Pediatric Urologist: “I Read 14 Potty Training Books And Found Some Really Bad Advice”

Potty struggles aren’t a behavior problem—they’re a constipation problem.

By Steve Hodges, M.D.

A mom recently emailed: “A book I’m reading says if you wait until a child is ‘ready’ to train, you could end up with a 6-year-old who requests diapers to poop. Is this true?”

In two words: heck no.

I was so intrigued by this bad advice that I bought the book, which described potty training past 30 months of age as “a chore for you and your child." Out of curiosity, I bought a couple other potty-training books. Then a few more. After reading 14 — yes 14! — books on potty training, I can say this: There is some seriously bad advice floating around — advice that will invite chronic constipation and land children in pediatric urology clinics like mine.

READ: What Preschool Potty Accidents and Teenage Bedwetting Have in Common (Spoiler Alert: Everything)

Most potty training books have one chief mission: getting your child out of diapers ASAP. The promises are enticing: Potty train in 3 days! In a weekend! In less than a day! As early as 6 months of age!

These promises are off base. I propose a far more important goal: setting your child up for a lifetime of healthy toileting habits. That's not as exciting as ditching diapers this weekend, but potty training right is more important than potty training fast.

I’ve treated thousands of children who toilet trained quickly and easily, only to develop enuresis (wetting problems), encopresis (poop accidents), and/or recurrent UTIs in grade school. That’s when the holding habits they developed as toddlers finally caught up with them. Potty training is prime time for children to become constipated, and the holding habit can become deeply ingrained, two facts unmentioned or glossed over in nearly all the books I read.

In most of my teenage bedwetting patients, their enuresis can be traced back to the potty-training years. No parent of a preschooler believes their child's toileting issues could possibly last that long, but I see it all time.

In this post, I highlight the potty-training advice I consider most harmful.

If you found this post because your child is new to toilet training and struggling, I would direct you to The Pre-M.O.P. Plan: How to Resolve Constipation in Babies and Toddlers. If you've already tried training and your child is having accidents, the M.O.P. Anthology walks parents step by step through the same treatment plan I use in my clinic to resolve bedwetting, daytime wetting, and encopresis.”

If you haven't yet started toilet training and your child has no history of constipation, I recommend Stress-Free Potty Training by Sara Au and Peter Stavinoha, Ph.D.. These authors wisely state: “Our methods are not tricks we guarantee will work in a prescribed amount of time.”

Also, Let’s Get This Potty Started! by Heather Wittenberg, Ph.D., offers sage advice, such as: “Set your expectations aside, and let your child drive the process.” Both books take constipation seriously, though they don’t offer specifics on robust treatment.

OK, on to the myths I found while binge-reading potty-training books.

Myth #1: There is a “window of opportunity for effortless potty training” between 20 and 30 months. If you miss the window, you’ll end up with a “potty refuser.”

This notion is everywhere! One author writes: “What do you suppose will happen if he decides he doesn’t want to use the potty and that the diaper is working just fine for him? . . . . It’s really hard to potty train children over three. They have free will and they know how to use it.”

This is line of thinking overlooks an important fact: When children over age 3 have difficulty training, it is not because they are “willful.” It’s because they are constipated. And when a child is constipated, toilet training is a futile, frustrating endeavor for parent and child alike.

Several authors maintain that the concept of “readiness” is bogus — that waiting for a child to be “ready” to train is responsible for the vast majority of “potty training drama.”

Again, untrue. Children who demonstrate readiness to train are far less likely to struggle than those who are less mature. “Ready” doesn’t just mean showing interest in using the toilet and noticing a wet or dirty diaper. More than anything, “ready” means being willing to interrupt activities to use the toilet.

READ: Potty Training is Not a Competitive Sport!

Most children become willing close to age 3, give or take. Sure, if you place a 1-year-old on the toilet at the right moment, she’ll pee in it. But that’s entirely different from having the judgment to promptly respond to nature’s call.

Many parents take pride when their children train early, the same way they beam when their kids talk or read before their peers. One author warns readers to “be wary of well-meaning friends who tell you that your child is too young . . . They have an emotional investment in your failure . . . You are going to have awesome bragging rights.”

But having a toilet trained toddler is nothing to brag about! It can be a disaster in the making. Toddlers simply aren’t equipped to make major life decisions on their own — and I assure you, deciding every day when (or if) to poop is a decision with consequences. The most seriously constipated among my patients are those who trained earliest and most easily. In other words, they’ve been in charge of their toileting — when to hold, when to let it out — the longest.

Myth #2: Early potty training reduces a child’s risk of having accidents and urinary tract infections.

The folks who promote myth #1 believe early training is not only easier but also healthier for children. One author writes: “There is no evidence that children trained early have any increase in the amount or frequency of accidents throughout childhood.”

False! In a study titled “The association of age of toilet training and dysfunctional voiding” and published in Global Pediatric Health, my clinic found that children under age 2 have triple the risk of becoming constipated and developing daytime wetting problems than children trained later.

Another author writes: “If your child isn’t fully trained by age 4, the likelihood of the child being a bedwetter are increased by 50%.” She completely misunderstands what it means when a 4-year-old isn't "fully trained."

READ: “Potty Regression,” “Potty Refusal,” “Not Fully Potty Trained": Why These Terms Should be Canceled

Certainly, children who have accidents at age 4 have high rates of bedwetting, but this isn't because parents initiated toilet training too late. It’s because chronic constipation made it impossible to train the child earlier. Constipation — not late training — is the direct cause of bedwetting. And none of this has to do with a lack of "training."

A common argument among early-training advocates is, “The sooner you start, the sooner your finish.” In truth, potty training doesn’t have a finish line. It’s not a skill like riding a bike, where the concept just “clicks” and your child is set forever. A child can be potty trained and develop the holding habit; it might just take a few years for the habit to start triggering accidents.

Don’t assume you’re out of the woods if you have a 2-year-old who stays dry. Rather than think in terms of finishing, stay vigilant after your child’s transition to underwear, monitoring the child for the 12 signs of constipation.

Myth #3: “Before you start for real, you must set some goals.”

Potty-training book authors are all about goals. “For example,” one writes, “you want her toilet trained by her third birthday in two months’ time. That is a lovely goal.”

Other authors recommend setting daily goals. For instance: “Goal on day 2 is to go out and come back without the child having an accident.”

Goal-setting is great if you want to, say, run a marathon or earn a promotion; it should play no role in potty training.

You can’t compel a child to poop or pee in the toilet any more than you can compel her to sleep. Micromanaging the process with goals (or rewards) can backfire in a big way. Step aside and allow your child to own this milestone, on their own timetable.

You may need to adjust your definition of “success.” One author writes: “The biggest measure of success is when your child can remain dry,” but she has it backward. If there’s any goal that matters, it’s the goal of responding to your body’s urges in a timely manner. A child can stay dry by ignoring her body’s signals — in other words by withholding pee or poop. This is not "success."

Myth #4: “It needs to be decided whether you’re going to just focus on daytime training or try to take your child out of diapers at night as well.”

One author advises that “becoming dry at night still requires a devoted effort on your part. Don’t shirk your parental responsibilities at this final hurdle!”

In reality, you have no responsibilities here. There’s no “decision” to be made. “Nighttime training” is not a thing. You simply cannot train a child to be dry overnight. It’s something that happens naturally, almost always by age 4.

READ: Nighttime Potty Training is not a Thing

Don’t withhold fluids at night, wake your child overnight to pee, force him to sleep in underwear to “feel” the wetness, or take any other measure designed to speed up overnight dryness.

If your child turns 4 and is not dry overnight, she’s probably constipated. Want to know for sure? Have your child x-rayed. (Yes, it's safe.)

Do not wait until your child is 7 to take action! I recommend treating bedwetting at age 4, ideally with an enema-based program such as the Modified O’Regan Protocol (M.O.P.).

MYTH #5: “When the child has not been successful . . . show that you are slightly disappointed.”

One author advises, “Be kind while at the same time being firm,” adding, “The child must never feel that . . . she can do whatever she wants.”

Another recommends giving “consequences” for accidents. For example, “After a few days, and when you are certain she knows the ropes, take away her toy. Whether it’s intentional rebelliousness or just being lazy, it’s still behavior.”

This guidance is alarming. Accidents have absolutely nothing to do with laziness or willful behavior, yet this damaging idea is ingrained in our culture. I wrote Bedwetting and Accidents Aren’t Your Fault, to relieve children of the shame and blame that our society heaps upon them.

READ: “Potty Refusal” or “Lying” About Accidents? It’s Physical, Not Behavioral

I cannot emphasize this enough: Never, EVER show disappointment in your child for having an accident. You can seriously sabotage toilet training, not to mention damage your child’s self-esteem, with even the most subtle suggestions of blame.

Potty training is not a time for a parent to exert control.

Myth #6: “A child cannot stay constipated forever. If you know her diet is good, at the very least you can rule out a purely physical problem.”

This is preposterous. Countless children remain constipated throughout childhood and adulthood, and a poor diet is rarely the cause. Certainly, a "good" diet is no bulwark against chronic constipation. Some of my most severely constipated patients have the most stellar eating habits.

READ: Why Is Your Child Constipated? Because We Live in the 21st Century

It’s the rare potty-training book that even mentions constipation. But even those that do tend to treat the topic as a minor, passing issue — and one that’s related entirely to diet.

Every day in my clinic I treat children who have been constipated for over a decade. Some children become constipated as infants. Many more kids become constipated while toilet training.

It is critical for parents to recognize the signs of constipation, and in this regard, most potty-training books fall short.

One author writes that “grunting, going red in the face, or hiding in a corner or behind the couch” are signs your child needs to poop. Nope: They are signs your child is constipated! (Download our free infographic, 12 Signs Your Child is Constipated, here.)

Another author, in a section about cleaning up after accidents, writes: “If you are particularly lucky, the stools will be well formed and captured in your toddler’s underpants.” Again: Nope! Well-formed stools indicate constipation. They may be easier to clean up, but they are a sign of impending trouble. As I emphasize in Jane and the Giant Poop, healthy poop looks like frozen yogurt or mushy blobs, not logs or pellets.

Yet another author, demonstrating a lack of understanding about constipation, writes, “

“For soiling, re-teach the wiping technique.”

In reality, soiled underwear and “skid marks” are signs of withholding poop, not poor wiping technique. They indicate a child is not fully emptying.

Possibly the biggest myth about potty training is that it’s a nightmare. That’s true when a child is not ready or is constipated. But a child who is mature enough to leave diapers behind, feels no pressure, and shows no signs of constipation, they can transition to underwear without any big ordeal.

If You Take Away Only Three Things:

• Potty training doesn’t cause accidents—but constipation does.

• Early training doesn’t prevent problems; it often creates them.

• When accidents persist, the answer isn’t charts, bribes, or consequences—it’s effective constipation treatment.