If you are wondering When You Can Start Potty Training Your Child, We have some answers for you!
You have found the leading bladder and bowel physical therapy clinic in Grand Rapids, Michigan. We know that the process of starting potty training can be overwhelming. We help adults and children overcome pelvic floor dysfunction, pelvic pain and bladder & bowel control problems. Quite often parents ask us our recommendations for potty training. Well, there’s a lot to consider and we’ll go into when you can start potty training here. Connect with us to learn more about how we can help.
Figuring out when you can start potty training is on the minds of many parents who are excited for their child to be out of diapers and using the potty. We are here to give some clarity!
Potty training checklist:
There are some behavioral milestones you want to see your child accomplishing that would tell you that it may be an appropriate time to begin the process of potty training:
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My child can dress and undress without help.
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My child shows interest in using the toilet.
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My child notices when he/she needs to pee or poop.
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My child tells me when she needs to pee or poop.
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My child is willing to interrupt activities to use the toilet.
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My child is waking up from naps dry. (This means their body is physiologically ready to use the toilet)
If you were able to check all of those boxes, then your child is ready to start potty training!
If, like a lot of children under 4, your child is missing one or most of those checkboxes, then they may not be ready for potty training just yet.
Don’t worry we are here to help! We treat children with a wide variety of bladder or bowel problems. These may range from loss of urine in the daytime to constipation, fear avoidance of the toilet, developmental delays, challenges with a child “listening” to their body or bedwetting. We use developmentally appropriate methods to help a child learn the complex task of effectively coordinating these muscles so they can control their bladder and bowel and use the toilet effectively. Our pediatric pelvic health physical therapist is specifically trained in children’s bladder and bowel treatment and loves to work with kids and parents to help them succeed. Here’s information on our treatment for kids.
It’s important to remember that there is a wide variety of normal in how children develop. For example, if you have one child who potty trained at a young age, it doesn’t necessarily mean that all of your children will… and that is ok!
It’s Important to Start Potty Training when Your Child is Developmentally Ready to do this. Too soon, and the process of potty training may prove stressful to everyone.
Setting your child up for lifelong success with toileting is our number one goal! Children who have negative associations with toileting or have attempted to potty train before they are ready are more likely to have difficulties with constipation, bedwetting, and incontinence in the long run. We have a whole program for helping children overcome bedwetting. To learn more about how physical therapy can help your child’s bladder control, you may be interested in this read. Let’s get them started off right! To learn more about how we can help you, connect with us here!
Is potty training a developmental milestone?
Potty training readiness is dependent on your child’s cognitive, socioemotional, proprioceptive, and neurologic development. A child-centered approach to potty training is recommended. We understand that sometimes the rules for getting a child into a preschool include they must be potty trained and, therefore, a working parent feels pressure to get the child potty trained maybe before the child is ready. This isn’t ideal and it isn’t child-centered. We have found that some preschools have these rules and are still willing to allow your child to attend, with certain agreements between the parent and the school; so it is always worth discussing if the rules can be flexible. Let’s take a deeper look at typical bladder milestones.
Bladder Milestones that occur before and after your start potty training:
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3 months old: voiding occurs hourly
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1-2 years old: awareness of bladder sensation and control begins
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~3 years old: voluntary control of periurethral striated muscles… your child can now choose to hold their pee back!
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1-3 years old: child voids about 11x/day
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4-5 years old: day and night time continence
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12 years old: child voids about 4-6x/day
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Daytime dryness will precede nighttime by about 10 months
What to do if my child shows no interest in starting potty training?
The most critical thing is that your child does not develop negative associations with toileting. A strong aversion can be difficult to overcome later on. If your child has zero interest, it may be best to delay initiating potty training. Sometimes just a month of two wait can make a big difference. If you notice your child is hiding rather than opting to use the toilet, use this as a sign that it is too soon.
Tips and tricks to help your child engage in toileting:
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Emphasize when you go to the bathroom and exaggerate how good you feel afterward.
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Example: “wow I am feeling a pressure low in my tummy, I better go use the bathroom. Do you want to see how mommy or daddy does it?” “wow, I feel so much better after using the potty. That pressure is totally gone!”
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Reward “trys” even if pee or poop did not occur
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Explore the bathroom and toilet together so it doesn’t feel intimidating. Allow them to help you flush the toilet, bring up/down the lid, or even practice sitting on the toilet. This could possibly be followed up by a reward.
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If you know that it has been 2 hours since your child urinated at they likely have to pee or are showing signs (“the potty dance”)that they need to use the bathroom, then you might tell them “if you go the bathroom we get to come back and play some more, if not we need to do (chore or other less enjoyable task).” This way going to the bathroom is a reward and not a punishment.
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Make sure to ask them how they feel after toileting. This will strengthen their internal sense for what it feels like when they need to pee, so they are not as reliant on you to prompt them.
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During the process of toilet training, try not to ask your child if they had an accident. The question, “Did your bladder or your bowel have a leak?” can be more empowering. This takes the shame or blame away from the child. Their bladder and bowel are still learning and growing too! Sometimes when children perceive that they have done something wrong, they internalize that they are bad. They might feel, “I am never going to be able to be dry because there’s something wrong with me.” If they feel like they have no power over the situation, then why would they put any effort into trying to make it better?
How can I help my child have a healthy bladder so that when we start potty training, we are off to a good start?
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Voiding at regular intervals
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Avoid “Just in case” peeing
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Proper wipe technique must be taught, when potty training begins.
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Avoid constipation, including before you start potty training. If your child has constipation, please work diligently to improve this.
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Good hydration: a good starting place for hydration is ½ body weight in ounces, but every child is different and hydration requirements vary based on activity level. Another clue is urine color. When urine is clear to opaque yellow, that is usually an indicator of adequate hydration.
Why does constipation affect the bladder and why might it mess up my child’s ability to start potty training?
In children, constipation can develop differently than in adults. Often, the stool accumulates in the rectum. The rectum is the sensing portion of your colon right before the anus. Typically it is the organ that informs you if you need to have a bowel movement.
The bladder sits in front of the rectum in the pelvis, so when the rectum is very full of stool it can push on the bladder and irritate nerves that control bladder function. This can cause the bladder to empty inappropriately and/or alter the bladder’s ability to fill. I often find that addressing constipation has a huge impact on bladder function! Therefore, when a child is struggling with potty training, we always look at their bowel habits and try to uncover if there may be an underlying constipation component that is contributing to urinary control issues. Connect with us here to see how we can help!
How do I know if my child is constipated?
Because constipation happens differently in children, it may not look the same as what we classically think of in adults. It is possible for a child to be having daily, smooth bowel movements and still be suffering from constipation.
Signs your child may be constipated:
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Clogging the toilet.
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Straining or taking more than 5 minutes to have a bowel movement.
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Any fecal incontinence, in almost all circumstances children do not poop their pants on purpose.
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Bedwetting
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Daytime bladder leaks
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Distended belly
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Abdominal pain
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4 or less bowel movements per week.
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Hard, pebbly stools
How do I prevent constipation?
Fiber intake, water, activity level, and toileting technique are four of the best strategies to use to maintain good bowel health.
Fiber recommendations vary for children, but the Institute of Medicine recommends Age 1-3: 19 grams; Age 4-8 25 grams; Age 9+ 30 grams.
More than 95% of Americans do not get enough fiber in their diet. It may be worth keeping a food diary for your family for 3 days in order to get a sense for your family’s fiber intake. Give us a call at (616) 516-4334 to learn more about our plans of care.
How can I get more fiber in my diet?
Foods that are processed tend to have very low fiber. If you are buying food in a package avoid anything with 2g or less listed on the nutrition label.
In general, foods that are high in fiber have a crunch to them like vegetables, fruit, nuts, and seeds. Chia seeds are very high in fiber and can thicken and improve the texture of a smoothie when added. I also love dates for their natural sweetness and high fiber content.
Little swaps like moving from a traditional to whole grain pasta or using fruits and veggies to dip instead of crackers or chips can make a huge difference. Your gut will thank you!
If you are hitting the fiber requirements already and still having problems or struggling to add more fiber into a picky eater’s diet, then you may want to consider fiber type first!
Fiber can generally be classified into two forms: soluble and insoluble.
Soluble fibers dissolve in water, so they act like a gel-like substance in your gut. Soluble fiber is fermentable and feeds your gut microbiota. It is found in fruits, peas, oats, nuts, apples, and blueberries.
Insoluble fiber does not dissolve in water and is not fermentable. Insoluble fiber bulks stool and stimulates motility of the gut. Insoluble fiber is found in seeds, nuts, skins of fruit, and wheat bran.
Total fiber intake should be about 75% soluble and 25% insoluble. Investigating and adjusting the portion of soluble and insoluble fiber in your family’s diet can also help ease symptoms. If your child is having soft, but less frequent bowel movements or is struggling with bloating, then they may need more insoluble fiber. If your child is having hard stools that are difficult to pass then soluble fiber may be the most helpful. Connect with us here to get your questions answered.
When should I talk to the doctor about Potty Training or my child’s bladder and bowel routine?
The following are signs and symptoms you should discuss with your child’s pediatrician:
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Pain before, during, or after a void.
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Child is straining to urinate
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Weak stream
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Intermittency: voiding in separate bursts vs continuous stream after age 3
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Hesitancy: difficulty beginning a void after age 5
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Post-micturition dribble: leaking urine immediately after a void
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Incontinence:
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Daytime or nighttime leaking after age 5 is worthy of discussion with your pediatrician
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Urgency: sudden and unexpected immediate need to void
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Worthy of discussing with doctor after age 5
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Nocturia: urge to void wakes the child up (not the same as bedwetting)
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Relevant after age 5
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Signs of significant constipation mentioned above. The earlier constipation is addressed, the easier it is to overcome!
If you want to read about the correlation of good chewing habits and bowel/bladder health, check out this blog we wrote!
Purple Mountain Physical Therapy is a specialty pelvic health clinic located in Grand Rapids, MI. We offer expert care to help children, women and men overcome pelvic floor dysfunction and bladder, bowel or pain related problems. Many of our parents and pediatric patients come to us frustrated due to lack of urinary control, bedwetting or constipation. We have advanced training and experience helping kids to learn how to control their bladder and bowel. We use a combination of exercises, manual therapy, external treatments, biofeedback, education for the child and parent, toileting technique practice and play based therapy. Everything we do is developmentally appropriate, meaning we understand how to best meet the needs of your child. We partner with parents to help you know how to best help your child. If you may be interested in learning more about physical therapy for your child’s bladder/bowel, you can contact us here. This work is an honor for us, it would be wonderful to meet you and your child!
Peace,
Dr. Maureen O’Keefe, DPT and the Purple Mountain Physical Therapy Team
