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Between the ages of two and three, most children do move out of nappies, but for some children, their parents and practitioners, it is not a smooth process. Over the past few years, there have also been some concerns that children are not out of nappies early enough, with some schools reporting that children are still in nappies when they arrive in reception. So what are the signs that children are ready to move out of nappies and how best should this process be managed?
A good starting point is to understand that there needs to be a joint collaboration with parents about how and when toilet training is to take place. Working together throughout the process means that it is likely to run more smoothly and the enemy of toilet training, stress, can be avoided.
In terms of the pressure to start before a child is really ready, it is worth recognising that for some cultures, putting a baby on a pot at a few weeks old is the norm and so being expected to wait for what must seem ages might be problematic. Then in these straitened economic times there is the cost of nappies, which can take a chunk out of a family budget. Then there are parents who feel under pressure because their friends' children are toilet trained.
Equally, there are reasons why some parents may wish to leave toilet training for longer. Some parents enjoy their last 'baby' and may want to hold onto this stage for longer. For others it may be the practical aspects, such as needing to also care for another member of the family or a family holiday that simply means it is not a good time.
TIMING
The key message about toilet training is that there is no set age by which children will move out of nappies. Incredibly, there are some children who are out of nappies as early as 11 months, while at the other end of the spectrum some children will be nearing their fourth birthday. This wide range means that it is important not to let parents think that their child is 'bound' to be out of nappies by a certain age. Instead, the focus needs to be on identifying when children are most likely to be ready.
PREPARATION PAYS OFF
There are some things that we and parents can do to prepare children from the move out of nappies. These are things that help children become more aware of their bodily functions. This includes changing children's nappies promptly when soiled or wet and telling children that we will make them clean again. We also need to agree with parents the language that is to be used to talk about going to the toilet, for example, 'wee' or 'poo'.We should look for those moments when children stop dead in their tracks because they are urinating and explain to children what is happening, 'I think that you might be having a wee now. When you've finished, we'll get you clean.'
Parents can also encourage their child to sit on the toilet or potty just before their child takes a shower or bath. The sound of running water seems to help even young toddlers pass urine, albeit it fairly involuntarily.
By doing this regularly, children can practise urinating without a nappy. It is, however, worth making the point to parents that just because their child can do this at bath time, it does not mean that the child is otherwise ready.
Finally, there is the issue of the nappy itself. There is some speculation that modern nappies do not provide an incentive for children to become clean and dry because they are not experiencing wetness. It can, therefore, be an idea in the run-up to toilet training to occasionally put on some inferior nappies so that children can feel 'wet' and so become more aware. If this approach is taken, children must be changed promptly to prevent nappy rash.
READY TO MAKE THE MOVE
Timing is everything when it comes to toilet training. As well as having some awareness of bodily functions, children's bladders have to be sufficiently mature. This means that they should be able to stay dry for some time - at least 90 minutes.If children's bladders are not mature, the project is doomed to failure. There is a practical aspect to this too, because who wants to have to keep taking a child to the toilet every half an hour on a shopping trip or some similar excursion?
A good way of telling whether or not the child is ready is to see if after a sleep the nappy is dry and, if not, monitoring the state of a child's nappy. It is also helpful if the child has sufficient communication skills to express that they want the toilet through words, signs or pointing to a picture.
Once this is in place, it is worth discussing with parents the timing of when to start. Ideally, this should happen soon after a child is showing the signs - sometimes the moment can be lost as children become aware of their functions but become used to staying in a nappy.
Sharing books with children about potty training and also letting children sit on a potty can be a good way of introducing the idea.
FIRST DAYS
When the day comes to try the move out of nappies, it is worth taking a low-key approach. Too much stress causes problems and makes children resistant. A good idea is to put a pair of pants on the child rather than a nappy and suggest they could use the potty or toilet today.While many children start with the potty, some children want to use the toilet. Once the child knows where the potty or toilet is, it is worth taking a back seat and asking the child after an hour or so if their 'wee is ready to come out yet'. In my opinion, it is not useful to constantly remind children as otherwise they may not learn to register the signals that the bladder is full.
Making children sit down when they do not want to or standing over children is to be avoided at all costs. This is because in order to release urine, the bladder has to relax and this is not likely to occur when children are feeling stressed.
After the first couple of days, some evaluation needs to take place as to whether or not to continue. This is because once a child is in pants, they may not want to return to wearing nappies, especially if they have been told that nappies are only for babies. While it is not necessarily a problem if the child has not managed to get 'one in' the potty, there is little point in continuing if the child has not shown any awareness at all. Moving towards the potty or toilet but not being in time, on the other hand, would suggest that the child will crack it with practice.
DEALING WITH SUCCESS AND FAILURE
It is important for children to feel successful and so commenting that a child has stayed dry for some time is a good idea as well as praising success in the actual potty. However, in the early days, over-rewarding children can actually cause problems.If they have an accident, they become upset because they will have missed out on a treat or sticker and so, for this reason, I am not a fan of the star chart for early potty training. A smile and a word of encouragement is usually all that is needed.
The same low-key approach is also needed when it comes to accidents. It is important to empower children by involving them in the changing process so that they are not being passive.
It is also a good idea to reassure children that it is common to have accidents at first. If a child is losing confidence, it might also be worth asking if they would like a reminder - this again means that the child is taking some control over the process.
TECHNICAL HITCHES
It would be unfair to suggest that toilet training is plain sailing, so here are some of the common problems.Children who were clean and dry before but are now having accidents
If children are feeling tired or poorly, this can sometimes cause them to have accidents. However, it is always worth checking whether a child who was fine has a urinary infection.
In addition, it is not uncommon for children to forget to go to the toilet once they become more relaxed, especially when absorbed in play.
It is important that these setbacks are seen as just that and, again, that children are told that this is part of the process.
Children who are ready but are not interested
Some children have the control but are not interested in being clean and dry. These are often older children who may have become used to being in nappies. For these children, reward charts and stickers do seem to work well.
Children need the toilet but want their nappies back on
This usually happens when children have become stressed by the process. If this happens right at the start, abandon toilet training and return to it when things are calmer.
For children who are nearly there or who only do this when they need to open their bowels, consider putting on the nappy loosely before graduating to putting the nappy over the potty and not on the child.
Finding a compromise strategy is important because of the danger of constipation or urinary infections.
Parents who say that their child is toilet trained, but in the setting the child is having constant accidents
It is worth checking how many reminders are provided at home. Sometimes, children have not learnt to recognise the signs of having a full bladder because adults are reminding them every 20 minutes or so.
If this is the case, the next piece of learning is for the child to experience a full bladder so that they can recognise the signs for themselves.
MORE INFORMATION
Picture books- I Want My Potty! by Tony Ross. Part of Ross's little princess series, in which HRH thinks (initially, at least) that nappies are 'YUUECH!', but potties are even worse.
- Nappy Duck and Potty Piggy by Bernette Ford and Sam Williams. Part of a lovely 'transitions' series from Boxer Books featuring these little animal friends. Duck wants to play but Pig is on the potty. How can Duck become 'grown up' too?
- On My Potty by Leslie Patricelli. Follows one baby's thoughts and hilarious actions as they learn to use the potty for the very first time.
- Trends - more children are starting school without being properly toilet trained. Are parents' attitudes too relaxed? www.nurseryworld.co.uk/article/1052446
- Essential information - a parent's guide to potty training, www.nurseryworld.co.uk/article/726116
- Child behaviour - what to do when a child holds off going to the toilet, www.nurseryworld.co.uk/article/855662
- First-hand experience - a parent wants to start potty training her two-year-old, www.nurseryworld.co.uk/article/881536
OBSERVATION MATTERS
- Is the child dry for periods of time?
- Does the child show an awareness of urinating?
- Does the child have the physical skills to remove clothing?
- Can the child communicate sufficiently?
- Is the child interested in either trying out the toilet or sitting on the potty?
SKILLS FOR PRACTICE
- Make sure that there are books about toilet training to introduce the concept to children.
- Provide information for parents from reputable sources, such as www.eric.org.uk www.nhs.uk.
- Work with parents to help children prepare for toilet training - for example, choosing a potty and reading stories.
- Change nappies promptly and talk to children about being clean.
- Gather some attractive spare clothes for children to change into in case of accidents.
- Consider how best to ensure that toilet training is a stress-free process for children.
- Make sure that potties and toilets are kept clean and attractive.