Most toilet training intervention studies use toilet training packages (multiple tactics at once). Making it hard to assess each tactic. However, I will try to assess each tactic based on relevant data and theory.
1. Underwear rather than nappies (diapers)
A couple of studies have found about a 50% success rate just by replacing nappies with underwear (with small sample sizes; 1,2). Underwear has also been found to speed the toilet training process when added to other tactics (1). There can be a delay in effectiveness. This makes sense because a large part of underwear’s effectiveness is probably the immediate and uncomfortable feedback when accidents happen, both in sensation and caregiver response. Immediate feedback promotes learning.
2. Training pants/ pull ups
There is no evidence that pull-up nappies are any better than normal nappies. Studies that have compared them have had sample sizes too small to trust. They probably feel very similar to a normal nappy, and don’t provide the benefits of immediate feedback provided by underwear. However, they are convenient for frequent toilet visits.
3. Scheduled sits on the toilet
The schedule of toilet sits varies, from every 15, 30, 60, or 90 minutes to usual poo times.
An intensive schedule of toilet sits (every 30 minutes) was found to have no effect alone, but a toilet training package including scheduled sits, underwear and rewards was more effective than any of the tactics in isolation (1).
4. Frequent undy (underwear) / nappy checks
Frequent checks would help to get the feedback closer to the event, but would probably not be as effective as the immediate feedback provided when naked or wearing undies. This often incorporates rewards for being dry (see 5 for my thoughts on this), and a change if wet.
Rewards in the form of food, or favoured toys or activities are used after successful toileting, requests to go to the toilet, and/or after finding that the child is dry.
Rewards were found to have no benefit in isolation nor in addition to underwear (1) in a couple of studies with 10 and 4 children in an early childhood center.
I would be inclined to avoid rewards for a few reasons:
A. Children generally want to copy their parents, and therefore motivation to go to the toilet like an adult is probably not the issue.
B. Even to children, rewards can seem controlling, and actually decrease any internal motivation they did have (self determination theory, also detailed in the book “Punished by rewards” by Alfie Kohn.)
C. You need to be very careful with what you reward. You don’t want your child ‘holding on’ so they get rewarded for being dry, nor asking for the toilet unnecessarily.
Although this has not been tested, as with any new skill, it can help if children understand what they are aiming to be able to do (see my post on modeling the bedtime routine). There are a number of options here:
A. Let your child watch you go to the toilet, and describe what you are doing.
B. Model with a toy (preferably one with pants to pull down).
C. Read a book. There are a number of potty training books on the market. Alex loves Potty, it is a fun story including modelling by the dog and cat, the thought process (I could go in my nappy… To which Alex shakes his head), the feeling of having to go, and realistic (and comic) expectations about how long they may have to wait on the potty.
7. Increased fluid intake
This would increase the frequency of toilet visits. This theoretically means more opportunities to learn. In practice it could increase accidents also. Sitting on the potty may hold less appeal if it breaks up play too frequently. This tactic is therefore likely to depend on the child. How much they enjoy sitting on the potty or toilet, and how happy they are to leave play for potty visits.
So in practice…
I plan to start toilet training my son soon. (I’ve since added a debrief below, so read on). Based on the research above, I intend to just model for a week (parents, soft toys, book). Then I was looking for a method involving underwear, scheduled sits, and praise but no further rewards for successful toileting trips. In this situation I think of praise not as a reward, but as a celebration of reaching a mutual goal. I have found a fast approach that seems to fit all these criteria, that involves three intensive training days while naked. This approach appeals to me because it is quick and probably minimises accidents in our carpeted apartment (I’ll do the intensive toilet training elsewhere). Naked training would ensure that feedback is immediate, and simplify the skill set, such that Alex can focus on learning to recognise and hold on when necessary before learning to pull clothes on and off. The approach is outlined in an ebook: Potty train in a weekend by Your Modern Family.
Please comment on what worked and didn’t work for you.
Days 1 and 2 went really well. We camped out on Mum and Dad’s lawn with food and play supplies, from first thing in the morning to just before bedtime at night, and came home for naps (with a nappy on). Day 1 and 2 were a really positive experience for Alex because he picked up the skill quickly. He was visibly excited when we told Nona, Pa, and Dad of his accomplishments. By Day 2 all poos and the vast majority of wees were in the potty. Alex was evidently ready to learn, which made learning a positive experience. That feeling of competence is really important for motivation, so I think this “intensive” approach is only a good idea if you are sure that your child is ready. Another thing that made it a positive experience was having so many people to play with, and the fact that all those people were relaxed about accidents and shared in the excitement of accomplishments. It would have been a much more negative experience if accidents were punished either directly or indirectly by people stressed about mess.
Day 3 ended abruptly and early. My assessment is that after two full days outside, learning a new skill, in the heat, actively playing, Alex was exhausted. A wee in his new undies tipped him over the edge. We called it there, came home, and left his nappy on. After he calmed down, he came and asked to do a wee wee, which he did in the toilet. Rather than going straight to undies, Alex wears undies at home, and pull ups when we go out (we bring the porta-potty everywhere). That way we can continue to be relaxed about accidents. Accidents have been very rare since we did the training.
Would I do it this way again? I wouldn’t attempt 3-days outside – that is just too much. If I had wooden floors, I might try it at home. I think next time I will take it slower. Model, take opportunities for naked play with a potty nearby, ask frequently whether she wants to use the potty. I think in this case the intensive approach worked pretty well, but it is risky for a few reasons:
A) You are asking your child to learn a new skill very quickly. If they are not ready, inability to meet this expectation could make them feel incompetent.
B) Intensive programs come with expectations. For example I expected Alex to be wearing undies with few accidents by the end of Day 3. As a parent it is hard to prevent those expectations from translating into pressure.
C) Both feelings of incompetence, and pressure can reduce motivation (see the Self Determination Theory and related research). Without the motivation to learn, potty training is likely to become a battle.
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1. Greer, B. D. (2013). An evaluation of toilet-training procedures. (Doctoral dissertation), University of Kansas, Kansas.
2. Simon, J. L., & Thompson, R. H. (2006). The effects of undergarment type on the urinary continence of toddlers. Journal of applied behavior analysis, 39(3), 363-368.