Infant and toddler health

Potty training is a big step for kids and their parents. The secret to success? Timing, patience and your guidance.

The first step is to get your child ready for potty training. You'll teach your child the basics about concepts such as toilets and passing urine and stool. The second step is to show your child how to use a potty chair. This takes plenty of practice, and you'll want to be kind and encouraging to your child throughout.

Here's what you need to know to get started.

Getting your child ready to potty train

You can teach your child some bathroom basics months before you start the actual potty training. These lessons help your child get ready to potty train. The American Academy of Pediatrics recommends the following timeline of steps to take.

By the time your child is 18 months old:

• Use and explain basic bathroom words. Start teaching your child simple words like "pee," "poop" and "potty." Say these words often. You can tell your child that every person pees and poops. You also can explain that pee and poop are like garbage that the body makes. But don't use words such as dirty or yucky when you talk about stool.
• Point out when your child needs to go to the bathroom. Some clues that your child needs to pass urine or stool include pacing, dancing, crossing the legs and tugging at clothes. When you see one of these clues, tell your child what it means. You could say that "poop is ready to come out" or "it's time to pee."
• Ask your child to come to you for diaper changes. Teach your child to let you know when your child soils a diaper. Try to make diaper changes pleasant too. Don't show any frustration or anger. Never yell at, scold or punish your child for soiling a diaper or urinating during a diaper change.

By the time your child is 21 months old:

• Explain what the toilet is used for. Can your child walk to and sit on a toilet?
• Point out other toilets. If you pass by toilets in a friend's home or a store, mention the toilets to your child. This helps your child remember what they are.

After your child understands what the toilet is used for:

• Teach what a potty chair is. Tell your child that the potty chair is like a small toilet for children.
• Prepare the potty chair. You don't need to put the potty chair in the bathroom right away. At first, place it wherever your child spends the most time. Let your child play with the chair for a few days. You could even put your child's name or picture on it.
• Show examples of toilet use. Can your child walk to and sit on a toilet?
• Teach not to sit on the potty chair in a diaper. Can your child walk to and sit on a toilet?
• Use make-believe. Ask your child to pretend to potty train a toy such as a stuffed animal or a doll.

If you answered mostly yes, your child might be ready. If you answered mostly no, you might want to wait — especially if your child is about to face a major change, such as a move or the arrival of a new sibling.

Your readiness is important, too. Let your child's motivation, instead of your eagerness, lead the process. Try not to equate potty training success or difficulty with your child's intelligence or stubbornness. Also, keep in mind that accidents are inevitable and punishment has no role in the process. Plan toilet training for when you or a caregiver can devote the time and energy to be consistent on a daily basis for a few months.

Is your child ready?

Potty training success hinges on various milestones rather than age. These milestones include how your child moves, acts, talks and controls the urge to urinate or pass stool.

Certain clues can help you figure out whether your child is ready to start potty training. Ask yourself if your child:

• Signals a need to use the bathroom, such as hopping up and down or tugging the pants.
• Can walk to the toilet and sit on the potty chair.
• Can pull clothes up and down.
• Can wait two or more hours at a time before urinating.
• Passes stool three or fewer times a day.
• Comes to you when a diaper needs to be changed.
• Knows that the toilet and potty chair are used for passing urine and stool.
• Enjoys sitting on the potty chair.
• Usually follows your directions.
• Can ask questions with one word: Here? Where? Now? What? When? How?

If your child does most of these things, your child might be ready. If you answered mostly no, you might want to wait. Waiting makes sense especially if your child is about to face a major change. For instance, your family may be in the middle of moving or getting ready for the birth of another child.

Your readiness is important too. Let your child's motivation and skills lead the process rather than your eagerness. Try not to equate potty training success with your child's intelligence or equate potty training trouble with stubbornness.

Ready, set, go!

Plan potty training for when you or a caregiver can devote the time and energy to it. It's ideal to do potty training on a daily basis for at least three months. And keep in mind that your child will wet or soil diapers by accident along the way. Stay calm when accidents happen. Don't get angry or punish your child.

When it's time to start potty training do practice runs to the potty chair.

Practice runs are when you lead your child to the bathroom and seat your child on the potty chair with diaper off. Do a practice run when your child shows signs of needing to pass urine or stool. Your child might make a certain face, hold the genital area or pull at the pants. Pacing, squatting, grunting or dancing in place also can be clues of needing to use the potty.

Help your child become familiar with these signals. For instance, you could say, "I know that means you need to use the potty." Then act fast. Stop what your child is doing and take your child to the bathroom. Praise your child for telling you about the need to go, rather than praising the actual urination or passing of stool. Keep your child in loose clothing that's easy to pull down or up.

You also can schedule potty breaks if needed.

If your child doesn't show signs of needing to use the bathroom, do practice runs every two hours. Also schedule practice runs first thing in the morning and right after naps.

Make potty breaks comfortable. Limit the time on the potty chair to five minutes. Let your child get up during this time if your child wants to. Even if your child simply sits there without passing urine or stool, offer praise for trying. Be sure not to flush the toilet while your child sits on the potty chair. Your child might get scared.

Also keep in mind that for boys, it's often best to master urination sitting down. Move to standing up after training to pass stool is complete.

After a month or two of practice runs, your child may start using the bathroom without your prompting. Once that happens a few times, you can do fewer practice runs. Over time, lead your child to the bathroom only when your child ignores a clear signal of needing to use the toilet.

Once your child no longer needs regular practice runs, you can explain hygiene and ditch the diapers.

Explain hygiene

Teach girls to spread their legs and wipe carefully from front to back. This helps prevent bringing germs from the rectum to the vagina or bladder. Also make sure your child washes hands afterward.

Ditch the diapers

Try to stop using diapers after a couple of weeks of successful potty breaks and staying dry during the day. You can start dressing your child in training pants or pull-on diapers instead.

After your child urinates into the potty without your prompting for a full day, you can then switch to regular underwear.

Once your child wears underwear, use diapers or pull-on diapers only during sleep and long trips away from home. Let your child chose underwear to buy.

Take breaks and be supportive

Let your child go back to wearing diapers if your child isn't able to stay dry. Also, try to encourage your child to use the potty chair more. Think about using a sticker or star chart along with rewards such as playtime or reading a book together.

When your child masters using the potty chair, you can slowly phase out the chair. For instance, you could have your child use the regular toilet with an over-the-toilet seat and step stool.

If your child resists using the potty chair or struggles to learn to use it for weeks, take a break. Chances are your child isn't ready yet. Pushing your child when your child isn't ready can lead to a frustrating power struggle. Try again in a few weeks or months. In the meantime, keep talking with your child about toilet training. It may help for you to read books or watch videos on the topic.

Nighttime training

Training through nap time and nighttime usually takes longer to achieve. Most children can stay dry at night between ages 5 and 7. In the meantime, use disposable training pants and mattress covers when your child sleeps.

Accidents will happen

To handle accidents, stay calm and be prepared.

Calmly change your child into a dry diaper or training pants. Don't get angry, shame your child or use punishments such as making your child wear a dirty diaper. Use kind, gentle encouragement instead.

For instance, you could say, "I know you'll get better at going to the potty." Rarely, it's OK to gently tell your child that you don't approve. For example, you could say, "Big kids don't like pee in their pants."

Keep a change of underwear and clothing handy, especially at school or in child care.

When to seek help

Talk with your child's healthcare professional if your child:

• Is older than 2 1/2 years old and has no interest in toilet training.
• Is older than 3 years old and isn't toilet trained during the daytime.
• Refuses to sit on the potty chair or toilet.
• Holds back stool.

Your child's healthcare professional can give you advice on what to do next. The healthcare professional also can check to see if a health condition is causing your child's trouble with potty training.