By Steve Hodges, M.D.
The other day I read an article in Yahoo!Sports headlined “Mom reveals how she potty-trained her baby at 3 months old.”
My first thought was: What the heck is this article doing in the sports section?
My second thought was: Makes sense.
After all, our culture treats potty training as a competitive sport — specifically, a competition among parents.
On social media, moms achieve celebrity status for potty training their children at an early age — 18 months, 8 months, 8 weeks. I’ve read countless articles like the one in Yahoo!Sports, affording breathless coverage to the performances of both mom and baby.
The Yahoo story even offers a play-by-play of the 26-year-old mom’s TikTok video. “In the final shot,” the article says, “the mom and daughter sit on a full-sized toilet. [The daughter] stares off into the distance as [Mom] looks down adoringly at her daughter.”
What’s wrong with all this?
First off, the praise heaped on moms who toilet train their children early suggests these folks are somehow more caring than the moms who wrap their children’s bottoms in diapers.
The 26-year-old mom says as much herself, insisting her daughter is “so much more content and happier” than other babies because she’s not “sitting around in poop,” screaming and crying.
Second, articles like these imply that babies who can pee and poop on the toilet before they can walk or talk are prodigies and particularly worthy of praise and awe.
“The 26-year-old hailed the breakthrough as a 'miracle',” one article reports. The story was picked up by new fewer than 20 media outlets, according to my Google alert!
Third, there’s the implication that, hey, if someone’s 3-month-old can use the toilet, then surely anyone’s 2-year-old can do so. The bar is set higher for everyone else.
All these implications put undue pressure on parents, often leading to feelings of frustration, failure, and guilt when things unravel months or years later.
But from my perspective as a pediatric urologist, the most damaging inference is that toilet training a baby is a risk-free proposition — simply a personal choice with no potential downside.
In fact, toilet training a baby or young toddler, whether using the elimination communication method or another approach, can be a precarious endeavor. Parents should know of the risks.
My research shows children toilet trained before age 2 face triple the odds of developing chronic constipation and daytime enuresis (wetting) than children who train later.
In addition, my 15 years of medical practice tells me the consequences of early toilet training, for parents and child alike, can be devastating and long-lasting.
“I started training my youngest at just couple months old and thought she was potty trained for number 2 by 5 months old — and here we are at age 6 and still dealing with wetting day and night,” one mom in our private Facebook support group posted.
This doesn’t mean every child trained as a baby or toddler will develop constipation or have accidents. Some kids end up fine. This same mom says her first child trained at 15 months and never developed problems.
But in a significant number of kids, early training leads to bowel and bladder difficulties that are fixable but challenging to overcome, usually requiring a regimen of enemas and laxatives. This fact never gets mentioned in articles titled “I skipped the potty and toilet trained my baby at just eight weeks old.”
Certainly, many babies and toddlers can be taught to pee and poop on the toilet — social media is packed with video evidence! But this is not the same thing as possessing the judgment to heed your body’s signals in a timely manner.
What matters most is the child’s ability to use the toilet when the urge strikes — not 3 hours or 13 hours later.
Many children simply don’t develop that kind of judgment until around age 3. Expecting them to have this wisdom earlier can backfire, setting in motion events that are not recognized until much later.
The other day a mom emailed me “out of desperation” because her 4-year-old, whom she had tried to toilet train at age 2, still “refuses” to sit on the toilet. She said he has “full blown meltdowns,” and when she takes away his diapers, “he withholds urine ALL DAY — I’m talking 12-13 hours.”
“As a parent, I feel like I’m failing,” she wrote.
I understand why she has that feeling.
Like many parents, this mom got the impression that age 2 was the “right” age to start training her son. She didn’t know that children trained before they are ready often develop a deeply ingrained habit of holding pee and poop. And this, in turn, can lead to chronic constipation, urinary frequency, urinary urgency, encopresis, enuresis, and/or chronic urinary tract infections (UTIs).
“I was influenced by another mom to start at age 2,” one mom in our private support group posted. “My son was fine for about 2 to 2.5 years. He pooped daily and had no accidents! Then the accidents came. Almost 3 years later we are still dealing with this. He is much improved, but we are not out of the woods.”
Another mom said that her daughter’s day care pushed her to toilet train just before age 2. “They kept pushing and starting doing nappy-free time there, so we felt we had to stop nappies at home, too. All the mums in the mum's groups were talking about toilet training. I still regret toilet training so early! It seemed initially successful, but she ended up with constipation, daytime and nighttime wetting.”
Yet another mom started her daughter peeing in the sink at 6 weeks old. “She had her first UTI at 6 months old! Then again at age 2 and pretty much constant for the next 4 years.”
Another mom said she was “definitely was influenced by a mom friend” and followed a book that advocated ditching diapers at 20 months. “Here we are 18 months later and still in potty training hell. Wish I would have waited a lot longer!”
The book she followed argues that “the longer you wait to potty train, the harder it gets” and describes early potty training as a way to “give your child dignity” (“Doesn’t he deserve the dignity of not crapping in a diaper and still worse, sitting in it?”).
The book also says training your child successfully at a young age will give you “awesome bragging rights.”
Again, potty training as a competitive sport.
You may wonder: What is the connection between early toilet training and chronic constipation? The connection isn’t intuitive, so I will explain briefly. For more detail, see The Pre-M.O.P. Plan: How to resolve constipation in babies and toddlers and overcome potty-training struggles.
The human body is designed to poop once a day; otherwise, stool piles up in the rectum and, over time, can wreak all sorts of havoc. In addition, a child’s growing bladder is healthiest when it empties every 2 to 3 hours, lest the bladder wall begin to thicken.
In general, young children don’t grasp the importance of using the toilet when nature calls. Toddlers think you dash to the restroom only when you feel desperate. Preschoolers are often reluctant to tell the teacher they need to pee or poop. Or, they’re too excited by all the fun or worried a classmate will steal their dump truck while they’re in the bathroom.
Babies, of course, have even less of a grasp on the importance of listening to their bodies.
Human beings have a significant capacity to override our bodies’ signals, and the praise that young children often receive for “staying dry” gives them incentive to delay peeing and pooping.
But this delay has consequences. The longer stool dwells in the rectum, an organ not intended for storage, the more water is absorbed and the drier the stool becomes. With each delay, the stool mass grows larger, eventually causing the rectum to stretch, often to twice or three times its normal diameter. (I measure rectal diameter on x-rays all the time. The concept is explained in the M.O.P. Anthology.)
A stretched rectum lacks the tone needed to fully evacuate, and the child stops feeling the urge to poop. When a child “refuses” to poop on the toilet, it’s not a display of disobedience. It’s because the child isn’t even getting the memo.
Over time, the bulging, stool-stuffed rectum can aggravate the bladder nerves, causing the bladder to empty without warning, daytime or nighttime. A wall bladder thickened by chronic pee holding exacerbates the problem.
This whole process often develops slowly and goes unrecognized. Sometimes, accidents are dismissed as “regression” due to “stress” — until the parents want to tear their hair out and the child ends up in a clinic like mine.
But nobody makes TikTok videos about that scenario! (Well, my co-author, Suzanne Schlosberg, did post a video on YouTube titled "How I Screwed Up (Royally) by Potty Training My Twins Too Soon." But it's not nearly as popular as the videos about 3-month-olds miraculously using the toilet)
One popular potty training book advises argues that waiting until your child is “ready” only leads to disasters, such as “six-year-olds requesting diapers so they can poop.”
Nonsense. When a child who’s 4, 5 or 6 has accidents or resists using the toilet it’s because . . . the child is constipated! (You can verify this by x-ray.) The child may have developed constipation because of an initial attempt to train too soon or simply because of the child’s genetics and temperament.
There are many reasons children become constipated, as I explain here, but delaying toilet training until “readiness” is not among them.
How do you know when your child is ready? I advise waiting until your can dress and undress without help, shows interest in using the toilet, notices a wet or dirty diaper, and tells you when she needs to pee or poop.
I’m not hung up on an exact age a child should toilet train. What’s important is that the child is not constipated to begin with and demonstrates the requisite maturity.
Whenever that day comes, it’s important for parents to remain vigilant for the signs of constipation, which are not well known and easily overlooked. They’re listed in our free download 12 Signs Your Child is Constipated. If your child does end up constipated, the treatment plan I recommend is spelled out in The Pre-M.O.P. Plan. The book also includes guidance on toilet training a child with a history of constipation.
According to one popular potty-training book, friends who discourage early potty training “have an emotional investment in your failure.”
I have no investment in anyone’s failure. I have invested a whole career in helping families reverse the consequences of chronic constipation.
I just wish our culture would stop glorifying early potty training because in this “sport,” no one wins.