By Steve Hodges, M.D.
According to the Wall Street Journal, Huggies has launched a campaign to promote earlier potty training, reportedly so parents will speed up the switch to Pull-Ups, which cost twice as much as diapers.
From a medical perspective, this is a terrible idea. But from a marketing perspective, it’s genius.
In fact, this campaign will work better than Huggies ever imagined, because children trained earlier are more likely to develop enuresis (daytime pee accidents and bedwetting) and encopresis (poop accidents). And since kids who have accidents need daytime and nighttime protection, Huggies — and its parent company, Kimberley-Clark — will score big-time. More 5-year-olds will have to wear Pull-Ups to kindergarten. More 10-year-olds will wear have to wear GoodNites “youth pants.”
Meantime, kids will suffer — embarrassment, low self-esteem, discomfort, rectal damage, and all the rest.
An inconvenient fact for Huggies is that kids trained earlier are more prone to developing chronic constipation. Constipation, in turn, is the cause of virtually all bedwetting and accidents.
As I explain in detail in The M.O.P. Book, when poop piles up in the rectum, it forms a large, hard mass that presses against and aggravates the bladder. The stretched rectum may also lose tone and sensation, so kids can’t sense when they need to poop, and stool falls out without the child noticing. Holding pee exacerbates the bladder problems created by holding poop.
Children trained before age 2 have triple the risk of developing constipation and daytime wetting problems down the road, as my published research shows. This doesn’t mean training a 26-month-old is a good idea — it’s not. It just means children trained before 2 are the most likely to land in continence clinics like mine.
Of course, not every child trained early will become constipated, but children trained as toddlers are more likely to become habitual holders than children trained around age 3. In our study, 60 percent of the children trained before age 2 were shown, via X-ray, to be severely constipated.
When you encourage children to train as toddlers, even when you do so “gently,” you’re asking for trouble. Yes, toddlers are physically capable of using the toilet; problem is, they lack the judgment to respond to nature’s call in a timely manner. Toddlers tend to become so engrossed in their fort building and finger painting that they ignore their body’s signals, holding their pee or poop until they absolutely can’t.
The holding habit can become deeply ingrained in children and persist for years, even into adulthood. I treat children of all ages — 4-year-olds, tweens, teens — and my patients’ difficulties usually date back to potty training.
Constipation is already epidemic in developed countries, largely due to our highly processed diet, our rush to potty train, and misguided school bathroom policies. So Huggies is making a bad situation worse by shifting the timetable earlier.
Huggies insists the company isn’t pressuring parents. One executive told the Wall Street Journal: "We would never tell mom implicitly when to start. It's a hard journey and it's messy and time-consuming. We're trying to help educate parents on the signs of readiness to help moms get comfortable with training."
That sounds benign, but it’s not. The idea of putting a toddler in Pull-Ups to help mom (and presumably child) “get comfortable” with training is misguided. Simply switching to Pull-Ups sends a message that’s inappropriate for toddlers: I want you to try to stay dry!
In other words: I want you to hold your pee and poop.
But toddlers aren’t mature enough to receive this message. Staying dry actually is not the important thing; heeding your body’s signals — emptying promptly — is what matters. That is a more nuanced message, one more suitable for children closer to age 3.
Deciding every day when to poop and pee is a decision with consequences. The most seriously constipated among my patients are those who trained earliest. In other words, they’ve been in charge of their toileting — deciding when to hold and when to let it out — the longest. Often it takes 2 or 3 years for the holding habit to catch up to these kids, and that’s when they land in my clinic.
Huggies’ entire potty-training campaign — “Diapers are for babies. Pull-Ups are for big kids” — has an underlying message that pressures children, subtly shaming “big kids” who might not be ready to use the toilet.
Huggies’ own website describes Pull-Ups as a “symbol to your child that it’s time to potty like a big kid.”
For an insightful explanation of why this message is so damaging, read Chapter 2, titled “Who’s My Big Boy?” of ParentSpeak, a new book by child advocate Jennifer Lehr. Lehr, reflecting on how she nudged her daughter to use the “big girl potty” too soon, writes: “It’s easy to cave to the pressure to do what everyone else seems to be doing.”
It’s especially easy to cave when a corporate giant like Huggies, with 53% of the market, has made a strategic decision to apply pressure.
Geez, parents today are under enough pressure to train their children early! Celebrities get fawning press for putting their 4-month-olds on the toilet. And countless preschools require 3-year-olds to be potty trained, a mandate that prompts stressed-out parents to start training their children far earlier so they’ll be potty pros by September.
But these mandates often backfire, and schools end up blaming parents and children for accidents. I routinely write letters to school directors and principals in support of children who have been threatened with suspension or expulsion for having accidents at school. But the reason these kids have accidents is that schools pushed them to train before they were ready!
Huggies insists they’re just trying to help families ease a “hard journey” that is “messy and time-consuming.” But they have it backward. Potty training is a hard journey only when children train before they are ready.
In fact, one of the signs of constipation is difficulty toilet training. (Download our 12 Signs a Child is Constipated infographic.) A child who is truly ready to train, feels no pressure, and shows no signs of constipation can transition to underwear quickly, often within a week or two.
What does “ready” mean? My definition is different from Huggies’. I advise potty training only when a child:
• Can dress and undress without help.
• Shows interest in using the toilet.
• Notices when she has a wet or dirty diaper.
• Tells you when she needs to pee or poop.
• Is willing to interrupt activities to use the toilet.
Willingness to interrupt activities is the most important. You may not know whether your child is willing until you start training. If you start and discover your child seems too preoccupied, back off and return to diapers.
Huggies would have you believe switching back is harmful to your child. Its website states: “Going back and forth from diapers to training pants can lead to confusion, and consistently putting them in Pull-Ups will help make his potty training journey a more successful one.”
This is a totally unfounded claim. What makes the potty-training journey successful is a child’s maturity, not the design of the child’s undergarments.
Your child must be the CEO of the potty-training enterprise; you’re just the support staff. It should be your child — not you, not Huggies’ brand managers — who decides when to leave diapers behind.
The stakes are higher than most adults realize. Not only do many kids suffer from the embarrassment and discomfort of accidents, but many of them are shamed or even physically abused by frustrated or enraged parents. Many of my patients are labeled as “lazy” or “behavior problems” by their parents or school staff who simply cannot believe a 9-year-old could pee or poop in their pants. (I heard this so many times that I was finally prompted to write Bedwetting and Accidents Aren't Your Fault.)
“Failed toilet training” is one of the leading triggers of child abuse, according to the Child Abuse Prevention Center. Every week brings more news reports of children injured or killed by parents out of frustration over toilet training. Typically the reason toilet training “failed” is that the children were trained too early.
I am a fan of products like Pull-Ups and Pampers’ Easy-Ups. I wish more preschools would allow kids to wear them to school, to ease the pressure on kids who are mandated to stay dry. But I don’t think Huggies’ brand managers should be telling parents, as the Wall Street Journal report, “Hey, we want children to start training earlier.”
Our culture needs to temper our expectations of toddlers and delay toilet training, not speed it up for the sake of selling more expensive products.