203 – Potty Training

Introduction to Toddler Potty Training 0:00

Hi, welcome to season two of the Baby Manual podcast for parents of toddlers. This season will help you feel confident as you navigate the difficulties of toddlerhood, from tantrums to sleep schedules to potty training. I'm your host, a pediatrician and mom, Dr. Carol Keim. Hello and thank you for listening. Today we're going to talk all about potter training and some of So to start off with, potty training can actually be started at any age. The most common age to starts in the US is between ages two and four years.

But you can even start as soon as your baby is born. And when you're potting training a child who is not talking yet or pre-verbal, that is called elimination communication. It's called that because you are sending signals to your babies when it's time to go potter and you also watching them for signals that they might need to do. Then you take them to help them through the whole process. Some examples for this are you can take your baby before your babies even walking. You can tell them it's time to go potty or whatever kind of phrase you want to use, and then take them into the bathroom and hold them over the toilet.

Or if they're breastfed babies, you could even hold him over this sink and let them just go right in the sink, can wash it down. Breastfed baby poop is water soluble. But once they start eating any solids or they are having more normal poops, it is better to over a pot. Then you make a little noise while you are holding them there. kind of like, you know, the peeing sound or go like a grunting sound to help them inspire them to poop.

Elimination Communication for Babies 1:32

And you just do this over and over again. The more consistent you are, The quicker they learn that you're signaling them To go to the bathroom and it really does work. It's pretty amazing. But if you're starting with a toddler, it can be a little bit trickier. So when you are starting to potty train your toddlers, some signs that they might be ready are that, they are dry for two hours at a time or more. They can indicate when they've gone, so they either tell you that the've already gone or you can see when their going.

Maybe they're hiding or, you could just see them grunting. You can start anticipating then, when the need to go. And so, the most common times to, go are right after eating and right, after waking up. You can also try using a schedule if it's a toddler and just have them go at regular times, like each time they finish breakfast and then maybe every, you know, two hours or something during the day. You. Can sit them on a potty, either a little baby potting seat or on the adult toilet seat with an adapter so that they don't fall in.

And they, don t necessarily have to be independent in taking off their clothes or telling you when they need to go or washing hands or all that kind of stuff. That all can come later. Really, you're just looking for signs that they need to let something out of their body, and then you are getting them onto the toilet and helping them. And usually you will be helping to take off their clothes, put them back on, wash hands, all that kind of stuff. You can use a technique called scaffolding, which is where you support their behaviors without doing everything for them, sort of like a scaffold on a building is supporting it while it's being built up.

You can, you know, say when they're close to being able to go to the potty, maybe you start to take their pants down and they can push them down the rest of the way. Or you put their legs through the holes and then they pull them up the other way, for example. So they don't need to be doing these tasks completely on their own, but also you don t have to 100% do it for them either. And you sort of teach them over time to do all of these skills that it takes to get to And remember, it can take a while to get the hang of it.

So potty training is not something that happens in a day. Even if you do the potter training in day method, they can still have accidents for six to 12 months afterwards.

Signs a Toddler Is Ready 3:40

It's a learning process and it is normal for it to take awhile. Make sure you're not punishing your child for any accidents that they have. They're doing it on purpose. And a lot of times in the child that's already been potting trained, if they start having pee accidents, It can be a sign of a urinary tract infection. So remember, they're not doing this as a behavior thing, so do not punish them for it. And try not to use treats unless you really have to inspire them just to, like, go try to the toilet.

If you feel like it's a behavioral thing and the child is just not wanting to go potty, you can try and reward them by trying to. But really, something coming out of your body is the reward in itself. Your baby should not need any food or stickers or any other treats for actually using the There's a great Daniel Tiger episode about going potty that has a little song that goes, if you have to go poty, stop and go right away, flush and wash and be on your way. And that is a good way to get your child used to the idea that when you go, you stop playing and you do.

So for children who don't mind sitting in their diapers that they don' tell you when they've gone pee or poop, I call these the secret poopers, you can try the Oh Crap potty training method, which is where you just have them without pants and without a diaper on during the day and keep giving them plenty to eat and drink. And then you have potties all over the place for them to sit on and use. You can also try letting them be outside without any pants or a a dipper or underwear on. and do, you know, nature pees and nature poops.

And those can sometimes be a little easier for children who are not, who just don't even really care where they've gone or whether they're gone. Potty training in a weekend method is where you give them a whole bunch of fluids, whatever their favorite drink is, and just let them drink a bunch and then you sit them on the toilet every hour at very regular intervals to see if anything comes out. Then they get used to that feeling of like, oh, this is what it's like when I need to go and when something comes And you do need to have a toilet seat in every room, so it's easy for these kind of methods when you're trying to really get them used to that feeling of like, oh, okay, guess this is what my body feels like right before I need go.

For children who are fighting using the potty that they just don't want to sit down, you can kind of get them used to it first with, um, making it like a fun time, having them keep their clothes on and just sit on the toilet seat, maybe with a book or a special toy and play while they're sitting there and get used sit with their pants off but still with the diaper on to be a little more comfortable like that and then finally sitting without anything on on the bottom half of their body and just get excited if anything comes out but don't get too disappointed if nothing does because it can take a while for them to get used to just sitting there.

Potty Training Methods and Motivation 6:32

You can also try nature pees and poops with children who are fighting the potty. Sometimes they like to go outside, you know, especially if they have like a pet dog, the dog goes outside and they'd like do that too. And it can be fun and not going to do it forever. So, it's a good sort of transitional way to get them to use the toilet. You also can try bringing the toilets seat into the bathroom with you when you go and having them just sit there while you're using the and then they sort of model after your behavior.

If you're wanting to inspire them with potty treats, so things like sticker charts, a lot of times in toddlers are just too delayed of a reward for them to understand. So, you know, giving them a sticker to use right now is fun for then. Also, if you wanted to do something like snacks or food treats usually that is not recommended because those are, they just tend to cause more psychological problems later. But if are gonna do like a food treat, you can do something like offer them one treat for trying and another treat if anything comes out.

A lot of times that just the, you know, oh, I get something extra if something comes up, but I still get a treat regardless can be enough to inspire them to want to use the toilet. So yeah, if you're feeling like it's entirely behavioral, your out of ideas as a last resort, it is okay to used treats in that sort of a way. It's great to praise attempts to use the potty and success, but remember that if you're praising too much, that they will get performance anxiety and they'll want to go just to get that praise or to give that treat.

Remember to just sort of take it easy because the whole idea is that they're wanting to use the toilet on their own as they get older because they don't want to sit in their waste. And so this is not something that their doing for your benefit. It's not just something they are doing to please adults. You know, it's something really that will want do over time on there own. And then if you become angry at your child for refusing to use the potty, a lot of times this can backfire. So if try to punish them for not wanting to the toilet or you try coerce them into using it or use psychological tricks.

then they will realize pretty soon that only they can control when stuff comes out of their body. You cannot force a child to pee or poop. Like you just can't make it come out their of body, they have complete control over that. And really they ultimately have control of where it happens as well. So shaming them will backfire, yelling at them is going to back fire on you and they're just going hold it even more because that's where they control in their lives. So you want to make the potty experience into something that is pleasant for them and only ever use positive rewards when good things happen and not negative rewards or negative consequences.

All right, so with constipation. Constipations is a decrease in the frequency or an increase in hardness of the bowel movements and sometimes associated with pain with pooping. And it can be acute or chronic. So for acute constipation, that means it's just like a one-time thing. Chronic is a little bit trickier to treat. For acute constant patient, a lot of times you don't need to do anything for that. You can just give them some water or maybe a bit of prune juice. Uh, for toddlers, one or two ounces of Prune Juice at a time is usually plenty.

It's not very sweet. you Don't want to water it down or mix it with anything because it irritates the gut and you want it use it as like medicine that is irritating the got to make everything flush out. And remember, too much pringes will cause diarrhea. So as a one-time thing, pronges is great, or even just like lots of water is good. For chronic constipation, when children go potty and it hurts, it makes them not want to go the next time, and so they try to hold it in. And sometimes they do hold in until, you know, the time they sit on the toilet.

And poop that sits in the intestines, while it's sitting there in a large intestine, the large intestines pulls water out of it constantly. So poop sitting in there gets harder over time. And it keeps building up, you know, as your food digests and goes into your intestines.

Handling Accidents and Avoiding Punishment 10:32

You'll get more and more poop buildup in large intestin. And it just keeps sucking that water out of it, making larger and harder stools so that it hurts even more the next time, and that'll make them want to hold it even. And so this can become a vicious cycle where just a little bit of constipation can easily turn into chronic consti. Also, as the poop is sitting in there, their body will initially tell them we have to go, but then as you hold it, it turns off that signal. Kind of like when you go into someone's house and they're baking a pie and you smell it initially and then you kind of stop smelling it after a while.

Your body stops sending you that single over and over again. You're like, okay, we got it. So the same thing happens with poop where it sits in the intestines and your body is like we've to, and if you're no, let's hold, its like okay. we will give you the signal a little bit later, sort of a thing. And over time, they stop being able to feel when they need to go. So it can become a serious problem in children that they just don't even feel like they needed to anymore and their bowels are totally full of stools.

How to avoid that? First of all, dietary stuff. So choosing very high fiber foods and low processed foods. So things like processed food like bread, even most grains, the way that we consume grains in the US, will lead to constipation. Also, a lot of the white or beige foods will cause constapation, so high-fiber things are things, like fresh fruit and vegetables. Those are the number one best thing that you can do. and make sure that you want your fresh fruits and veggies to be at least half of the meal that your child is consuming or 10 fistfuls of their size of fist per day.

Dairy products can also cause constipation. I see a lot of kids when they turn one and they switch over from formula to milk to start to get pretty severe constapation, so Keep an eye on how much dairy your child is consuming, even things like cheese, ice cream, straight up milk, cups of milk. Those can all cause pretty severe constipation. Yogurt is one that can sometimes help because it has probiotics in it, but also has the dairy in. You know, it's one that you sort of want to use with caution.

Understanding and Preventing Constipation 12:40

And then make sure they're drinking lots of water every day, at least a half an ounce of Water per pound of body weight each day. So a 25 pound child should be drinking at Least 12 and a Half ounces of fresh water everyday. then also try to have positive associations with sitting on the toilet and let them sit for a long time so that they can allow that time for their poop to come out so they're not just in a rush trying to hold it for the next time. And then when it's an acute like that so we talked about how you know using pringes as a laxative you can also use a glycerin suppository if their poo is really hard or even an enema for one-time clean out but that's something that I would only do an enema if it's been a few days and it is really painful and none of the other stuff is working.

So for chronic constipation, you do want to first disimpact them. Sometimes an enemas is a good thing as a one time to get it out and or a suppository one-time. And then you can use a stimulant laxative. Now stimulants are things that cause the guts to squeeze and make everything come out. And if you have hard stool in there, it's just going to cause a lot of cramping and pain. So I don't love laxiatives. The other thing is if use it more than two or three days in a row, your body can become dependent on it and then won't be able to poop without it.

So a stimulant laxative is something that if a child has chronic constipation, we do that initial clean out. We use that glycerin suppository. If it's still not working, you can use the stimulants for maybe two or three days at the most. And then you want to add a stool softener on for several weeks and then also increase that fiber and water and decrease the processed foods and eliminate dairy at same time. Now with stool softeners, The one that I like the most is MiraLax. Insilium is another good one.

And then there's something called Colace or Semethicone. That one is really more of a gas bubble decreaser. It decreases your gas bubbles and doesn't do a whole lot for softening the stool. So I don't love that one as much. But Miralax and psyllium both work in a mechanical way. So they work by pulling water into the intestines and into to the poop and keeping it fluffy. They're fighting against the body's natural way of dehydrating the stools by putting the water back into stool and keep it soft.

MiraLAX is great. It's polyethylene glycol is the generic of that. it is basically a gel in powder form that just soaks water in. And it doesn't get absorbed into the body at all. and when you put it in water or juice or anything, it's completely colorless and flavorless. So it disappears completely and the child doesn' even know that they're getting any, you know, stool softeners in so MiraLax is wonderful in that sense because it' easy to get kids to take it. Cilium works in the same way, but it's pretty gritty and it does have a little bit of a flavor and you can definitely, like it has a texture that's grity and also gooey at the time.

So it kind of like sand and jello mixed together. A lot of children don't love taking drinks that have cilum in them, it is a more natural option than Miralax if you wanted to do that. but they both work in the same sense and they're great. You can titrate their use up and down because they are not getting absorbed into the body. If it's not working quite well enough, increase water first, but then also you can increase the dose of the Miralex or the psyllium to twice a day. But you could even do it more than twice the day if you need to.

And then if it is too much, you go down to like half as much per day before weaning it off completely. When you're treating chronic constipation, you do need to give your child at least a few weeks, at two to three weeks of them pooping once a day with the medicine before you start to think about weaning it off. If you wean it of too quickly, they'll get hard stools and they get right back into that cycle of painful bowel movements and withholding and more constepation. All right, diarrhea real quickly, the opposite.

So diarrhea can sometimes happen from viral infections. It can happen form foods. You could have that sort of ball game diarrhea where if you have too much hot dogs and chili, basically, or other low quality foods, you get diarrhea from that. Toddlers will get it from too much juice. Juice has a lot of pectin in it and that can cause diarrhea and also teething can causes diarrhea. So when they're getting their initial set of teeth, like especially the molars around one to one and a half years and then the two and half to three years, those typically they'll swallow that extra saliva and it just turns to slime in their intestines and causes these like softer stools.

Diarrhea is just any increase in frequency of bowel movements, increase of volume or a decrease in the consistency, so like more watery stoles. So when to be worried about it. If it's going on for more than a week in children, usually that's a sign that it is some kind of infection that might need some treatment. And then also if it just really profuse, like if they get a whole bunch of diarrhea several times in a row and you're worried So the most important thing for treating diarrhea in children, we don't use medicines because medicines typically make the infection get worse and can make it go in their bloodstream.

We just try to keep them hydrated.

Treating Diarrhea and Staying Hydrated 17:48

So increase their water. You can do the brat diet for a day. 24 hours is all that's intended for. And brat diets is bananas, rice, applesauce, and toast. Those are just bland foods or beige foods. or even processed foods, those are things that will bind up stool. And they do it sort of, they don't necessarily make your child get better. They just make it a little easier for you to clean up their stool, so they make a it little bit more solid. Try to avoid dairy when they have diarrhea. Dairy can also cause diarrhea in addition to causing constipation.

It's one of those that causes both kind of things. A lot of viral infections will cause a temporary lactose intolerance. So if your child has a viral illness and they get diarrhea, seem to get a little bit better and then are just having these like watery stools all the time, that could be related to dairy intake. So you might want to try avoiding dairy for at least a few days, maybe a week or two, until their diarrhea gets better. Probiotics can help, and all probiotics are pretty equally good.

So any over-the-counter probiotic is great for your child. And again, just trying to avoid that dehydration by pushing those fluids. If you wanted to do oral rehydration solution, you can look up a recipe for that. It's basically just water with sugar and salt in it. We have brand name things like Gitterade and Pedialyte, which are also good, but you don't necessarily need to get those. Water and sugar, salt is really what they need, to be replacing. You can just Google a recipe for that and it's super easy to make.

Even just watered down juice, like less than one quarter juice with three quarters or more water, can also help to rehydrate children. In order to avoid spread to family members, make sure you're cleaning your hands with soap and water after changing diarrhea diapers or helping your child wipe. And also the rotavirus vaccine has been super helpful in preventing viral infections in young children. So if you have any young babies in the house, especially with older siblings, it's a good idea for them to get that rotovirus vaccine.

We typically give it at ages two, four and six months. For urinary tract infections, so this is something that can happen in children when they're learning to potty train, when there's still in diapers, and then also it's more common in girls than boys, just because the urethra is closer to the anus in girl's and so you might just get some bacteria from their stool that gets in there. Other risk factors for UTIs are wearing tight clothing, especially in the summer when it is hot and sweaty, or being in a swimsuit for too long.

So symptoms of a urinary tract infection are pain with urination. So you might notice your child is crying when they pee or they might say that it hurts. Urinary frequency, so going more often but only having small amounts coming out each time. urgency, which is running to the bathroom needing to go very suddenly, or having accidents in a potty trained child. Sometimes you'll get a bad smell to the urine, but not usually. So I don't always rely on that. And fever is a late sign of a urinary tract infection.

Recognizing and Preventing UTIs 20:38

That's usually a sign that it's spreading, so that's a pretty bad, like into the kidneys or into bloodstream. Fever is the later sign the infection is worse. Also, constipation can lead to urinary tract infections in children. We don't exactly know the process, just that there is an association there. And bubble baths can also sometimes lead UTIs, especially in girls. I think it's partly because you get a little bit of irritation and vaginitis from the bubble-baths but then also just the soap particles making things from from the anal region, like your stool particles wash forward towards your urethra.

I don't know exactly. It's just one of those. Nobody really knows, but there is an association with bubble baths. So plain water bath can sometimes help to avoid UTIs Really, the only treatment for urinary tract infection is antibiotics. So yeah, increasing fluids will help a little bit. Cranberry juice is thought to help, but usually to get children to drink enough, there's so much sugar in it that it's actually feeding the infection and there is not much of a benefit there. The only thing that will actually make it go away is an antibiotic because it is a bacterial infection.

So talk to your doctor if your child does have signs of a UTI. And then for prevention, for children who are getting more than one UDI, sometimes we will do an ultrasound of the kidneys to see if they have a risk for pyelonephritis, which is an infection of kidneys. But just overall, you can help them by drinking plenty of water, using loose clothing. Cotton underwear can helps avoiding all those other risk factors like not staying in a wet swimsuit too long, avoiding bubble baths. and then also decreasing sugar intake because sugar does feed the bacteria that will cause UTIs.

All right, so these are the major things with potty training and some of the things that can go wrong.

Wrap-Up and Podcast Outro 22:28

I hope this helps. Keep an eye out over the next couple of weeks for more episodes going by age. So we're talking about toddlers during this season. And if you're having another baby or if have a friend who is, go ahead and check out season one of The Baby Manual podcast, which is for the first year of life. All right, have a great day and I hope we'll see you next time. Thank you for listening to the Baby Manual Podcast. Please hit that subscribe button below so you don't miss the new episodes as they come out.

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