Recent generations have softened their attitudes to toilet training, but with high numbers of children starting school in nappies, are we waiting too long? Caroline Vollans
Recent guidance suggests that waiting for the child to be ‘ready’ is not always correct
Recent guidance suggests that waiting for the child to be ‘ready’ is not always correct

Early toilet training is seen as something from a bygone era, often associated with negative psychological effects. Parents in the UK are usually advised to wait for signs that the child is ready before starting. It may come as a surprise to hear that the Institute of Health Visiting (IHV) proposes something different.

Focusing primarily on children with special educational needs and/or disabilities (SEND), they say, in guidance from April, ‘starting early has shown to be particularly successful. Becoming toilet trained is about learning a set of skills that can be taught.’

The organisation Bladder & Bowel UK also focuses on the importance of learning skills, and comments, ‘It is important to remember that many children with typical development find learning the skills for toilet training difficult.’

Is it time to rethink toilet training, and put more emphasis on teaching children the skills they need, rather than wait for them to appear ready?

THE PROBLEM WITH CHILD-READINESS

Bladder & Bowel UK points out that many children, including those with SEND, may not show signs of readiness. This, however, does not mean they cannot start the process.

‘Rather than waiting for your child to appear to be ready to potty or toilet train, it is recommended that you start to teach your child the skills that they will need to use the potty or toilet as early as possible. This will mean that your child is not expected to change their routine of using a nappy as they get older, which they may find difficult.’

The thinking behind this is straightforward: if toileting routines are introduced from early on as part of a normal daily routine, using the toilet won’t be such a big transition for young children.

TEACHING THE NECESSARY SKILLS

Getting all the practical steps right is key to success. The IHV suggests most children will be ready to start following toilet-training routines from around 18 months. How it is approached is of central importance. It highlights the need to:

  • use a calm and patient manner
  • bear in mind that each child is different – don’t compare them
  • not rush it to get it out of the way
  • maintain consistency between the home and setting.

Bladder & Bowel UK reiterates the importance of these things for children with SEND: ‘As with all children, those with additional needs benefit from a calm, consistent and persistent approach for as long as they need. It is helpful if everyone follows the same routines and starts the process at the same time. Good communication between you and anyone else involved in your child’s care (e.g., nursery or school or grandparents) is important.’

They also point out that if a child is struggling to learn the skills needed for toilet training, they should be referred for an assessment to a healthcare professional. This is in part to make sure there are no underlying problems affecting the child, such as constipation.

WHERE WE ARE WITH TOILET TRAINING

ERIC, The Children’s Bowel & Bladder Charity, points out, ‘Over the last century, the average age of children in the UK being toilet trained has moved from 12-18 months to three or four years.’

We now also know that since the Covid-19 pandemic, children are arriving in Reception with fewer self-help skills. Nine in ten Reception teachers said at least one child in their class was not toilet trained, the 2022 School Readiness Survey found.

A systematic review of the research suggests that the optimal time to start toilet training may be prior to the age of 24 months. The research also suggests that later toilet training may be associated with health difficulties in later childhood such as infrequent urination, over-frequent urination and constipation.

ADVICE TO PARENTS

It is common for parents to ask for guidance from settings about toilet training. However, it is likely that much of that advice is based on waiting for signs for children to be ready to start toilet-training. This is not in line with the most recent guidance and research discussed.

Surely, then, it is important to rethink the advice that we give to parents.

Toilet tips

The IHV’s tips include:

  • encouraging an interest in the potty/toilet using books, stories, songs, apps
  • talking about the process, answering children’s questions
  • introducing the child to a potty – playing with it, trying to sit on it
  • sitting on it as part of the daily routine
  • having a book to look at when doing a poo
  • Increasing the number of times a day and how long they sit
  • encouraging the child to sit on the potty at times of the day when they are most likely to need a wee or a poo
  • looking out for signs that the child is having a wee or poo: fidgeting, walking in a funny fashion, pulling a particular face…
  • swapping nappies for trainer pants – these are easy to pull up and down. Also, they will feel wet and begin to associate this with needing to do a wee
  • reminding them to use the potty throughout the day.

They add, ‘Children with additional needs may benefit from learning these skills in a more structured way.’ For guidance on toilet training for children with autism or difficulties related to development, a useful guide can be found at Bladder & Bowel UK (bbuk.org.uk).

CASE STUDY: parental guidance

Honey Kaur is a childminder. She is also the childminder partner in East London’s Stronger Practice Hub ‘A Brighter Start’.

‘Parents often come to me asking about potty training with a mixed bag of nerves and anxiety. They have an array of questions for me, before they attempt to start: “Is it too early?” or “Will you help me?” Plus, the most common question of, “How do I get started?”

‘The truth is every child is different. I also believe that so is every circumstance. I often ask my parents, “Are you ready?” For me, this is probably the most important question. Transitions can be difficult, and some parents will need a lot of reassurance and support in order to be ready. Parent-readiness is definitely an area to work on with them.

‘After 14 years of experience, I think the most important thing is to know your child. Though age can play a part, the child’s development stage and understanding are more relevant.

‘I often feel we can overly complicate and over-think potty training – soon enough it becomes overwhelming and a chore with loads of stress attached.

‘Potty training takes time, requiring dedication and patience. I ask parents to start the process themselves for a minimum of two days. During this time, the child can be supported in their home with their most trusted person.

‘I advise parents to speak to their child about potty training. Reading stories together is a great way for children to start gaining an understanding. Going out to choose new underwear can also be helpful: character-themed ones tend to work well.

‘I strongly advise that once parents have started to potty train, it is best to stick at it. Children usually respond best to consistent and clear messages. It’s worth, then, trying not to choose a stressful time to begin.

‘Preparation is key. Practical things help, such as ensuring there are plenty of fresh changing clothes and telling close family and friends so that they can be supportive. Sometimes parents are advised to take their child’s underwear off or to keep a potty in every room. I prefer to keep it simple and true to life: we don’t walk around without underwear or have a toilet in every room.

‘I appreciate every circumstance is different, so I try to reassure them that it’s best to do what works for them and their child. The main thing is for parents to feel confident in the transition.

‘Communication and consistency is key in the child’s setting and with one another in the household. The more everyone works together, the easier the transition will be for the child.’

ADDITIONAL READING