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  • By Steve Hodges, M.D.

Potty training during a pandemic is not a good idea!


A pandemic is an awesome time to clean out your garage (I did that!) or learn 59 ways to cook an egg (I'm too lazy). But the fact that you’re stuck at home doesn’t make it a good time to toilet train your toddler.

Yet apparently everyone’s doing it.

“The most obvious reason is, we’re all home,” one potty-training consultant told a Florida morning show. “You have the time to slow down and be consistent.”

In an article titled “Potty Training is the Latest Trend for Parents in Coronavirus Quarantine,” moms say they’re “turning lemons into lemonade.”

Yet another mom argues toilet training now could “accelerate your toddler’s potty-training trajectory.” She asks: “Why not make the most of your time and potty train?”

I’ll tell you why not: because toilet training out of convenience, rather than because your child has demonstrated the requisite maturity, can ultimately land your child in a urology clinic like mine.

I specialize in treating enuresis (bedwetting and daytime wetting) and encopresis (poop accidents), conditions directly caused by chronic constipation.

When withholding becomes a habit, as it often does in children, stool piles up, forms a hard mass, and stretches the rectum. Over time, the oversized rectum aggravates the bladder nerves, triggering the bladder to empty without notice. In encopresis cases, the rectum becomes so stretched and floppy that it loses tone and sensation. Poop just falls out.

I see 3,000 patients a year, many of them tweens and teens, and in most of these cases their troubles can be traced back to potty training.

Some kids were trained too early. Some were constipated as babies and became more severely backed up as they toilet trained. Some were super poopers as toddlers but, for myriad reasons, became super withholders upon graduating from diapers.

My patients even include children who toilet trained easily — “She practically potty trained herself” is something I often hear from parents.

How can that be? Well, toilet training is a more complex skill than it seems.

Plenty of toddlers can learn to poop on the toilet. Even some babies can. But what defines success is not the ability to avoid accidents. It’s the capacity to immediately heed the body’s urge to evacuate — in other words, to interrupt your finger painting, march yourself over to the toilet, and sit there long enough to empty fully.

Not many 2-year-olds possess the maturity to do that, which is why I recommend parents hold off training until the child is around 3.

My research has found that children trained before age 2 have triple the risk of developing chronic constipation and enuresis. This doesn’t mean any age over 24 months is fine; it means training a child younger than 2 is an especially risky pursuit.

Why Early Potty Training Often Leads to Constipation

Once children are introduced to the toilet, they make some enlightening discoveries: They can control when they poop, and they can override the urge with some timely squeezing!

Many young kids capitalize on these newfound powers and delay pooping on a regular basis. Pretty quickly, a child who was dropping cow patties every day like clockwork is straining to shove out a big, hard log a few days a week. Constipation has commenced! The habit can become deeply ingrained very quickly, and all sorts of problems ensue.

I understand why potty training during a lockdown is appealing. But think of it this way: With extra time on your hands, would you teach your 2-year-old to read? Would you teach your 5-year-old long division?

Of course not, because those skills require readiness!

Toilet training on your timeline, or the coronavirus's, rather than your child’s will at best frustrate both of you and at worst backfire big time.

When I say “backfire,” I don’t mean the episode will end with tears, a return to diapers, and a parental feeling of failure. From where I stand, that’s actually a happy ending. You may feel disappointed, but by backing down now, you’re priming your child for a lifetime of healthy pooping habits.

No, I’m referring to two more serious scenarios:

1) Your child starts to withhold, connects pooping with pain (it hurts to push out a big, hard mass of stool!), and withholds even more, setting off a vicious and miserable cycle that’s very hard to halt.

2.) Your child appears to have mastered training — Yay! No more diapers! We made lemonade out of lemons during the pandemic! — only to develop a stealth habit of withholding. A year or two later, accidents start, then escalate. At age 10, she’s still wetting the bed.

Both are scenarios I encounter every day.

Some parents who’ve attempted potty training during our pandemic have been lucky enough to encounter immediate disaster and wise enough to make a beeline back to diapers.

One mom, an ob/gyn, figured potty training would help her “take back control” of her life after the pandemic wreaked havoc on her medical practice. She gave up after a string of debacles involving bribery with chocolate chips and a trail of poop in the hallway.

“Back to diapers we went,” she wrote. “Potty training was officially over.”

Good work, Mom!

Meantime, I received an email from a mom experiencing backfire scenario #1. She wrote:

My daughter is suddenly afraid of pooping because it hurts. She tells me she has to go potty, but then she flips out and says, “No want to go potty.” Miralax has helped soften the poop but she’s still good at holding it. She has become much less active — it’s easier for her to hold it in if she’s sitting on the couch. I am afraid if I give her a diaper, I am just giving in.

Kudos to this mom for tuning into the problem, using a laxative, and noticing her daughter’s withholding powers are more formidable than that laxative.

Many parents in her situation, and indeed many physicians, might brand the child as “willful” or a “potty refuser” and plow ahead with training, attempting to counter the “refusal” with higher doses of Miralax.

I recommended a different approach: Save toilet training for another day, and treat the girl’s constipation more aggressively, combining laxatives with a daily liquid glycerin suppository, a regimen I describe in The Pre-M.O.P. Plan: How to Resolve Constipation in Babies and Toddlers and Overcome Potty Training Struggles. (Nope, fiber, hydration, probiotics, and eliminating dairy will not do the job!)

In cases like these, it’s important to delay potty training until the child’s rectum has been fully cleaned out every day for months and the child no longer shows any signs of withholding.

How will you know? Because she’ll be happily pooping a big pile of mush (no pellets or XXL logs!) in her diaper every single day, no straining or hiding.

Sadly, the mom who emailed felt that returning to diapers would be “giving in.” I don’t know whether she meant giving in to our culture’s pressure to train early or capitulating to her daughter’s strong will. Either way, potty training shouldn’t be viewed in competitive terms.

Yet so many parents feel that giving up will brand them a failure.

A mom quoted in yet another pandemic article recounts that she deemed training during the pandemic “a brilliant idea,” only to encounter relentless accidents and her son’s rejection of jelly-bean bribes.

“At times,” she wrote, “I want to give up, but now that we are a month in, what's the point?”

The point is that her child isn’t ready!

When a child is ready, toilet training is not difficult and does not require jelly beans.

But I feel for this mom, who feels pressured by her preschool’s September potty-training deadline. If she can’t find another preschool, she should at least wait to train until right before school starts.

Who knows? Maybe that’s when the pandemic’s second wave will hit, and she’ll have more time than she expected

Get Dr. Hodges' updated recommendations for treating bedwetting and accidents!

The M.O.P. Book: Anthology Edition teaches you to implement the Modified O'Regan Protocol with confidence. Get your child on the path to dryness!

Must-read books for kids by Steve Hodges, M.D.

• Bedwetting and Accidents Aren't Your Fault

• Jane and the Giant Poop

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Feel free to contact Dr. Hodges or Suzanne directly:
shodges@wakehealth.edu
suzanne@bedwettingandaccidents.com

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