046: How to potty train a child
27th August 2017 • Your Parenting Mojo - Respectful, research-based parenting ideas to help kids thrive • Jen Lumanlan
00:00:00
00:44:51
Shownotes
When should I start potty training? What books should I read? Can I do it in a day (or a week)? Do I need stickers (for rewards)? Does it have to be stressful?
I get these kinds of questions pretty often, and I’d resisted doing an episode on potty training because there are so many books on it already, and everyone has their opinion, and I really didn’t want to wade into it. But ya’ll kept asking and my resolve has finally crumbled, so today we’re going to talk all about what the research says, what the books say, and how there’s essentially no correlation between the books and the research. We’ll review the “do it in a day!” methods and what makes them successful, and we’ll also look at child-led methods. You’ll leave this episode with a clear picture of which is probably going to work best for you, and some concrete tools you can put to work (today, if you need to!) to start what I prefer to call the “toilet learning” process.
Other episodes references in this show
021: Talk Sex Today
009: Do you punish your child with rewards?
020: How do I get my child to do what I want them to do? (Unconditional parenting)
042: Manners
References
Au, S. &; Stavinoha, P.L. (2008). Stress-free potty training: A commonsense guide to finding the right approach for your child. New York, NY: AMACOM.
Barone, J.G., Jasutkar, N., & Schneider, D. (2009). Later toilet training is associated with urge incontinence in children. Journal of Pediatric Urology 5, 458-461.
Benjusuwantep, B., & Ruangdaraganon, N. (2011). Infant toilet training in Thailand: Starting and completion age and factors determining them. Journal of the Medical Association of Thailand 94(12), 1441-1446.
Blum, N.J., Taubman, B., & Nemeth, N. (2003). Relationship between age at initiation of toilet training and duration of training: A prospective study. Pediatrics 111(4), 810-814.
Butler, J.F. (The toilet training success of parents after reading Toilet Training In Less Than A Day. Behavior Therapy 7, 185-191.
Duong, T.H., Jansson, U-B., & Hellstrom, A-L. (2013). Vietnamese mothers’ experiences with potty training procedure for children from birth to 2 years of age. Journal of Pediatric Urology 9, 808-814.
Fertleman, C., & Cave, S. (2011). Potty training girls the easy way: A stress-free guide to helping your daughter learn quickly. Philadelphia, PA: Da Capo.
Fertleman, C. & Cave, S. (2009). Potty training boys the easy way: Helping your son learn quickly – even if he’s a late starter. Philadelphia, PA: Da Capo.
Gerber, M. (2002). Dear parent: Caring for infants with respect (2 nd Ed.). Los Angeles, CA: Resources for Infant Educarers.
Glowacki, J. (2015). Oh, crap! Potty training: Everything modern parents need to know to do it once and do it right. New York, NY: Simon & Schuster.
Goode, E. (1999, January 12). Two experts do battle over potty training. The New York Times. Retrieved from: http://www.nytimes.com/1999/01/12/us/two-experts- do-battle- over-potty- training.html
Gross-Loh, C. (2007). The diaper-free baby: The natural toilet training alternative. New York, NY: William Morrow.
Horn, I.B., Brenner, R., Rao, M., & Cheng, T.L. (2006). Beliefs about the appropriate age for initiating toilet training: Are there racial and socioeconomic differences? Journal of Pediatrics 149, 165-168.
Kaerts, N., Van Hal, G., Vermandel, A., & Wyndaele, J-J. (2012). Readiness signs used to define the proper moment to start toilet training: A review of the literature. Neurology and Urodynamics 31, 437-440.
Kimball, V. (2016). The perils and pitfalls of potty training. Pediatric Annals 45(6), 199-201.
Koc, I., Camurdan, A.D., Beyazova, U., Ilhan, M.N., & Sahin, F. (2008). Toilet training in Turkey: The factors that affect timing and duration in different sociocultural groups. Child: Care, Health and Development 34(4), 475-481.
Martin, J.A., King, D.R., Maccoby, E.E., & Jacklin, C.N. (1984). Secular trends and individual differences in toilet-training progress. Journal of Pediatric Psychology 9(4), 457-468.
Matson, J.L., & Ollendick, T.H. (1977). Issues in toilet training normal children. Behavior Theraly 8, 549-553.
Shaikh, N. (2004). Time to get on the potty: Are constipation and toileting refusal causing delayed toilet training? Journal of Pediatrics 145, 12-13.
Taubman, B. (1997). Toilet training and toileting refusal for stool only: A prospective study. Pediatrics 99(1), 54-58.
Vermadel, A., Van Kamepn, M., Van Gorp, C., & Wyndaele, J-J. (2008). How to toilet train healthy children? A review of the literature. Neurology & Urodynamics 27, 162-166.
Barone, J.G., Jasutkar, N., & Schneider, D. (2009). Later toilet training is associated with urge incontinence in children. Journal of Pediatric Urology 5, 458-461.
Benjusuwantep, B., & Ruangdaraganon, N. (2011). Infant toilet training in Thailand: Starting and completion age and factors determining them. Journal of the Medical Association of Thailand 94(12), 1441-1446.
Blum, N.J., Taubman, B., & Nemeth, N. (2003). Relationship between age at initiation of toilet training and duration of training: A prospective study. Pediatrics 111(4), 810-814.
Butler, J.F. (The toilet training success of parents after reading Toilet Training In Less Than A Day. Behavior Therapy 7, 185-191.
Duong, T.H., Jansson, U-B., & Hellstrom, A-L. (2013). Vietnamese mothers’ experiences with potty training procedure for children from birth to 2 years of age. Journal of Pediatric Urology 9, 808-814.
Fertleman, C., & Cave, S. (2011). Potty training girls the easy way: A stress-free guide to helping your daughter learn quickly. Philadelphia, PA: Da Capo.
Fertleman, C. & Cave, S. (2009). Potty training boys the easy way: Helping your son learn quickly – even if he’s a late starter. Philadelphia, PA: Da Capo.
Gerber, M. (2002). Dear parent: Caring for infants with respect (2 nd Ed.). Los Angeles, CA: Resources for Infant Educarers.
Glowacki, J. (2015). Oh, crap! Potty training: Everything modern parents need to know to do it once and do it right. New York, NY: Simon & Schuster.
Goode, E. (1999, January 12). Two experts do battle over potty training. The New York Times. Retrieved from: http://www.nytimes.com/1999/01/12/us/two-experts- do-battle- over-potty- training.html
Gross-Loh, C. (2007). The diaper-free baby: The natural toilet training alternative. New York, NY: William Morrow.
Horn, I.B., Brenner, R., Rao, M., & Cheng, T.L. (2006). Beliefs about the appropriate age for initiating toilet training: Are there racial and socioeconomic differences? Journal of Pediatrics 149, 165-168.
Kaerts, N., Van Hal, G., Vermandel, A., & Wyndaele, J-J. (2012). Readiness signs used to define the proper moment to start toilet training: A review of the literature. Neurology and Urodynamics 31, 437-440.
Kimball, V. (2016). The perils and pitfalls of potty training. Pediatric Annals 45(6), 199-201.
Koc, I., Camurdan, A.D., Beyazova, U., Ilhan, M.N., & Sahin, F. (2008). Toilet training in Turkey: The factors that affect timing and duration in different sociocultural groups. Child: Care, Health and Development 34(4), 475-481.
Martin, J.A., King, D.R., Maccoby, E.E., & Jacklin, C.N. (1984). Secular trends and individual differences in toilet-training progress. Journal of Pediatric Psychology 9(4), 457-468.
Matson, J.L., & Ollendick, T.H. (1977). Issues in toilet training normal children. Behavior Theraly 8, 549-553.
Shaikh, N. (2004). Time to get on the potty: Are constipation and toileting refusal causing delayed toilet training? Journal of Pediatrics 145, 12-13.
Taubman, B. (1997). Toilet training and toileting refusal for stool only: A prospective study. Pediatrics 99(1), 54-58.
Vermadel, A., Van Kamepn, M., Van Gorp, C., & Wyndaele, J-J. (2008). How to toilet train healthy children? A review of the literature. Neurology & Urodynamics 27, 162-166.
Read Full Transcript
Transcript Hello and welcome to the Your Parenting Mojo podcast. I had actually resisted doing an episode on today’s topic for quite a while but listeners kept emailing to ask me about it so my resistance has crumbled and today we’re going to talk about potty training. I prefer to call it toilet learning, but we’re going to look at a lot of different studies on this topic and I’m going to use the language that the individual authors use in their work. There are SO MANY books about it and everyone seems to have their own opinion about it and I kind of didn’t want to stir the pot. Or even put my oar in it, to mix metaphors. But you, my dear listeners, have spoken, and so I, your humble research assistant, have listened, and so today we are going to talk about potty training. And toilet learning. And we’re going to look at all of this through the lens of respectful parenting, because practitioners of respectful parenting have a fair bit to say on this topic. So for those of you who listen to the show regularly, it probably won’t be enormously surprising for you to hear that toilet learning is profoundly impacted by cultural considerations. Starting with the earliest possible age for toilet learning, we come to the concept of Elimination Communication, abbreviated to EC, which was popularized anew in Christine Gross-Loh’s book The Diaper-Free Baby, and I’m going to spare you the $13 on Amazon or even the three week wait in your library’s hold queue and tell you that the method basically involves watching for and learning a baby’s signals that he or she needs to pee or poo and providing opportunities to go at that time, providing opportunities to go at regular intervals even when the baby doesn’t indicate readiness, and making a whistling or zzzzz sound while you hold the baby over a potty or a hole in the garden which tells the baby that it’s time to go. Not much to it, right? This approach is, of course, most common in countries where interdependence, rather than independence, is prized – since it relies so heavily on reading signals given by others, it’s not surprising that this approach is used in countries like China and Vietnam where a big part of being a citizen in society is developing the ability to read signals given by other people. The key to all of this is that it’s done when the baby is very young. And I’m talking infant stage. A study conducted by a joint Vietnamese-Swedish research team interviewed forty seven mothers about their potty training experiences from the time the babies were newborns until they were 24 months old; the researchers stopped interviewing the mothers when the babies were 24 months because all of the children were potty trained by then. To a Western audience, that must sound incredible – I was certainly pretty surprised, and I even had some experience with EC. The Digo tribe in East Africa begins toilet training a few weeks after birth; they expect some dryness at night by around six months and complete dryness at one year. The babies are in constant contact with the mothers for the first couple of months of the baby’s life and whenever the mothers sense that the baby needs to pee or poop the mother holds the baby between her knees. When the baby is 3-5 months old a sibling or other female family member aged between 5-12 years takes over primary care of the baby during the day, and if an accident occurs it is actually the caregiver rather than the infant who is punished. So in the Digo culture, it is primarily the responsibility of parents and caregivers to recognize and respond to the child after the child indicates their need to pee or poop. This is in stark contrast to Western cultures where the responsibility is primarily placed on the child to indicate that they need to pee or poop and to get themselves to the toilet, undress, void, wipe, and re-dress. One study looked at mothers from different backgrounds in Turkey, and found that the both the age of initiation of potty training as well as the age of completion was much earlier among rural families that lived in homes without an inside toilet, families using washable diapers, and families who punish children. Mothers having an education of more than 12 years tended to initiate training much later and used a more child-led approach. We had a pretty traumatic first few months with my own daughter’s peeing; she would cry as soon as she peed and would continue to cry until her diaper was changed. She was also very gassy as well so she actually cried a lot of the time in those early days and we had the Pamper’s diapers with the stripe on them that turns from yellow to blue when it gets wet. She would start to cry and we would quickly check the stripe to see if it was blue, and it wouldn’t be blue, and she would keep crying and twenty seconds later it would turn blue – she was actually more reactive than the wetness indicator stripe. We wondered if she might have a urinary tract infection but sometimes she would pee mid-change and wouldn’t cry at all then. We went through sixteen diapers a day in the first few months; I know this because I hiked around Mont Blanc with her when she was eight weeks old and I had to count how many diapers we were using each day before we went so we could be sure to carry enough. I think I read The Diaper-Free Baby when she was about five months old, because my in-laws were living with us from the time she was four through six months old to help take care of her while I went back to work. I knew they would think I was crazy for trying EC so I waited until the day they left to start. Within a couple of weeks she was doing pretty much all of her pees and about half of her poops on the potty, and when our nanny started work a few weeks later she was stunned to find a seven month-old mostly using the potty. And the nanny was actually from Thailand, but I guess she had been in the States for entirely too long because a study out of Thailand reports that 80% of 50 infants who were followed by some Thai researchers were fully toilet trained by 12 months. That study also found that children who weren’t the first child, and who were taken care of by a well-educated mother, were found to start toilet training late – perhaps exposure to more Western ideas, as well as having enough money to be able to afford diapers, were behind this trend. I read a few books on potty training to prepare for this episode, along with a whole host of empirical research, and I have to say that that’s where the correlation between the two ends – researchers publish the results of empirical studies, but the people who write books on potty training seem not to read that research – or at least, I’ve yet to meet a book that cites any of it. So let’s start going through some of that research and I’ll bring in information from the books as it seems appropriate. If we missed the window for teaching through EC, which by all accounts has to be done early in the child’s life, then we have two-main choices for how to proceed – we can do a parent-led approach where we establish a date when we will “train” the child, and we train them on that day – we expect results the same day or certainly within the same week. Or we can watch for signs that the child is ready to begin learning how to use the toilet, and allow the child to lead the process. This readiness is, like many of these kinds of things, something that is culturally determined. A study of 779 parents visiting child health providers in and around Washington D.C. found that the average age at which Caucasian parents believed toilet training should be initiated was 25.4 months, significantly later than African American parents (18.2 months) and parents of other races at 19.4 months. Higher income was also associated with later toilet training. This is certainly later than parents have toilet trained in the past – I found an abstract for a study from 1983 (although I couldn’t find the full study) stating that the first appearance of toileting skills appeared between 18 and 36 months in a dataset from 1975, which itself is described as being much later than in a comparable cohort (we have to assume they mean “mostly white”) from 1947. Another study found that when children start training at a younger age then toilet training takes longer, although these children do end up completing training earlier than children who start later. Training before the age of 27 months is apparently not correlated with the earlier completion of training, suggesting that there is little benefit to starting before then. A variety of researchers have produced impressive-looking charts of signals that a child is ready to begin potty training. One literature review graphed twenty one signs of readiness according to when the sign appears – some of these included the ability to sit and to walk, which appear between four and 18 months, acquiring voluntary control of the pelvic muscles which appears between 9-24 months, and understanding and responding to directions or questions and being able to follow simple commands appears between 9 and 26 months. The majority of researchers as well as lay authors writing about potty training stress the importance of readiness, but there is no consensus whatsoever in the literature about how many of these readiness signs need to be present for the child to start potty training, which ones are more important in terms of judging an individual child’s readiness. Many of the authors who say “a child must be ready” often give ages at which certain readiness signs should be present give different ages from each other. So that gives us some information about when we might start thinking about toilet learning, but what do we actually do when we think that window has opened? Well, it seems as though there are basically two approaches, and some people who attempt a middle ground between the two. One approach seems to see toilet learning as the process of “getting urine and feces in the toilet,” as Magda Gerber, who founded the RIE approach to parenting, puts it. Parents who see toilet training in this way will do whatever it takes to get the urine and feces in the toilet, typically making extensive use of rewards to make that happen. Let’s cover the with the parent-led approach to toilet training first, which was formally developed by two psychologists named Asrin and Fox in 1974. Any book published since then that promises parents they can potty train in a defined and short period of time probably uses some elements of this approach, although what they invariably neglect to state is that it was actually developed for “retarded and brain-damaged children,” and then the researchers appear to have decided that it was also applicable to normally developing children as well. I should be up-front here and say that I haven’t read the book; I couldn’t get it from the library and honestly I didn’t want to give the researchers any money by buying it. So if you’re considering this approach you should certainly read the book, but the gist of it is that once children are 20 months old (I’m not sure why this is the magic number) and can meet a variety of other criteria like being able to walk, staying dry for a couple of hours at a time, and following simple instructions, you set aside a day for potty training. You set up a potty in an area big enough to play in, like the kitchen, and you show the child how to use the potty by showing a doll “drinking” water and “urinating” on the potty after taking its diaper off. You do this a couple of times, first successfully, so the doll “pees” on the potty and gets a reward, and then “unsuccessfully” so the doll wets its underwear and then has to do a practice drill of going to the potty even though they don’t need to go. You make sure your child drinks lots of fluids so he needs to pee. Then repeat the same process with the child – when the child pees on the potty, he gets a reward. If the child pees in his underwear, he has to do the drill of sitting on the potty. Azrin and Fox tested their method on 34 children with the average child completing training in 3.9 hours and having a 97% decrease in accidents the week after training. Sounds good, right? Apparently there were so many reports about failures of parents to train their children using the book that people began to form classes to train parents in using the Asrin and Fox method. One researcher noted that parts of the procedure are subtle (so don’t try to use this method just from my description; you’ll have to go and read the book) – and parents might lack the self-control required for this method. It turns out that having extra support ends up being fairly critical for success – one admittedly very small study of ten children randomly assigned the children to either have a parent who would just read the book, or have a parent read the book as well as have an experienced trainer available for “supervision and prompting.” Children whose mothers just read the book had about five accidents per day at the beginning of treatment, which dropped to about four over the course of five days of treatment, but actually rebounded to a peak of SEVEN accidents per day seven weeks after training before dropping again slightly to a level that was still above where they were when they started. Children whose parents read the book and had “supervision and prompting” started with four accidents per day and dropped to an average of half an accident per day by day three, and maintained somewhere between half and one accident per day for the next ten weeks. Now a couple of things stuck out to me here. Firstly, that the researchers said that ALL of the mothers reported “emotional side effects” in their children, primarily consisting of tantrums and avoidance behavior. These behaviors were more evident in mothers who only read the book and didn’t get support, and among younger children and usually occurred after an accident when the child didn’t want to sit on the potty again when they didn’t need to go. Four of the ten mothers felt so uncomfortable that they wanted to stop the training, but “encouragement” resulted in three of the four continuing. Does this remind you of anything? Anything at all? I’m thinking back to Stanley Milgram’s famous experiment on...
Transcript Hello and welcome to the Your Parenting Mojo podcast. I had actually resisted doing an episode on today’s topic for quite a while but listeners kept emailing to ask me about it so my resistance has crumbled and today we’re going to talk about potty training. I prefer to call it toilet learning, but we’re going to look at a lot of different studies on this topic and I’m going to use the language that the individual authors use in their work. There are SO MANY books about it and everyone seems to have their own opinion about it and I kind of didn’t want to stir the pot. Or even put my oar in it, to mix metaphors. But you, my dear listeners, have spoken, and so I, your humble research assistant, have listened, and so today we are going to talk about potty training. And toilet learning. And we’re going to look at all of this through the lens of respectful parenting, because practitioners of respectful parenting have a fair bit to say on this topic. So for those of you who listen to the show regularly, it probably won’t be enormously surprising for you to hear that toilet learning is profoundly impacted by cultural considerations. Starting with the earliest possible age for toilet learning, we come to the concept of Elimination Communication, abbreviated to EC, which was popularized anew in Christine Gross-Loh’s book The Diaper-Free Baby, and I’m going to spare you the $13 on Amazon or even the three week wait in your library’s hold queue and tell you that the method basically involves watching for and learning a baby’s signals that he or she needs to pee or poo and providing opportunities to go at that time, providing opportunities to go at regular intervals even when the baby doesn’t indicate readiness, and making a whistling or zzzzz sound while you hold the baby over a potty or a hole in the garden which tells the baby that it’s time to go. Not much to it, right? This approach is, of course, most common in countries where interdependence, rather than independence, is prized – since it relies so heavily on reading signals given by others, it’s not surprising that this approach is used in countries like China and Vietnam where a big part of being a citizen in society is developing the ability to read signals given by other people. The key to all of this is that it’s done when the baby is very young. And I’m talking infant stage. A study conducted by a joint Vietnamese-Swedish research team interviewed forty seven mothers about their potty training experiences from the time the babies were newborns until they were 24 months old; the researchers stopped interviewing the mothers when the babies were 24 months because all of the children were potty trained by then. To a Western audience, that must sound incredible – I was certainly pretty surprised, and I even had some experience with EC. The Digo tribe in East Africa begins toilet training a few weeks after birth; they expect some dryness at night by around six months and complete dryness at one year. The babies are in constant contact with the mothers for the first couple of months of the baby’s life and whenever the mothers sense that the baby needs to pee or poop the mother holds the baby between her knees. When the baby is 3-5 months old a sibling or other female family member aged between 5-12 years takes over primary care of the baby during the day, and if an accident occurs it is actually the caregiver rather than the infant who is punished. So in the Digo culture, it is primarily the responsibility of parents and caregivers to recognize and respond to the child after the child indicates their need to pee or poop. This is in stark contrast to Western cultures where the responsibility is primarily placed on the child to indicate that they need to pee or poop and to get themselves to the toilet, undress, void, wipe, and re-dress. One study looked at mothers from different backgrounds in Turkey, and found that the both the age of initiation of potty training as well as the age of completion was much earlier among rural families that lived in homes without an inside toilet, families using washable diapers, and families who punish children. Mothers having an education of more than 12 years tended to initiate training much later and used a more child-led approach. We had a pretty traumatic first few months with my own daughter’s peeing; she would cry as soon as she peed and would continue to cry until her diaper was changed. She was also very gassy as well so she actually cried a lot of the time in those early days and we had the Pamper’s diapers with the stripe on them that turns from yellow to blue when it gets wet. She would start to cry and we would quickly check the stripe to see if it was blue, and it wouldn’t be blue, and she would keep crying and twenty seconds later it would turn blue – she was actually more reactive than the wetness indicator stripe. We wondered if she might have a urinary tract infection but sometimes she would pee mid-change and wouldn’t cry at all then. We went through sixteen diapers a day in the first few months; I know this because I hiked around Mont Blanc with her when she was eight weeks old and I had to count how many diapers we were using each day before we went so we could be sure to carry enough. I think I read The Diaper-Free Baby when she was about five months old, because my in-laws were living with us from the time she was four through six months old to help take care of her while I went back to work. I knew they would think I was crazy for trying EC so I waited until the day they left to start. Within a couple of weeks she was doing pretty much all of her pees and about half of her poops on the potty, and when our nanny started work a few weeks later she was stunned to find a seven month-old mostly using the potty. And the nanny was actually from Thailand, but I guess she had been in the States for entirely too long because a study out of Thailand reports that 80% of 50 infants who were followed by some Thai researchers were fully toilet trained by 12 months. That study also found that children who weren’t the first child, and who were taken care of by a well-educated mother, were found to start toilet training late – perhaps exposure to more Western ideas, as well as having enough money to be able to afford diapers, were behind this trend. I read a few books on potty training to prepare for this episode, along with a whole host of empirical research, and I have to say that that’s where the correlation between the two ends – researchers publish the results of empirical studies, but the people who write books on potty training seem not to read that research – or at least, I’ve yet to meet a book that cites any of it. So let’s start going through some of that research and I’ll bring in information from the books as it seems appropriate. If we missed the window for teaching through EC, which by all accounts has to be done early in the child’s life, then we have two-main choices for how to proceed – we can do a parent-led approach where we establish a date when we will “train” the child, and we train them on that day – we expect results the same day or certainly within the same week. Or we can watch for signs that the child is ready to begin learning how to use the toilet, and allow the child to lead the process. This readiness is, like many of these kinds of things, something that is culturally determined. A study of 779 parents visiting child health providers in and around Washington D.C. found that the average age at which Caucasian parents believed toilet training should be initiated was 25.4 months, significantly later than African American parents (18.2 months) and parents of other races at 19.4 months. Higher income was also associated with later toilet training. This is certainly later than parents have toilet trained in the past – I found an abstract for a study from 1983 (although I couldn’t find the full study) stating that the first appearance of toileting skills appeared between 18 and 36 months in a dataset from 1975, which itself is described as being much later than in a comparable cohort (we have to assume they mean “mostly white”) from 1947. Another study found that when children start training at a younger age then toilet training takes longer, although these children do end up completing training earlier than children who start later. Training before the age of 27 months is apparently not correlated with the earlier completion of training, suggesting that there is little benefit to starting before then. A variety of researchers have produced impressive-looking charts of signals that a child is ready to begin potty training. One literature review graphed twenty one signs of readiness according to when the sign appears – some of these included the ability to sit and to walk, which appear between four and 18 months, acquiring voluntary control of the pelvic muscles which appears between 9-24 months, and understanding and responding to directions or questions and being able to follow simple commands appears between 9 and 26 months. The majority of researchers as well as lay authors writing about potty training stress the importance of readiness, but there is no consensus whatsoever in the literature about how many of these readiness signs need to be present for the child to start potty training, which ones are more important in terms of judging an individual child’s readiness. Many of the authors who say “a child must be ready” often give ages at which certain readiness signs should be present give different ages from each other. So that gives us some information about when we might start thinking about toilet learning, but what do we actually do when we think that window has opened? Well, it seems as though there are basically two approaches, and some people who attempt a middle ground between the two. One approach seems to see toilet learning as the process of “getting urine and feces in the toilet,” as Magda Gerber, who founded the RIE approach to parenting, puts it. Parents who see toilet training in this way will do whatever it takes to get the urine and feces in the toilet, typically making extensive use of rewards to make that happen. Let’s cover the with the parent-led approach to toilet training first, which was formally developed by two psychologists named Asrin and Fox in 1974. Any book published since then that promises parents they can potty train in a defined and short period of time probably uses some elements of this approach, although what they invariably neglect to state is that it was actually developed for “retarded and brain-damaged children,” and then the researchers appear to have decided that it was also applicable to normally developing children as well. I should be up-front here and say that I haven’t read the book; I couldn’t get it from the library and honestly I didn’t want to give the researchers any money by buying it. So if you’re considering this approach you should certainly read the book, but the gist of it is that once children are 20 months old (I’m not sure why this is the magic number) and can meet a variety of other criteria like being able to walk, staying dry for a couple of hours at a time, and following simple instructions, you set aside a day for potty training. You set up a potty in an area big enough to play in, like the kitchen, and you show the child how to use the potty by showing a doll “drinking” water and “urinating” on the potty after taking its diaper off. You do this a couple of times, first successfully, so the doll “pees” on the potty and gets a reward, and then “unsuccessfully” so the doll wets its underwear and then has to do a practice drill of going to the potty even though they don’t need to go. You make sure your child drinks lots of fluids so he needs to pee. Then repeat the same process with the child – when the child pees on the potty, he gets a reward. If the child pees in his underwear, he has to do the drill of sitting on the potty. Azrin and Fox tested their method on 34 children with the average child completing training in 3.9 hours and having a 97% decrease in accidents the week after training. Sounds good, right? Apparently there were so many reports about failures of parents to train their children using the book that people began to form classes to train parents in using the Asrin and Fox method. One researcher noted that parts of the procedure are subtle (so don’t try to use this method just from my description; you’ll have to go and read the book) – and parents might lack the self-control required for this method. It turns out that having extra support ends up being fairly critical for success – one admittedly very small study of ten children randomly assigned the children to either have a parent who would just read the book, or have a parent read the book as well as have an experienced trainer available for “supervision and prompting.” Children whose mothers just read the book had about five accidents per day at the beginning of treatment, which dropped to about four over the course of five days of treatment, but actually rebounded to a peak of SEVEN accidents per day seven weeks after training before dropping again slightly to a level that was still above where they were when they started. Children whose parents read the book and had “supervision and prompting” started with four accidents per day and dropped to an average of half an accident per day by day three, and maintained somewhere between half and one accident per day for the next ten weeks. Now a couple of things stuck out to me here. Firstly, that the researchers said that ALL of the mothers reported “emotional side effects” in their children, primarily consisting of tantrums and avoidance behavior. These behaviors were more evident in mothers who only read the book and didn’t get support, and among younger children and usually occurred after an accident when the child didn’t want to sit on the potty again when they didn’t need to go. Four of the ten mothers felt so uncomfortable that they wanted to stop the training, but “encouragement” resulted in three of the four continuing. Does this remind you of anything? Anything at all? I’m thinking back to Stanley Milgram’s famous experiment on...