203 – Potty Training

In this episode, Dr. Carole Keim talks all about potty training. While potty training usually involves toddlers – the common age is between two and four years – it can be started as early as infanthood with what’s called elimination communication. Dr. Keim walks parents through all the major questions and issues about potty training. 

Dr. Keim first explains how to identify when your toddler is ready to start training. She then talks about how to potty train and explains various methods of working with a reluctant toddler or what she calls “secret poopers”. In addition she addresses various things that could go wrong, such as constipation or diarrhea, and how to take care of your toddler if one of these issues should arise. Dr. Keim imparts sound and thorough advice to prepare parents for the journey of getting toddlers to use the toilet.

In this episode….

• Elimination communication
• Signs your toddler is ready
• Secret poopers 
• Resistant children
• Constipation
• Diarrhea
• UTIs

Elimination communication 00:42

• Can start at any age
• Pre-verbal children
• You indicate when it’s time to potty and make noises while holding them over a potty, adult toilet, or sink
• Times to take them : after they eat, when they wake up

Toddler potty training 01:45

• Dry for 2+ hours at a time
• They indicate when they’ve gone or you can tell when they’re going
• Start anticipating these times (after meals, upon waking) and/or use a schedule
• Sit them on the potty / toilet seat with adapter 
• They don’t have to be fully independent with moving/removing clothing, pulling up pants, getting on and off the toilet, and washing hands.  Use scaffolding.
• It can take a while for them to get the hang of it
• Don’t punish them for accidents
• Don’t use treats unless you need to 
• Daniel Tiger episode 

Children who don’t mind sitting in a dirty diaper 04:51

• aka “secret poopers” 
• Can try the “oh crap” book
• Allow them to run around without diaper or pants on, especially outside
• Try nature pees/poops
• Can try the potty training in a weekend method
• Have a potty in each room so it’s easy

Children who fight using the potty 05:56

• Try nature pees/poops
• Have a potty in each room to get them used to it
• Let them sit on the potty fully clothed and play while siting there
• Have fun potty time – read a special book together, play with a toy on the potty
• If using potty treats: sticker charts are often too delayed of a reward except in children 4 and up.  I suggest a treat for trying, and a treat if anything comes out.  Food treats tend to motivate children more but are also associated with more performance anxiety.  
• It is ok to praise attempts to use the potty and success in using it, but excessive praise can also cause performance anxiety
• Becoming angry at child for refusing to use the potty can backfire on parents, as this is one of the only things a child can control

Constipation 09:17

• Decrease in frequency or size of bowel movements, harder stools, pain with stooling
• Can be acute or chronic
• How chronic constipation happens
• Avoiding it: choose high fiber and low processed foods – fresh fruit and veggies for more than 50% of each meal / 10 fistfuls per day.  Avoid dairy products.  Make sure child is drinking 1/2oz per pound of weight in water each day (so a 25 lb child should drink at least 12.5oz of water).  Try to establish positive associations with sitting on the toilet.
• Treating it when it’s acute: can try prune juice as a laxative, a glycerin suppository if stool is very hard, or an enema for a one-time cleanout.
• Chronic constipation: first disimpaction – enema of hypertonic saline or a suppository x1, followed by a stimulant laxative x 2-3 days, and a stool softener for several weeks.  At the same time, increase fiber and water, decrease processed foods, and eliminate dairy.  Encourage frequent and prolonged sitting on the toilet.
• How stimulant laxatives work and why they are addictive and shouldn’t be used more than a few days
• How miralax and psyllium work as stool softeners and why they can be used long term

Diarrhea 16:32

• Teething – symptoms, why it happens
• Viral – tend to have no or low-grade fever, no blood, can be foul smelling and green 
• Bacteria – can have fever, can have blood, can have it for over a week, can be profuse or just a few times per day.  Requires test to determine type of bacteria to guide treatment; sometimes antibiotics help, sometimes they make it worse.
• After antibiotics
• From juice
• From food
• When to be concerned
• Treatment – more water, BRAT diet x 1 day, bland foods, avoid dairy, probiotics, avoid dehydration 
• Why we can’t use diarrhea medicines in children
• Avoiding spread to family members
• Rotavirus vaccine

UTIs 19:48

• Symptoms: pain with urination, urinary frequency…