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Monday, August 23, 2010

Potty Trained by 22 months!

When I was pregnant, I read in a book that many kids don't get out of diapers until age 3 or later.  I was horrified.  "Are you kidding?" I thought.  "You mean to say that kids who are capable of speaking in complete sentences, feeding themselves, and performing many other self-care tasks still use diapers?"  Now, this age probably refers to being Night Trained and not just Day Trained (various online sources say that the average age in the US is about 30 months) but still, my gut reaction had a lasting effect.

I was likely influenced by an article I read years before on Elimination Communication (also known as Natural Infant Hygiene or Infant Potty Training.)  The idea behind EC is that you watch your infant for signs that they need to go, give them "potty opportunities" (or "pottytunities,") and make "cueing sounds" while they go, which they will eventually associate with eliminating (much like Pavlov's dogs.)  I'd thought briefly of doing a little casual ECing with my son when he was new:  I was going to make a cueing noise anytime I noticed him going in hopes that it might stick.  In reality, the only times I noticed him going were when he peed during a diaper change, and I was usually too busy going "Whoa!" and trying to cover him up to remember the cueing sound.  In the end, EC was more work than I wanted to do at that stage in his life.  (I've since heard the theory that children eliminate once the diaper is removed because they instinctively don't want to "defecate where they live," ie, in their clothing--something that makes sense, although it was too late for me to take advantage of this.)

But I digress.  The article on EC also mentioned that in most of the world, children are potty trained much earlier than in the US--around their first birthdays, or definitely before their second.  It pointed out that many potty training problems could be due to the fact that parents wait to train until well after age 2, when kids are notoriously willful anyway.  I've also learned that in the 1950s, 95% of children were potty trained by 18 months--so obviously it's not impossible, nor will learning younger scar a child forever.

I'm not a doctor, a child psychologist, or any kind of certified professional, but these concepts made sense to me.  I therefore decided that I would potty train my child before he turned 2.

Once my son was born, I realized how early this is for most families, and as such there is very little support for people who want to potty train a young toddler.  Fortunately, it turns out that I have many like-minded friends, and my close family has been nothing but supportive (or perhaps they all recognize that I'm stubborn and will do it my way anyway--love you guys!)  From most other directions, however, I've heard a lot of "you don't want to do it before he's ready" or "it won't work if he's too young"--and not the least of these was from the pediatrician.  The pediatrician also recommends using bribes--I mean rewards--as well, something I'm not keen on since I don't want my child to come to expect candy every time he performs a perfectly ordinary bodily function.

It was difficult to find techniques as well.  Fortunately, I did come across the "Naked and $75" tactic from John Rosemond, which gave me a framework on which to build.  It's worth a read for anybody looking for how to approach potty training a child under 2.  Given the lack of resources for parents trying to do this, I will detail our approach below.  Anybody who finds discussion of bodily functions to be TMI, it would be best to stop reading now.

I wanted to start training at 18 months, but I decided it would be wise to wait until after the family vacations were over.  Then he learned to climb out of a crib, so we waited until he was used to having a day bed.  We started when he was about 20 months.

Our Procedure and Process
Technique in Summary
Materials
Optional Materials

Our Procedure and Process:

We prepped our son ahead of time by letting him see us (especially his Daddy) use the toilet and by putting him on his potty between diaper changes.  We did this for several months before we began training in earnest.  I'd been hoping that he'd have an "Aha!" moment after accidentally doing it, but no such luck.  He did pee in the potty two or three times during those months, but it wasn't anything he ever tried to repeat.  By the end of our "prep" time, he was no longer sitting on the potty but using it as a stool to stand in front of the toilet like his Daddy.

John Rosemond's technique recommends you set aside a week in which you can remain homebound.  You dress them in underwear, clean up messes without fuss while telling them to use the potty next time (but don't tell them messes are okay because they're not,) and set a "potty bell" to ring every hour or so, at which point you plop them on the potty, walk away, and tell them to let you know when they've done something.

I chose not to follow the "potty bell" advice.  Instead, I simply told my son to tell me when he needed to go and sometimes asked him whether he wanted to try.  I also didn't leave him alone in the bathroom as the novelty of sitting on the potty had long since worn off for him, and I knew that if I left the room he'd just stand up and follow me. 
As Rosemond suggests, we pretty much went cold turkey on the diapers.  My son's attire for the first week (and even sometimes now, when we're at home) consisted of a shirt and a pair of underwear.  On Day 1, when I got him up I put a pair of underwear on him and told him that his goal for the day was to keep his underwear dry.

I knew it was going to be a messy day, but the point of the underwear is to make sure he feels it when he has an accident.  After breakfast we went to the basement to play because the flooring there is laminate, which would be much easier for me to clean than the carpet upstairs.  On the advice of a friend, I took water and several sweet drinks with us, and I continually suggested he take a drink as we played.

It was about 3 hours before he peed (I'd missed the first-pee-of-the-day-right-after-waking-up teaching moment), and he did so in grand style all over the floor.  He then went three more times over the course of the next hour.  Each time it hit the floor, and each time I told him he needed to do that in his toilet next time.

I chose to put him in pullups for his nap because I value naptime (that's when I write) and didn't want him waking up halfway through it because his sheets got all wet.  During the course of the week I learned that he's usually dry while he takes his nap, so pullups aren't really necessary--provided I'm planning on rushing to get him the moment I hear him stir.  Oftentimes, though, I'll leave him in his room for a little while (especially if he didn't sleep for very long, which he did a lot during our first week because he wasn't going out to get much exercise) so on those occasions the pullup was wet.

By the end of Day 1 (9 pairs of underwear, 2 shirts, and 1 bathrug later) he hadn't used the potty but he was recognizing the feeling of needing to go and associating it with the potty.  He would tap his crotch (his nonverbal sign to us that he needed to go) and would run to where the potty was--too late, of course, but we were happy with this progress.

On Day 2, I once again missed the first-pee-of-the-morning and he went nearly four hours without peeing again.  We'd been playing in the basement for a long time and he suddenly got really cranky, so I figured he was holding it and it was starting to get uncomfortable.  I picked him up, told him it was okay to pee, I just wanted him to do it in his toilet, and that I needed to go too.  I put his potty in the basement bathroom (he wanted it in the shower stall,) sat him on it, and I used the toilet next to him.  And what do you know, he went!  I had to help him point himself downward so there was a bit of a mess to clean up, but that didn't stop us from throwing a party.  I poured it into the toilet and let him flush (he LOVES flushing toilets but we only allow him to do so after he uses it) and then we danced and played and just generally got really excited.  We were on our way.

He had one more success later in the day and also told me (in his tap-his-crotch way) that he needed to go many times, although he didn't produce most of those times.  We still went through 5 pairs of underwear but we were all really proud of what he'd accomplished.

On Day 3, we went through 6 pairs of underwear but most of them only had a small wet spot because he stopped himself after feeling it begin.  He had one major success and also went through about a half hour of "tell Mommy he needs to go, sit on the toilet, indicate he wants Mommy to leave the room, and come to get Mommy to show her the few drops in the bottom of the potty."  I figured that was a good sign that he was learning to control the muscles, even though it was a frustrating exercise to do during dinner.

He was pretty fussy and cranky on Day 3 also, and I discovered late in the day that he was cutting a canine tooth.  I considered pausing the process and starting up a few days (or weeks) later, but I didn't want to undo the progress he'd already made.  I knew it would be harder on both of us, but I decided to carry on.

Days 4 and 5 kind of went backwards.  It was probably due in part to the teething and in part because he was testing us.  He was resisting doing what he'd already done well (he would pee on the bathroom floor right next to the toilet but wouldn't sit on it) and my patience was fraying.  He was also throwing tantrums and I was close to tears.  On Day 5 I tried to set a "potty bell" and leave him in the bathroom alone for two minutes each time it rang, but that was when he got most angry and we only did that for a few hours.

For the first two days, I had carried the potty chair into every room we went to, but after his first success in the downstairs shower, that was the only place he wanted to do it.  However, after the drama of Day 5 I moved the potty chair back upstairs, to the bathroom where we used to change his diapers.  In that bathroom, he wanted to use it as a stool to stand at the big toilet.  In this way he had a few successes and a much more cheerful day on Day 6.  I believe this was also the first day he pooped in the toilet (and not his underwear or a pullup.)

He chose not to cooperate again on Days 7 and 8.  I outright lost my temper and turned into Hulk Mama on Day 8.  Part of my frustration was due to the fact that Rosemond had implied that it should only take a week.  It was wrong of me to expect that, I suppose, but I felt like it was an unfulfilled promise--it was the same way I had felt when I still had breastfeeding pain after two weeks even though all the "experts" and books said such pain should be gone by then.  Anyway, the good thing is that when Hulk Mama emerges my husband becomes super reasonable, so he dealt with the mess.  After this, I decided my son and I both needed a day off.  I decided that I would still take my son to the toilet if he told me he needed to go, but if he was in pullups and I didn't have to clean up messes all day, I would be in a much better mood.

One day off turned into three because the dentist told me a spot had opened up so I could have have my wisdom teeth removed on what would've been day 10, and on day 11 I was so groggy from the drugs that I wasn't up to dealing with it.  He had a few successes on those days, I believe... it's hard to remember now.

On Day 12 I was tired but no longer exhausted, so I asked my son whether he wanted to wear a pullup or underwear.  He went to his dresser and handed me a pair of underwear, so we were back on.

During my wisdom-tooth-down-time, I found this video and article on Wendy Sweeney's Booty Camp.  She has a group of toddlers come to her house, feeds them salty snacks and sugary drinks (the salty snacks keep making them thirsty so they want to keep drinking, unlike my attempts to push fluids on my son, which he resisted after a few days anyway,) never asks them if they have to go (she just tells them that if they need to go, they should do it in the potty,) and makes them clean up their own messes.  She doesn't train kids until they're two and a half, but I decided to employ some of her tactics when we resumed.

I no longer asked my son if he needed to use the toilet (I hadn't done much of that anyway) but instead told him it was his responsibility to let me know when he needed to go.  I also told him it was his responsibility to clean up any messes he made.  Whenever he made a mess that day (and beyond) I told him he needed to do that in the toilet next time, got him out of his wet clothes, put a towel in his hand, and showed him where to clean up.  If he didn't want to cooperate, I would sit him in front of me, put my hand on top of his, and "help" him clean up the mess.  When he fussed, I told him "yes, this isn't fun but this is what happens when you miss the toilet because you have to clean up your messes."  I was much calmer this time around, and I'm sure my attitude adjustment helped as much as the new "chore" did.

From that point on, my son did much better.  I stopped counting the days, but after three weeks he'd gone most days without accidents, allowed people other than me to help him, and been able to go at someone else's house.  A few days after that, I got him to use his travel potty (see below) for the first time, which meant we could leave the house without (much) fear of accidents.   As time has progressed, he's just gotten better and better.

We still have a few things to work on.  I'm currently the one removing his clothing, although he's getting better at taking his underwear off (he still can't get them back on though.)  His aim is atrocious, so I have to help with that too--so he isn't independent yet.

Poop is also less far along than I'd like.  He hasn't pooped in his underwear in over a month, but he mostly manages to go in his pullup right after waking up--before I get to him.  That, combined with the fact that he only goes approximately once per day, means he hasn't had as much practice mastering that part.  He does recognize the feeling, although he sometimes wants to poop while standing too.  He also holds it until later in the day, or even the next day if he doesn't have the opportunity to use the pullup, so I'm considering altering his died to be mostly fiber so he won't be able to withhold it.  He has had a handful of successes though, so we'll see if that's necessary.  I'll write a follow-up post once I feel he's consistent.

Potty Training Before Age Two Technique in Summary:

(Including the various bits I would do next time.)
  1. Prepare the child ahead of time by letting them see Mommy and Daddy (and other family) use the toilet, give them opportunities to sit on/stand at the toilet between diaper changes, and tell them during diaper changes that cleanup will be easier once they stop wearing diapers
  2. Set aside an initial week of intensive potty training and expect a few weeks/months of reinforcement after
  3. Give them an opportunity to use the toilet first thing in the morning if you can catch them before they go in their diaper
  4. Dress them in underwear right away, and tell them that 1) it is their goal to keep their underwear dry, 2) it is their responsibility to either use the potty or tell you when they need help using the potty, and 3) it is their responsibility to clean up any messes they make (although I might wait a few days before making them do the clean up.)
  5. Spend as much time as you can away from carpeted surfaces (for your own sanity)
  6. Give them lots of salty snacks (so they'll get thirsty) and keep sugary drinks on hand (which won't quench the thirst so they'll keep drinking.)  This will give them more opportunities to learn, but only use this diet for a day or two, since it will decrease the nutrition they get at normal meals.
  7. When they have an accident, tell them as calmly as you can that they need to do that in the toilet next time.  Don't tell them it's okay, but try not to get upset.  Then clean them and the mess up (or "help" them clean it up.)
  8. When they succeed for the first time, get really excited and be generous with praise.  Gradually taper your praise down to a few encouraging words as they do it more regularly.
  9. Expect them to test you after they've been successful for a while.  It's really frustrating when you both know they could have used the potty, but remember to stay as calm as possible.  Just remind them that they need to do that in the toilet and clean up their own mess.
  10. Use pullups or diapers at bedtime (and naptime if you like.)  Get the kind that change color or have disappearing designs when wet so you can tell when they're no longer necessary.
  11. Continue to use the underwear when going out and about if you can.  A portable potty chair or folding toilet seat reducer can help, but eventually they'll have to learn to use public toilets.  Always carry supplies to deal with messes in the diaper bag.
  12. Remember that it's difficult for your child to learn to control his/her body (we train them from birth to sit in their own messes, after all) and frequently tell them how proud you are of their progress.
Materials:
A potty chair.
     Rosemond recommends a simple one that doesn't play songs or have designs on it, and I agreed with the idea of keeping it distraction-free.  We purchased the Safety 1st Nature Next 3 in 1 Potty chair.









     It has met our needs and I liked the fact that it's made of environmentally friendly plastic, but I wouldn't buy it again.  The pot is too small to catch pee and poo at the same time, and the pee guard is too low.  It mostly functions as a stool these days.

Underwear.
     2T/3T is the smallest size the stores seem to carry, so it could be difficult to find something for a really small kid.  Special order, I suppose.  Rosemond recommends dressing a boy in "the thinnest cotton underwear you can find" so any messes will travel unimpeded down his legs.  Girls underwear is both thinner and cheaper than boys (which, in some small way, might make up for the much greater amount of money women spend on underwear) so I bought two sets:  panties and briefs.  The idea was that the girl underwear (mostly white, though a few floral prints snuck in) would be training underwear, and he would graduate to the boy underwear once he knew how to keep it dry.  However, it became clear on Day 1 that the girl underwear was too thin.  Sure, some of the mess went down his legs, but most of it actually shot a few inches from his body despite the thin layer of fabric.  We quickly changed him into the boy underwear from that moment forward.  (At least I now have a stock if my next child turns out to be a girl.  If not, well, there's always consignment stores.)
     Rosemond recommends having a girl be naked from the waist down, but after doing this process with my son, I think I would probably put underwear on a girl too.  The number of pairs we went through each day was a good marker of our progress and it taught the lesson of keeping them dry.

Patience
     Very, very important.  Expect messes.  Lots of messes.  Try not to get upset, just handle it matter-of-factly like you would teaching any other skill.

Pullups for naps and Bedtime
     We use the Target brand pullups which have small decals of planets on the front which fade when wet--leading to the amusing (at least to us) phrase "we must consult the planets to see if he's peed."

Cleaning supplies
     Towels and Formula 409 (or similar) for hard floors; towels and soapy water or carpet cleaner for carpeted surfaces.

Sugary drinks and salty snacks
     Whatever your child already likes to eat and drink--otherwise you might wind up buying a small bottle of sprite and having nobody drink it.

Did I mention Patience?
     This is especially important when they test you.  I failed here and turned into Hulk Mama a few times, but we just had to take a step back and try again.

Optional Materials:
The Cool Gear Travel Potty

This product is AWESOME!  It folds up like a suitcase (light enough for the toddler to carry, if he's in the mood) and folds out into a portable potty seat.  It can even support up to 80 pounds.

It uses standard gallon zip-top bags and the zipper part stays clean and dry, so you just remove the bag, zip it up, and throw it away after the child is done.  It took my son a few days before willingly using this (I had to force the issue by keeping him outside and pumping him full of liquids until he couldn't hold it anymore) but once he used it once, he happily did so again and again.  I currently take this with me whenever we go out anywhere.  He hasn't used public toilets yet, but he's been willing to use this on the floor of the handicap stall.  I love this thing!

Primo Folding Potty Seat with Handles

I keep this folded up in the diaper bag, in the pocket where my changing mat used to be.  He's sat on it a few times but has yet to use it.  I'm sure it's only a matter of doing it once, just like it was for the travel potty.  I like the idea of being able to reduce the size of public toilets, and of him having a clean surface to sit on.  It's supposed to hold up to 40 pounds, although I'm not sure it's that sturdy.  And since my son likes standing so much, I have a feeling that if I could find a really compact folding stool, it would probably be a better investment.  But we'll see how this one goes.

I started this post last night, and since I began penning it, my son had three accidents.  Perhaps he's trying to make me into a liar or is testing me again, or maybe our friend Murphy just decided to play his hand.  It's also possible that my son isn't feeling well--he has no fever but he's been fussy and he spit up right before bed, which he hasn't done in... months?  Possibly in more than a year.  He did successfully poop in the toilet tonight, though.

More than ever, this proves that the journey is still ongoing.  But... I do consider him to be daytime Potty Trained--and we have two more months in which to refine our technique before he turns 2.  I believe that I met the goal I set for myself before my son's birth.

If you've read this far, you probably either know me personally or are looking for potty training advice.  In either case, thanks, and if it's the latter, Good Luck!

3 comments:

Linda said...

Well, I read the whole thing and my potty-training years are in the distant past! My girls were trained by 2, and the boys about 6 months later than that (although we did have some bedwetters until 6 or so). Having kids only 14 or 18 months apart speeds up the decision making, I found. As does using cloth diapers- both the laundress and the wearer enjoy getting rid of those things.

I remember during the 70's the catch phrase for explaining problem children was "improper toilet training"!

Brian said...

I'll have to reread this in about a year and a half. But maybe I can manage some kind of "hey, you're urinating on me" noise. That's happening often enough now.

Eileen Rhoadarmer said...

Brian, are you a new daddy??!! Congratulations!