What is the best approach for potty training an 18-month-old child?

Toilet Training an 18-Month-Old

For an 18-month-old child, it is too early to begin formal toilet training; instead, focus on parent education and preparing for readiness assessment, with actual training typically not starting before age 2 years or when clear developmental readiness signs emerge around 18-30 months.

Timing and Readiness Assessment

The American Academy of Pediatrics recommends beginning toilet training when the child shows signs of readiness, but typically not before age 2 years. 1, 2 Parent counseling about toilet training can appropriately begin at the 18- to 24-month well child visit, but this is for education and preparation, not to initiate training. 2, 3

Key Developmental Readiness Markers (Usually After 18-30 Months)

The child must demonstrate several capabilities before training should begin:

• Physical skills: Ability to walk, put on and remove clothing independently 3
• Cognitive skills: Ability to understand and follow parental instructions, expressive language development 4, 3
• Bladder/bowel awareness: Recognition of a full bladder or rectum, demonstrated dissatisfaction with a soiled diaper 3
• Behavioral cues: Imitating toileting behavior, expressing desire to use the toilet, staying dry through a nap or overnight 3

Most children achieve the physiologic, cognitive, and emotional development necessary for toilet training by 18 to 30 months of age, with mastery of required developmental skills typically occurring after 24 months. 4, 3

What to Do at 18 Months

Parent Education Focus

At this age, the priority is preparing parents with realistic expectations:

• Explain that no single training method is superior to another—parents should choose an approach best suited to their family and child. 3
• Emphasize the child-oriented approach: Training should use positive reinforcement, praise success with positive terms, and avoid punishment, shaming, or force. 1, 2
• Set realistic timeline expectations: In the United States, the average age at which training begins has increased to between 21 and 36 months, and newer studies suggest no benefit of intensive training before 27 months of age. 4

Preparation Activities (Not Formal Training)

• Allow the child to observe family members using the toilet to encourage imitation 3
• Introduce toilet-related vocabulary in a positive, casual manner
• Consider having a potty chair available for the child to explore without pressure

When to Actually Begin Training

Formal toilet training should begin when the child demonstrates multiple readiness signs, typically not before 24-27 months of age. 4, 3 Girls usually complete training earlier than boys. 4

Training Approach When Ready

Once readiness is established:

• Ensure proper toilet posture: Provide buttock support, foot support, and comfortable hip abduction to avoid activating abdominal muscles that can cause pelvic floor co-activation. 1
• Teach proper hygiene: Include wiping technique and hand washing after toileting as part of the comprehensive program. 1
• Use positive reinforcement: Make training positive, nonthreatening, and natural. 2
• Address constipation promptly: Constipation can interfere with toilet training and should be managed with oral laxatives if needed, followed by maintenance bowel management. 1

Important Caveats

• Starting too early (before developmental readiness) provides no benefit and may lead to frustration for both parent and child. 4
• While some cultures practice assisted infant toilet training starting as early as 1-3 months, this requires intensive caregiver observation and is not the standard Western approach. 5, 6
• Children with medical conditions like cerebral palsy, Down syndrome, or autism spectrum disorder may require longer training periods and specialized approaches, potentially requiring early consultation with occupational therapists or developmental pediatricians. 1, 3