Our son Max is 3. He has been toilet trained for months. He uses the potty or the toilet at home and at preschool with hardly any help. But anywhere else he almost always wets his pants. We try to remind him, but we can’t go on every play date or watch him every minute. Should we tell him he can’t wear underwear if he’s going to be wet all the time?
“Is your child toilet trained yet?” may seem like a question that can be answered “yes” or “no.” However, the answer depends in part on how you define the phrase “toilet trained.” To some parents, a child is toilet trained when he can wear underpants and stay dry and accident free throughout the day with help and supervision from an adult. He is cooperative, but still needs reminders and encouragement from his parents and some assistance with clothing or cleaning up. To other parents, a child is toilet trained when he is able to independently remember to use the toilet, rarely needs prompting and can take care of himself in the bathroom without assistance. One way to describe the child who still needs help is to call him “half trained.”
There are some things that parents can do to help their child move from being half trained to using the toilet independently. During the first stage of toilet training, it helps parents if you dress your child in elastic waist pants or other types of easy to remove clothing. If a child needs to struggle with buttons, zippers, tights or overalls before or after going to the bathroom, the effort may discourage him from taking a break from play. If he waits until he has no choice, he may wind up having an accident.
When parents notice wet pants in a child who is often able to stay dry, the degree of wetness will offer a clue to what may be the problem. If your child is soaked or if he has a complete bowel movement in his pants, it is likely that he was not motivated enough to stop his activity to go to the bathroom. However, if his pants are simply damp or the bowel movement is very small, it is likely that he did notice the feeling but was trying to hold on. The smaller accident is from letting go slightly to relieve pressure.
Another common pattern among half-trained children is that they are able to get to the bathroom easily at home or in familiar places, but frequently soak or soil their underpants when they are away from home. This may be what you are noticing with Max. He is mature enough to master the physical control necessary to use the toilet and stay dry, but he’s not old enough to be psychologically in control as well. When he is in a familiar place, he can take himself to the bathroom, perhaps with a reminder or perhaps without any help at all. Away from home, he has accidents because he has many new experiences to distract him, and he is not paying attention to the signals from his body that say, “Time to go.” It’s not necessarily a lack of motivation, and it’s certainly not “laziness” as some parents think. It is simply that when you are very young, it is difficult to pay attention to many things at the same time!
Since you notice that Max has accidents when he is out but not at home, you may want to think about limiting the number of away-from-home events and excursions for now. A common reason for delayed toilet training is that children need more time to be at home. When you are out and about, you are probably providing stimulating and interesting activities for Max. Those activities are a distraction from the quieter, familiar environment of home. Guess which environment makes it easier for a child to practice using the toilet? I have sometimes advised families to take a month off from extracurricular activity so that their not-yet-trained child can practice at home. Consistency without pressure is often the best plan.
If you don’t want to cut out all of your extra activities you can tell Max until he is older, you want him to wear diapers or pull-ups when you are out. Tell him that even if he is in diapers, he can still use the bathroom if he wants to. When you go to unfamiliar places, find the bathroom when you arrive. Offer him a chance to use it then and after an hour or two. If he has not used the bathroom before it is time to leave, you can suggest that he try then. Learning a new routine of trying to go before you “have” to go can be helpful. If Max is visiting somewhere without you, make sure that before you leave, someone has shown him where the bathroom is and that he feels comfortable using it. Don’t assume that grandparents or parents of other children will remind him or help him unless you ask them to do so. Most people simply do not think about a young child’s bathroom needs unless the child is their own.
When Max forgets to go to the bathroom, whether he is at home or away from home, it is unlikely to be because of carelessness. Although he may want to use the potty, he is also busy learning and doing many other things that are
very important to him. He will need time to get from being half trained to being fully trained, but with patience — mostly yours — he will get there.
Meg Zweiback, RN, MPH, is a certified pediatric nurse practitioner and family consultant in Oakland. She is an associate clinical professor of nursing at University of California, San Francisco and posts articles and other resources on her Web site, bringingupkids.com. To possibly have your question included, please send your questions to firstname.lastname@example.org - See more at: http://www.bayareahealthykids.com/bay-area-healthy-kids/category/meg-zweiback#sthash.CtWEuQyF.dpuf