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Toilet Training Setbacks
Q: My son is nearly three and has been potty training for about six weeks now. He does well with peeing in the potty, better away from home than at home. He frequently will pee in his pants during time-out and also has trouble pooping in the potty. I am starting to lose patience with the wet pants and I'm trying not to punish him. Could it have something to do with our new five-month-old twins?
A: Overall, it sounds like you are right on target! Although it is best to avoid "traumatic" (in his eyes) events when beginning to toilet train, this obviously is not always possible. The addition of new siblings can initially be difficult to handle for a young preschooler, as he no longer has your totally undivided attention. Continue to praise him for success when he cooperates with practice sessions or has a favorable attempt at going in the potty. Have him regularly sit on the potty after each meal. Learning to use the toilet is like learning to walk -- everyone will do it at some point, but when that is varies from child to child. Many children are trained between 18 and 36 months, although some accomplish it earlier and others do it later.
Bowel training generally takes longer than bladder training. Be sure your son is learning to urinate in the potty while sitting down. Although boys can be trained to urinate standing up, this should only be attempted after bowel control is established. Standing up to urinate may cause them to forget to have BMs sitting down. When your son goes in his diaper, take him to the potty and empty the diaper there with neutral words of encouragement. Although you should never keep children in dirty diapers as punishment because it creates a confusing message of what is truly desired, you also do not need to drop everything as soon as he comes asking to be changed. Tell him you will first finish whatever you are doing and then change it. These times are not meant to be pleasurable or fun, but you should also try not to sound disapproving.
Most importantly, if frustration is setting in for you or him, it may be best to take a break from training for a while. Do not expect perfection -- three steps forward, one step back, is the norm. An important aspect of training is a relaxed, casual attitude with a sense of humor. Avoid pressure, coercion (being too forceful), or punishment at all costs. For your son to succeed, the timing must be right.
Hank Bernstein Children's Hospital
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.