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Tara Neumayr, MD (Guest):  Hi, I’m Dr. Tara Neumayr. I’m a Washington University St. Louis Children’s Hospital Pediatric Critical Care Physician and Pediatric Nephrologist and I’m also a MomDoc.

Melanie Cole (Host):  Heh, this is MomDocs, the podcast from St. Louis Children’s Hospital. I’m Melanie Cole. And today, we’re talking about potty training. Dr. Neumayr I’m so glad to have you join us today. Let’s just start with the best time to start potty training. How do parents know?

Dr. Neumayr:  Thank you for having me. I think that’s the biggest question people have to start off with. They want to know how do I know my child is ready. And there’s a couple of ways that people have talked about being able to figure this out. Most of the time, the first sign that your child is maybe thinking about potty training, is that they take a big interest in the potty in general. Maybe they follow you into the bathroom. Maybe they talk about the toilet paper or the wiping or the act of going. Maybe they just ask you about the potty or want to help you flush. That’s usually the first sign.

Next, they might start telling you when they think their diaper needs a change. They might tell you that they are wet, or they might fuss more than they usually do when they are wet. And after that, they might start thinking it’s a good idea to try to sit on the potty. The pace at which those things happens, varies between children. And it doesn’t necessarily have to follow that exact order. But that’s kind of the general pattern that starts to signal some readiness to start talking about potty training.

Host:  So, as we’re talking about how long it might take, do boys and girls respond differently Dr. Neumayr? How do we teach boys to pee standing up and aim correctly. It would seem to be harder than teaching a girl.

Dr. Neumayr:  It does seem to be harder. Most boys like to start by sitting down because they are not trying to then to learn two skills for the two different eliminations. Then there are a number of people who have advocated different modes of having them sit on the potty. So, some people have advocated having them sit facing backwards and some people have advocated just having them sit the usual way. My own son, likes to sit the usual way. We talk to him about the importance of aiming which in fact, most little boys enjoy aiming things. And it went pretty smoothly from that standpoint. He understood that the target was to get it in the toilet.

A lot of people have advocated other modes of inspiring your boy to want to keep the pee in the toilet. They’ve talked about letting cheerios float in the toilet and then the little boy can aim at the cheerios and try to sink the cheerios. I didn’t personally try that. But people have told me it works. In general, I think the idea is to set up for both boys and girls what your cultural expectations are surrounding potty training. And one of the things to talk to them about is this is so we don’t get messy and we don’t need to do more cleaning up. And if you have them help you with clean up activities when messes are made, they’ll understand that they would rather go and play than do more clean up. And so, involving them in sort of all aspects of the process will help them understand that the goal is to keep it in the potty and make it a pretty efficient process.

Boys and girls are reported to have different sort of paces and levels of interest. A lot of people will tell you that girls want to potty train earlier and boys are just happy to wait and do it a little bit later. But I think that’s really variable in between children and it’s not particularly concerning if your daughter were to potty train at the same time as the boys in her class or if your son wanted to potty train relatively early. It’s really very individual.

Host:  Well Doctor, since we’ve heard that potty training can be not traumatic, but you know, cause therapy down the line; how do we know when to back off if our kids really don’t want to do it or they’ve told us they want to and then they decide that it’s too scary and too easy the other way. How do we know when to back off?

Dr. Neumayr:  That’s a very, very common scenario. When you think about it, there are some things about learning to use the potty that are sort of scary or sort of surprising. So, for a small child, when they first learn to defecate or to go poop on the potty, one of the things that tends to surprise them is if something plops down and the water splashes back up and they don’t tend to like that. And that might be something that they express some discomfort about or fear about and reassurance is a good idea at that time. If they then go through a period of time where they really don’t want to try again, my advice is don’t push it. When you think about the timing in which they absolutely need to be potty trained; it’s about the time that they’re about ready to go to school. I actually don’t know of any kids and then we are talking about sort of neurotypical development kids, but I don’t know of any who waited anywhere near that long to become fully potty trained.

And so, if you let them go at their own pace and have times where they are sort of more interested and then they kind of back off on their interest and then they get interested again. I think that that’s actually pretty manageable and it’s when you start getting into fights with your children over using the potty that you are kind of setting yourself up for more struggles down the road. the things that you really want to avoid in terms of the negativity surrounding potty training is teaching them to hold it too long, particularly when you are talking about going poop. Because that can set them up for long term problems with constipation, with even urinary tract infections and having more accidents down the line. So, you really want to be as positive as possible to avoid those problems down the line and just keep in mind that even if it takes the better part of several months, every child eventually gets there. And the less traumatic the better.

Host:  Well Doctor, as we’re making the switch from diapers to training pants even to underwear; how often are we supposed to ask our child if they have to go the bathroom? I mean typically for a child, do they have to pee every hour, every couple of hours and then, when you’re answering that please tell us about accidents and how we have to be patient but how can we encourage them to make it to the bathroom as we’re asking them how many times a day do you have to go to the bathroom?

Dr. Neumayr:  So, for most children, during the day, they should be offered a chance to go to the bathroom every couple of hours. However, there are also some sort of prime times that most people will think about using the toilet even if it’s not in that sort of it’s been two hours timeframe. So, for most children, you might want to start by letting them sit on the potty when they wake up in the morning, particularly if they have woken up dry. Go ahead and put them right on the potty because the likelihood of success is really high. You might want to put them on the potty ten or fifteen minutes after they have had something to eat. And then right before bedtime. Those are all good times to sort of think of as offering the potty during the day and then if they are really interested and really moving forward with potty training, also thinking about offering it every couple of hours to avoid accidents.

Accidents are inevitable when you are first starting. And the big keys to that are to be as matter of fact about it as possible. And you say, oh everybody is just learning, that’s okay. We’ll clean it right up and we’ll do better the next time. And then you maybe give them hints about did you maybe feel how you needed to go and you maybe waited a little bit and if they are able to verbalize that they waited a little while, then you say okay well next time, let’s do it when we feel it at first instead of waiting longer and then maybe we won’t have an accident.

So, giving them little tips and pointers in a nonjudgmental, nonangry way will really help them see that this is just a learning process, and everybody goes through that learning process. You also have to have some backup plans in place. So, let’s say the accident happens when you are out at the store or you’re at an event. You have to be carrying along those extra clothes and be as matter of fact about that as possible. I like these little baggies that they make for people’s wet swimsuits. Just stick one of those in your bag and then if you have an accident you throw the clothes in there, put on the clean ones and then off you go without having to deal with where do you put these clothes that had the accident. So, there’s a lot of sort of matter of fact things to think about in terms of it’s important not to make it a big deal and big failure. And to be as matter of fact about it as possible.

Host:  Well that is absolutely great advice. And before we wrap up, what about night times? So, we can get through the day, we pay attention, we’re patient, we’re encouraging. Night time is a different deal because they are sleeping and getting up in the middle of the night. Give us some tips for night time potty training.

Dr. Neumayr:  Sure. So, it’s important to remember that most children stay dry at night at a later time than they stay dry during the day. And of course, that’s because they are sleeping deeply at night and they not feel the urge to go when they need to go. So, it’s okay if they wear nighttime pullups or something like that for a longer period of time. And eventually, most kids will get to the point where they’ll tell you I don’t really want to wear that anymore. And that’s the time to switch them into their underpants at night. They may still have some accidents at night too. Again, be really matter of fact, talking about that’s okay, everybody’s learning, you’ll get there eventually, and it will be okay.

The other thing to remember if you are doing nighttime potty training is to not load them up with drinks before they go to bed. So, a couple of hours before bedtime, definitely eliminate things like juice and then keep their amounts of water or milk before bedtime relatively small. So, maybe a half a cup instead of a full cup or something like that before they go to bed.

Host:  That’s really important for parents to know is about the liquids that you do at bedtime. Wrap it up for us, best advice on potty training Doctor and what you tell parents al the time about this.

Dr. Neumayr:  My best advice is pay attention to your child’s cues. They will tell you when they’re ready and if you wait long enough for them to be ready, it’ll go faster than you can imagine. So, most parents when they look back at potty training will say, oh, one day they were in diapers and the next day it seemed like they were just all potty trained and we were fine. And that’s because they waited until their child was truly ready. Wait for your child. Make sure that you are on their timeline instead of your own and it will all go just fine.

Host:  Absolutely great information. Thank you so much Dr. Neumayr for joining us today. That concludes another episode of MomDocs with St. Louis Children’s Hospital. You can find lots of potty training advice and articles on the MomDocs website at www.childrensmd.org. Please remember to subscribe, rate and review this podcast and all the other St. Louis Children’s MomDocs podcasts. Share this show with other new parents that you know because it’s great information and we’re getting it from the MomDoc experts at St. Louis Children’s Hospital. I’m Melanie Cole.