Thursday, December 29, 2011

The Big "T" Word

I was talking to the mother of a 4 year old a few months ago about her daughter’s absolute refusal to use the toilet.  Mom was really looking for a solution as a new baby was due in a couple months.  The thought of 2 children in diapers was depressing enough, but she also worried that if they didn’t clear this hurdle before the birth, it would be months before they would be up to the task.
Mom had talked to a lot of people about how to motivate and teach her daughter to use the bathroom.  From “fill her up with liquids” to “she’ll train when she is ready” to “tell her she can’t go to school until she is trained”, good meaning people had good meaning ideas.  But they all missed one key fact – the child was completely aware of the bathroom, what it was for and how to go about it.  She simply CHOSE to not be bothered with all that – for whatever reason, of which I have no clue.
Now I am certainly not discussing a younger child of a more traditional toilet training age.  I am talking about a healthy, lively, intelligent 4 year old who has been staying dry for long stretches and during naps for a year and a half, who has successfully used the toilet on a couple occasions and who can dress and undress herself.  When such a child is not toilet trained, she is choosing not to be.
We often don’t know why children make the choices they do.  But in today’s society, we often believe we need to know.  If we don’t know, we make up reasons that usually have to do with the child’s hurt feelings or poor psychological health or low self-esteem.  Then we go about trying to solve the made up reason.  And generally we get little or no change to the choice the child is making.  But we get ourselves really worried!
A far better approach is to simply become the parental leader who clearly states the expected behavior and clearly follows up with consequences when the expected behavior does not occur.  CALM, matter of fact consequences.
So what did I advise this mom?  Starting on a morning when you can be mostly home for several days, tell your daughter that she is to use the toilet from now on.  Spend some time (about 10 minutes) with her to rehearse the skills needed – going into the bathroom, removing her clothes, sitting on the toilet, wiping herself, adjusting her clothes, washing her hands, etc.  Be calm, gentle and matter of fact – absolutely no threats, no bribes, no promises.  Then tell her that if she has an accident, she will be responsible for going into the bathroom to change her clothes, clean herself up and rinse out her soiled clothes. (Make sure that all the necessary supplies are in place for her).  Tell her this calmly and matter of factly – no yelling, no screaming, no threats.  Then take off her diaper, put her in big girl underwear and a loose shirt.  You also might consider confining her to some limited portion of the house that might include the bathroom and kitchen.  From here on, she is on her own.  Mom and Dad do not remind her or ask her if she needs to use the potty.  When she is successful, a calm word of encouragement is all that is needed – no great big treats or excited, over the top praise – those can be self defeating.  When she has an accident (and she will), no great big negative reactions – just point her in the direction of the bathroom to clean up.   The most important thing is to not over react and to not back down.  If Mom and Dad are calm and consistent, she should choose to take over this new responsibility within a couple weeks.
Mom did indeed look at me like I was nuts.  But she pondered the ideas for a few weeks and then realized how completely inconsistent they had been in communicating to their daughter that she was to use the toilet from now on.  So although she tweaked some of my suggestions, she did announce that a new day had dawned and diapers would be no more.  And indeed this beautiful little girl is now completely toilet trained and getting ready to welcome the new baby as the big sister she is really becoming!

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