Amanda Wilde (Host): Welcome to UK HealthCast, a podcast presented by UK HealthCare. In this episode, the 411 on the potty, that is we'll discuss the when, what and how-to's of potty training with our expert, Dr. LaTawnya Pleasant, pediatrician at Kentucky Children's Hospital. I'm Amanda Wilde. And Dr. Pleasant, welcome back to the podcast.

LaTawnya Pleasant, MD: Hi. Thank you for having me again.

Host: In general, when should parents begin potty training or start thinking about that?

LaTawnya Pleasant, MD: So in general, parents should consider potty training around the age of 18 to 20 months. But for every child, it varies.

Host: So, do children let us know when they are ready to be potty trained?

LaTawnya Pleasant, MD: Yes. There are several signs that your child may have and they may display to you to kind of help you know if they are ready or not. And I would love to share those with you. So, the first one that I say is that, typically, children when they are kind of reaching that period, when they may be ready for potty training, is that you may notice that they stay drier longer. So, again, this happens around 18 to 20 months, and this is when children's bladder capacity increases. So, what this simply means is that kiddos under the age of 20 months typically cannot physically hold pee in their bladder for long periods of time. But as they get older, their bladder capacity increases. So once that happens, you may notice that your kiddo may stay drier for longer periods, for instance, like 2 hours after a nap.

The second thing is that they must be able to communicate. So if your toddler can communicate that they need to go potty, then this is typically a sign that they are also ready to start. But just remember, even if they are not speaking complete complex sentences, as long as they have the ability to communicate that they feel the urges to poop or pee, then it's likely time to consider. One important thing in communication is that every child's language develops differently. So, some less verbal children may grab their diaper and that could be their method to communicate to you that they need to go to the potty.

The third thing is that they have to show interest. So typically, your toddler will want to tag along to the bathroom with you, or they may ask to start wearing underwear like you, and those are typically signs of interest.

The last couple things are that they poop at a certain time every day. And so for any of us who have children, you may notice that, after lunchtime, they may hide in the corner. And that's usually what they do when they're going to go poop. And so if you notice that, then that means that they're developing a regular rhythm to when they're going to have bowel movements.

And the last two things are when they take off their diaper. At some point, many toddlers go through a stage that they don't like dirty or wet diapers. So if your child has a distaste for having poop on them, then that is an important sign that they may be ready.

And last but not least is that your child has to have independence, and this is more so going to be physical independence. So, they have to have the capability of pulling their pants up or down or at least helping do that, so like stretchy pants or dresses and things along those lines. And they may start saying, "I can do it."

Host: So, children do develop an awareness that they have to go or that the diaper is dirty. When these things start happening, how should parents prepare for potty training?

LaTawnya Pleasant, MD: That's a great question. So, just remember that potty training can be very intense once you start the process. It can be pretty stressful too. But there is a method that I prefer and I usually recommend amongst my patients, which is called the three-day potty method. Is it a hundred percent foolproof? No, but it usually works if you try it out. So, I can explain it.

The three-day potty method is a process that your child must go without any type of diapers, pullups or even underpants for about three consistent days in the house, and that's when you unfortunately are not really able to leave your home. So, the idea is that by keeping your toddler naked from the waist down, again, no pullups, no diapers, no underpants, because you want them to learn to be more in tune for when they need to use the potty. Yes, there will be accidents, but that's the point, because you want your child to know what it's like to have icky poop running down their legs or a stream of urine flowing onto their feet.

The three key points of this process are they must be naked from the waist down. They cannot have pullups, diapers or underpants. Number two, unfortunately, you cannot leave the house, because as soon as you slip on that pullup or the diaper, your child will potty in the diaper. And the third key point is praise, praise, praise. So, you must praise them for even trying. Because making it fun is always important, but even more importantly, children love praise from their parents.

So, the process, you want to get all of your errands out of the way. A long three-day weekend is even better. And the purpose is to create consistency, because children thrive off of consistency and routines. So, what I typically say on day one, as when your child wakes up, you're going to take off their pants with their diaper pullup and have them naked from the waist down. They could wear a T-shirt or a dress in the house and you're going to tell them that we don't need to wear diapers anymore, we're going to pee-pee on the potty. And I generally say that put the potty in a place that they feel most comfortable. So, like it could even be the living room, it could be the bedroom, it could be the TV room, just as long as they are comfortable.

The next part is that you are going to monitor them throughout the day to watch for signs that they need to go potty, whether they're like grabbing their pants, or whether they are just kind of squirmish and moving around a lot. In general, this means about every one to one and a half hours, which I know sounds very intense. But if you set an alarm on your phone that can kind of alarm you that, "Hey, you know, maybe we need to try to sit on the potty." And then if they're successful and they actually pee-pee on the potty, then you make it a huge celebration. I say, make it like the Macy's Thanksgiving Day parade. You want to jump up and down and sing their praises. And then, you can even give them a reward or a toy or sticker, but just remember to praise them for even trying. If they do have an accident, you just wipe it and tell them that, "Next time we'll try to pee and poop on the potty." And you should continue this process all throughout the day.

Now, the only time that you're going to put a diaper or a pullup on them is right before nap time, because you really don't want them to pee-pee in their bed and we don't expect children to be completely potty trained at night for several years. But encourage them to use the potty before they take a nap and before they go to bed.

Host: So, that's a lot. You said it was intense. It can be frustrating, but you also talked about making it fun. So, let's talk about the biggest obstacles or challenges parents run against when it comes to potty training and how we should address those.

LaTawnya Pleasant, MD: So, one of the biggest frustrations that parents experience is that children don't like to poop in the potty. The three-day method is great for children to start to learn to hold their urine. But you will find that children develop the ability or, I guess, lack of fear of pooping in the potty a little bit later.

Another frustration that can happen is that your child may develop the ability to pee in the potty during the day, but they may still have wet pullups or diapers at night for many years after this, and that can last up to age even eight.

And the last point is that, children, if you think about it, for several months and sometimes years of their life, they've been used to pooping and peeing in their diaper, and then to ask them to sit on this porcelain toilet and poop and pee, it could be very intimidating. So, just if they have any fear or anxiety, and they seem to just be terrified by doing it, maybe step back and wait a little bit because they may just not be ready emotionally.

Host: And since we can learn from each other's mistakes, are there some most common mistakes parents make while potty training?

LaTawnya Pleasant, MD: Yes. Some of the most common mistakes are what I previously mentioned that people start the process of the three-day potty training. And then, they'll say, "Oh, I need to go do this errand" or, "Oh, I need to go do this," and they slip on the diaper or the pullup. And then, as soon as they do that, the child is going to go in the diaper. So, that's the biggest mistake. Once you start, you have to be consistent, particularly if your child is interested in doing it.

And the other biggest mistake would be pushing it and forcing your child to do it when they are not ready. Some children, they're over the age of two and that's completely okay because potty training is more so not just physical development, but also emotional development.

Host: Right. So, stay attuned to what your child's behavior is saying. What is the most important piece of advice you'd give parents when it comes to potty training?

LaTawnya Pleasant, MD: I guess my two take-home messages would be remember children learn to hold their urine or their pee first, then they learn to hold their poop. So, don't worry about nighttime dryness for several years. And then, just remember to not give up. Follow your child's cues and take one day at a time They will let you know when they are ready. And I frequently tell parents that remember Rome was not built in a day, right? So, the key is to be patient with your child as well as with yourself. Just because your friends', you know, kiddos can be potty trained by 18 months doesn't mean that your baby will. So, be patient with your child, but more importantly, be patient with yourself because you're trying as hard as you can and you just have to take one day at a time.

Host: Great information and tips on potty training. Thank you so much for setting us up for success with this developmental milestone. Really appreciate your time.

LaTawnya Pleasant, MD: Thank you. I appreciate you guys having me.

Host: You can contact the UK HealthCare General Pediatrics Program by calling 859-323-6211. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for listening to UK HealthCast, a podcast from UK HealthCare.