basic issue is that to go to the toilet successfully the child needs to be relaxed and to learn to “let go” – anxiety or discomfort make this hard to happen. Then the child can easily put off learning and resort to taking a step back and using a nappy. Further, toilet training is usually driven by the parents’ agenda, for example, getting the child ready to start pre-school, and there could be time pressures, such as getting the training done during the holidays.

As a result, it is easy for the process to become pressured, causing the child (who is moving at a different pace) to resist and even dig their heels in. This makes it even harder for the child to relax and “let go” and use the toilet. For some parents, toilet training, especially using the potty for relieving their bowels, can become their first “battle of wills” with their toddler.

The good news is that there is a lot you can do to get the process back on track. The first thing is to take a step back yourself and take a break from mentioning toilet training. Use this time to closely observe your son and his patterns of doing his “wees” and “poos” in his nappy and also to watch what motivates him or what he is interested in.

You say he still shows an interest in using the toilet – how does he show this? This might give you something you can build upon. For example, you might notice if he comes into the bathroom when you are there and comment on this without pressure. There are also lots of nice children’s books about toileting that you could read with him as a way of preparing him and also to gauge his readiness to restart training. Some of these, for example, Everyone Poos by Taro Gomi, can be fun and appealing.

Then once you and he are ready, pick a date in the near future to restart toilet training. If it is a big issue, it is okay to start his training in his current nappies and not pants if that makes him more comfortable and co-operative. The key is to start the training gradually, breaking the process into tiny steps including some of which he does already.

To help motivate him you might have a small reward for what he does already (go into the bathroom with his nappy on) and then a bigger reward such as for the next step (take his nappy off and sit on toilet) and then a super reward when he finally does a wee or poo.

The rewards don’t have to be big to work, for example, different sized stars and a jelly for the last step. You can also make each of the steps rewarding in themselves by reading his favourite book or blowing bubbles with him when he waits on the toilet without his nappy. These are particularly useful in distracting him from any fears and helping him relax.

Before you start, it is a good idea to explain the toilet training steps and it can help to make a chart together which has pictures illustrating each step as well as the rewards he can gain. You might acknowledge that it was sore the last time he used the toilet but you can say that the “sore is all gone now, and it will be fun using the toilet like a big boy again”. At two years of age you really have to explain the chart in simple language to ensure he understands that when he wees in toilet, he gets a jelly, and make the chart appear colourful and attractive.

Your actions will speak louder than words – when he sees you put up the first sticker for the small step of visiting the bathroom, this will help him get started. If problems persist, consult your public health nurse for more information who can refer to specialist services if need be.

Dr John Sharry is a social worker and psychotherapist and director of Parents Plus charity. His website is solutiontalk.ie.

Readers queries are welcome and will be answered through the column, but John regrets that he cannot enter into individual correspondence. Questions should be e-mailed to healthsupplement@irishtimes.com