Toilet Training: When to Begin and How to Approach It
Toilet training should be initiated when a child shows signs of readiness, typically between 18 and 30 months of age, not before. 1, 2
Signs of Readiness for Toilet Training
Children develop the physiological, cognitive, and emotional capabilities necessary for successful toilet training at different ages. Look for these specific readiness markers:
Physical Readiness
- Ability to walk steadily
- Ability to sit down and get up independently
- Manual dexterity to remove and put on simple clothing
- Staying dry through naps or for at least 2 hours
- Regular, predictable bowel movements
Cognitive/Behavioral Readiness
- Following simple instructions
- Expressive language skills to communicate needs
- Awareness of a full bladder or rectum
- Showing discomfort with soiled diapers
- Interest in using the toilet or imitating others' toileting behavior
- Desire for independence
Approach to Toilet Training
The American Academy of Pediatrics recommends a child-oriented approach that includes 1, 2:
- Begin only when readiness signs are present (typically not before 24 months)
- Use positive reinforcement for successes
- Avoid punishment, shaming, or force
- Make the process positive and non-threatening
Special Populations
For children with specific medical conditions, toilet training may require modification:
- Children with Down syndrome, autism spectrum disorder, or cerebral palsy often achieve toilet training later
- Early consultation with developmental specialists may be beneficial for these children 1
Common Complications
Be aware of potential complications that may require further assessment:
- Stool toileting refusal
- Stool withholding
- Encopresis
- Hiding to defecate
- Enuresis
Important Considerations
- Girls typically complete toilet training earlier than boys 3
- Most children achieve daytime continence by age 3-4 years
- Nighttime continence often takes longer, with full nighttime dryness typically achieved between ages 5-7
- For children with nephrogenic diabetes insipidus, toilet training should proceed as with any other child, though full continence is usually only reached in the second decade of life due to large urine volumes 4
Practical Tips for Parents
- Begin toilet training discussions during well-child visits at 18-24 months
- Encourage parents to choose a method that suits their child's temperament and family situation
- Emphasize consistency in the approach
- Ensure the child can sit securely on the toilet with proper foot and buttock support
- Teach correct posture to enable relaxed voiding
Despite various toilet training methods available, no single approach has been proven superior to others. The key is to match the method to the child's developmental readiness and the family's preferences while maintaining a positive, supportive environment.