When potty training gets messy

“When we’re trying to provide a safe and secure environment, I always bring play into the interventions with the children that I serve and support, having them play with their stuffy or having them play with their favorite toy on the toilet.”

Quiara Smith, Pediatric Pelvic Floor Occupational Therapist

Is your child refusing to sit on the toilet? Or waiting until the pull-up is on to go poop? You’re not alone. For a lot of parents, the potty learning process is more drawn out than we anticipate. For some, it takes months or even years.

In previous episodes, you heard some common potty-training scenarios. We shared the advice of the author of Oh Crap Potty Training and Nicole Kavanaugh’s Montessori approach. In today’s episode, Host Jessica Rolph welcomes Quiara Smith, an occupational therapist specializing in pediatric pelvic floor health, to help with the trickier cases when it comes to learning potty etiquette.

Highlights:

[1:42] What scenarios are most common in Quiara’s practice? 

[2:28]  What are Quiara’s recommendations for a child who is withholding poop until nap time or night? 

[3:25] What if the child’s sensory system is overwhelmed?

[4:55] Is there anything that parents can do to create a more favorable environment in the bathroom for their child? 

[6:46] A specific potty challenge scenario from one of Lovevery’s listeners.

[8:42] How firmly should parents hold boundaries around the use of diapers to poop? 

[9:46] A listener asks a question about how we can help a toddler to differentiate between a diaper and pull-ups/training pants.

[12:26] How can parents help their children to transition from the potty to the toilet? Listen to a parent whose child has been rejecting the regular toilet for almost a year.

[15:24] What to do when your child uses the potty at school, but not at home? Or visa versa.

[17:33] What can parents do when their child is withholding to the point of constipation?

[20:09] What is the average time frame for learning to use the potty? Is there a point at which parents should seek outside help?

[21:40] What do parents do if their child is potty trained and then experiences a regression? 

[22:36] Quiara shares tips to continue potty training while traveling.

[24:09] Quiara’s final advice. 

[25:37] Jessica gives her takeaways from the conversation with Quiara Smith.

Mentioned in this episode:

Listen to Perspectives on Toileting with the Author of ‘Oh Crap! Potty Training’ and 

A Montessori Perspective on Toilet Learning

Transcript:

Common potty training issues

Jessica: Oh, your specialty is so needed for so many families. What scenarios are most common in your practice? 

Quiara: There are many challenges that come into my practice, but I’ll share with you some of the common ones. First and foremost, withholding poop until nap time or night is huge. Another one is asking to poop in a diaper, so the child preferring to use the diaper rather than going into a toilet or a potty. And fear of the regular toilet is another big one. And lastly, withholding to the point of constipation, which we know is not comfortable for any child or any family.

Jessica: Okay, so let’s break these down, ‘cause I want to know about all of it, don’t hold back with us, okay.

So, no pun intended, but withholding poop until nap time or night, we’ve experienced this in our home. Tell me, what are your suggestions? 

Stool withholding until nap or night time

Quiara: There are a variety of reasons why a child might be doing this, and one is often constipation, that they’ve had one painful poop and they’re not comfortable yet letting the poop out in a potty or toilet, if that’s something that is expected of them. So they wait until they’re alone in their crib or in their bed, and when they’re given a pull-up or diaper or sometimes even underwear or training pants, they’re safer, their body feels more secure and they think that it’s not going to hurt as much. Another potential possibility for withholding poop until this time is the child’s sensory system is just not feeling secure for whatever reason with letting poop out in a potty or a toilet.

Jessica: Okay, what should we do about that? If our sensory system isn’t ready, what do you recommend? 

Quiara: So I would recommend having just very clear expectations on supporting the child with having poop come out. So it depends too on where they are in the potty learning process. If a child is just a new learner, we might give them a little bit more time to understand our expectations of having the poop come out in the toilet rather than their diaper or pull up, and just talking them through the steps, “Oh, before we go to nap, I know that you really want to use your pull-up or your diaper to let the poop out, but tomorrow, we’re going to practice with this”, and just giving them those clear expectations. And then, also understanding when this is happening and trying to problem-solve, if their sensory system needs a little bit more simulation, meaning maybe they need more gross motor play before nap time, then intervening and having them practice a sit time on the toilet before they go to nap in preparation for maybe the child will stool if they more in their body and also more regulated.

Jessica: I think that one of the things that we were thinking about, we wrote books about this exact scenario at Lovevery. In researching, we heard from so many families that it might be even that coziness of the diaper or that safe-ness of being… As you said, being alone, or… Is there anything that we can do as parents to create a better environment on the potty for a child to feel more safe? 

Quiara: Yeah, and when we’re trying to have that kind of safe and secure environment, I always bring play into the interventions with the children that I serve and support, and having them play with their stuffy or having them play with their favorite toy on the toilet. “Maybe you’re a little playful yourself and talk about having the stuffy wear the diaper and putting them on the potty and the stuffy talking and saying, “I really prefer to let the poop out in my diaper right now before I take a nap, and oh, one day we’ll be able to not have to use the diaper and the pool will go in the toilet”. So modeling through social play is really important and can help the child’s nervous system feel more comfortable.” Going back to the sensory component, that diaper, just that feeling of the feedback on the skin can be, for some kids comforting, other kids, it’s uncomfortable, they don’t want that feeling. But some kids who do have sensory differences will prefer having that feeling knowing that they’re safe and that the poop and pee is not going to necessarily hurt them, and then we can have those social stories around it saying, “I noticed that your body feels more safe and comfortable with the diaper, but one day when your body doesn’t need it, we’re going to be able to put it in the potty or the toilet.”

And I always like to use that future kind of thinking to support the child to say, “Right now, you’re really having a hard time, and I can see that, and I’m here to support you, but one day you won’t need it and we’re going to practice and we’re going to play through it”.

Jessica: So we asked our community to share some of their specific potty challenges, and so one mother called in with the scenario. I’m going to play it right now.

Child wants diaper on all the time

Caller 1: Hello. My son starts crying the second we take off his diaper, he wants the diaper back on. He gets really upset. Can you please tell me what should be done in that situation? Thank you.

Jessica: Yeah. Quiara, what do you… What should we say to her? 

Quiara: This scenario is also very common, and going back to that comfort and that safety and security. For some children going through that potty learning process is a big transition, both cognitively, emotionally, socially, there are so many things that impact a child’s development. And these children who are crying like this mother says, when the diaper is taken off, their nervous system is telling us, “Wait, I don’t feel so safe right now, and this is how I’m able to communicate with you”.

These are ways that they’re trying to communicate that they’re not safe or secure. So how can we as parents or even healthcare providers support this child in their moment of need? And that is to validate. Validate the feeling. Narrate what you see. Ah, I see that when I take off your diaper, you’re crying, and it seems that that’s really upsetting to you, and I’m trying to help you learn how to take care of your body, but it seems like that’s not something that we’re ready for… You’re ready for right now, so I’m going to help you put the diaper back on. And then in a minute or two, maybe we can try to wear the training pant or no diaper.” So you’re giving a choice and you’re narrating through that process where the child is saying, “I just don’t feel quite yet safe or secure for this particular task”.

Jessica: And then, would you ever pause and come back to it a few months later, or what? How much should we be persisting holding boundaries around this stuff or giving it a rest? 

Quiara: Yeah. So for that mom’s particular situation, maybe in that moment, I would pause and I would validate just how I explained. And then do a preferred activity, maybe the child really loves playing trains, and so you spend five minutes playing trains on the ground with him, really getting his body moving. And then again, maybe in 20 minutes offering that particular sequence of tasks that you’re working on, being able to take off the diaper and then counting to five and then putting it back on. And praising and saying, “Oh, I noticed that you were able to keep the diaper off and now we can move on to having a snack”. So all these little bits of opportunity to practice actually build skill. It’s these bite-sized moments of opportunities throughout their day with a caregiver or a parent or an educator who they feel safe with and who they feel confident in as well.

How to differentiate between diapers and pull-ups

Jessica: That makes sense. And so how do we get our toddler to differentiate between the diaper and like pull-ups or training pants? I have another clip to play for you from a listener.

Caller 2: My son recently started potty training, and he does well when he doesn’t have a diaper on, he can pee and poop in the potty. But once we put training pants or underwear on, he reverts back to having a diaper. So my question is, how can I get him to still pee and poop in the potty with the training pants and underwear on and not treat it like a diaper? 

Quiara: So sometimes when we’re seeing this type of behavior, it’s because the child’s what we call tactile system, might be hypersensitive or hyper-responsive to certain touch. And so sometimes children, when they’re going through the potty learning process, and they’re learning sphincter control and they’re learning the steps needed or required to be able to independently take themselves to the bathroom, they don’t necessarily… They can’t differentiate their tactile system. The way that they respond to touch is very sensitive, so once they get something on a pull-up or training pant, they just have this reaction of letting go. So how to train that is to be able to track the child’s body pattern, so knowing when they are going on their natural bio-rhythms, when they’re voiding, are they voiding every hour? Are they voiding every two hours? And then you just make it short amounts of opportunities, like I said, the practice of skill, the mastery of skill happens in small opportunities and small moments, so that could look like maybe you put that training pant on for 30 seconds in play and you’re watching, you’re not walking away from your child, you’re fully present and you’re there and you’re really observing, maybe their cues, their cues of urge could be crossing legs, maybe they’re going into that squat position.

And really understanding when they are alerting a parent or caregiver on when they might need to go and then offering to go and sit and take care of their body. And I use that kind of language of caring for their body and not potty breaks or toilet-ing breaks, maybe I will say a bio break for children who are a little bit older, but really getting them into the understanding of, “I am building body autonomy and I am caring for my body, so I can partner with my body to do all the fun things I really love to do, like play”.

Jessica: It’s really helpful to hear. So you talked about fear of the regular toilet being something else that was very common in your practice. Here, is a parent whose child has been rejecting the regular toilet for almost a year, let’s play this.

Transitioning from potty to adult toilet

Caller 3: How do we transition from the potty to the toilet? I’ve being doing this since the end of November. My son loves his potty, we have the stool, we have a small potty seat or toilet seat within the bigger toilet seat he can use. He’s done it before, he’s done it other places. But he still prefers his potty at home. Thank you.

Quiara: This transition from the floor potty to a larger potty is sometimes an uphill battle for families. Like this mother, who is sharing with us that her child can go to a public restroom or a toilet or use a toilet outside of their home, so she’s kind of confused as to why this is such an issue within her home. Often times the environment plays a huge role in how a child’s nervous system is feeling comfortable, safe or secure to be able to do something, like bowel and bladder control or voiding.

And you can ask the child if they’re able to communicate that, maybe there’s a certain smell, maybe there’s a certain sound, maybe their body doesn’t feel comfortable on that particular toilet seat insert or their feet are actually not quite touching or in the correct position of where they feel most stable to maintain that upright seated position on the floor potty, their body is very stable because it’s on the ground. These little ones have the ability to have the knees above the hips, which makes it a wonderful position to fully empty and have their pelvic floor in a relaxed position for sphincters to open and close when they need to. So I would recommend that. Another thing that I would do is transition the floor potty, so if it’s not in the bathroom environment, you slowly move that expectation of the child’s going to go into the bathroom and utilize the floor potty.

And then maybe you just practice a few sitting bio-breaks with no expectation of them to void pee or poo in, but just getting used to that positioning, sitting on that toilet in the home.

Child using the potty at school but not at home

Jessica: So another listener says her child will use the potty at school, but not at home. So do you see that often in your practice? Any thoughts? 

Quiara: Yes. So kind of piggy-backing on the last scenario that we just spoke about, it’s really looking at the environment. But also looking at the task demands or expectations of toilet-ing in the school environment or daycare setting. There are often different rules that are at school than there is at home, right? And so, we have to understand how can we best support this child’s, number one, and you always hear me say this, but their nervous system, because without that regulation, they’re not going to be able to learn the skill, but also be able to have really good bowel and bladder control and management if they’re not feeling safe or secure. And so, I think being able to understand and partner with the educators at school and asking maybe if there’s a schedule you can look at and see when are those bio breaks or potty breaks for the child? When are those opportunities throughout their day? 

How do they align with what they’re already doing at home? Maybe it’s off by an hour, so their body, their natural rhythms have to wait longer than normally. Another piece of it is, what are the expectations of the child to go independently? Do they have to ask? Do they have to get up in front of their classroom to say they need to go, or is it open access? Is the bathroom really far away from the classroom or is it at a close distance? That all is really important information, because a child, once they feel urge and depending on what’s happening, are they able to hold their sphincters close and their pelvic floor enough to get all the way to the bathroom in time?

How to handle withholding poop

Jessica: We had talked, you said kind of the top four things in your practice included the withholding to the point of constipation, that was one of the last thing that you mentioned. This is so common, it feels, at least we experience this in our home. Tell us more about this. What can we do about it? 

Quiara: So, withholding to the point of constipation is something that is a very common thing when children are not only going through the potty learning a potty training process, but when there’s different life transitions and they just sometimes don’t feel comfortable for whatever reason, letting it out. And when the child is really withholding, what happens is that stool accumulates in the rectum and with that it starts to stretch the smooth muscle in the rectum and can cause what we call encopresis or fecal leaks, and this is when there’s a massive stool in the rectum and softer stool goes around it. And the issue with that is, if they’re not… If the child is not getting complete emptying of their rectum every day or what their regular rhythm was, they start losing sensation of feeling urge.

And so, how we can help address this is kind of giving them just the education, right? The piece of, this is how the body works, and if we’re holding it in, this can happen. And a big part of my practice is that education piece with the child and with the family, and letting them know, “I know that this is hard for you right now, and this is scary, but this is also something that you can help your body with.” And then figuring out, there might be things that we have to go back to the general practitioner or the pediatrician with and say, “These things we’re noticing and we would like more support, maybe to help manage the constipation with things like supplements, or… And I like to call them supports because some children might need those supports acutely versus chronically, just to get them over this bridge of not withholding.

So withholding is such an issue because the child is volitional holding the stool and closing their sphincters and closing their pelvic floor muscles. So oftentimes, we need them to be able to stimulate that urge to go through medications or supports such as stool softeners for stimulant laxatives. And those are the types of things that the pediatrician or GI doctor can support them with.

How long does potty training take?

Jessica: That’s really great advice. Potty training rarely goes according to schedule, as so many of us parents know, what is the average time frame for learning to use the potty and is there a point at which parents should seek outside help? 

Quiara: So my clinical experience, it sometimes takes between six months to one year for a child to be completely independent in what we call a bowel and bladder management, so they’re going to… They’re feeling urge, they’re going to the bathroom on their own, and they’re not having any leaks or accidents. But when it’s not going so well or according to plan, I typically will say if you’ve tried for two or three weeks and your child is still having a lot of leaks or accidents, it doesn’t seem like they’re getting the appropriate urge or they’re withholding stool or urine, that it’s totally fine to go back to diapers and take a little rest break, but you continue to monitor their natural biorhythms. So that means looking at what time of day are they avoiding pee and poop? What are those stools looking like? Are they constipated stools or are they good? Are they emptying their bladder at regular intervals? And then when it seems like the child is in a better place or you are just feeling more confident in supporting your child, then taking up the potty learning process again. It’s so understandable and fine to take a pause and come right back to it.

Potty training regression

Jessica: Great. So what do you do if your child is potty trained and then experiences a regression, whether that’s like… It comes from, I don’t know, having a new sibling in the home or a big change in their life, they’re regressing, what should you do? 

Quiara: I would go back a step and really look at what the child was able to do before that regression and slowly help them get back to what their skill level was, doing the strategies that worked previously.  I would just try and meet the child where they’re at and help them along. If you need to put them in a diaper because you’re traveling five hours in a car where before you were able to do that and they were able to stay dry, like, that’s fine. You can always just go back to where they feel supported and you kind of work through those tough times.

Potty training while traveling

Jessica: That’s great advice and permission for us to not be so hard on ourselves, if our children have a regression. You can get support. Everybody can get support. What about traveling during this process? Do we put everything on hold while we’re away? Do you have any tips for how we can bring potty learning on the go? 

Quiara: Yeah, potty learning on the go is something that makes parents super anxious, [laughter] I’ve now noticed in my practice. But it’s something that is completely doable and you won’t believe how creative parents get, which I really love. I say, you just have to be well-equipped with things that your child are familiar with already, so something like a toilet seat insert that you want to use to help them go to the bathroom in the airport or in the airplane, make sure that they’re familiar with it. Bring it out, talk about it. Have their dollies or their stuffies, play with it. Make sure that the tools or equipment that you’re using is something that your child has seen before.

And I would also recommend understanding what your schedule’s going to be like. So if you’re traveling abroad or there’s a time difference, making sure you understand your child is still on that biorhythm that you might have to tweak along the way, but offering those opportunities for bio breaks to take care of their body during the traveling journey is going to be really helpful.

And if you need the training underwear or you need the pull-up, because you’re going to be in an airplane for a significant amount of hours, so be it. This is still a learning process for everybody, and if you kind of check in with your child during those times that you know that their body naturally needs to void, then you can kind of prevent some of those leaks or accidents from happening.

Final advice about potty training

Jessica: That’s great advice. Any final advice for our listeners that we have not covered today? 

Quiara: I think the final advice that I would give your listeners is just to be curious about how to support your child’s nervous system, I think during this new learning experience. Because it could be scary for a lot of children and a lot of parents, like, they’re frightened with this developmental milestone. And I think that finding that harmony and that balance between regulating your nervous system and your child’s nervous system can do wonders. Also, just being able to be in the moment, and I know that there’s so much noise around, this is how you should parent, this is what you should be doing, but really you are the expert of your child. And our intuition sometimes is quieted, because we think we don’t know as much, but I will tell you, parents and caregivers really know what their child needs best, and I would say just attune to that. And lastly, avoid constipation at all costs. [chuckle] If that’s something that you can avoid, it will help the potty learning journey and process, but also have this grace for yourself and your child, and you will do fine. You will do fine. 

Jessica: That’s so helpful to hear. Quiara, it’s been great having you with us.

Quiara: Thank you so much for having me, Jessica.

Takeaways:

1. It’s OK to name the behaviors you observe in your child, even if you aren’t happy with those behaviors. Articulate how you would like them to change: “I know you want to use your pull-up to poop, but before we go to nap today we’re going to practice using the toilet.”
2. Play can help your child to get more comfortable with the environment in the bathroom. Put a favorite stuffy on the potty, and construct a dialogue around that stuffy’s reservations about using the potty. Modeling through social play is helpful in so many challenging situations! 
3. If your child is upset when the diaper is off, validate their feelings and narrate what you see: “I notice that when I take off the diaper, you’re crying. I’m trying to help you take care of your body, but I see that you’re not ready to use the potty yet. Let’s try again in a few minutes.” Then take a break and do a preferred activity — gross motor play, for example, could help get them more in tune with their body. 
4. Your child may feel more secure on the small, floor potty because their feet are on the floor and their knees are up. Consider adjusting the setup on the larger toilet. The environment can play a significant role in regulating a child’s nervous system, and if your child is stressed, they may have trouble relaxing their pelvic floor.
5. On average, a child will need 6 months to a year before using the toilet independently and going long stretches without an accident. If it’s not going smoothly, there’s no shame in taking a break and going back to diapers. Continue to monitor their biorhythms during this break so you can use that information when you try again: Are they often constipated? Are they emptying their bowels at regular intervals? 
6. Constipation can create a negative cycle for potty learning. If they are not emptying their bowels daily, they can lose the urge to do so. Consider consulting your pediatrician. Supplements may help get back on track. 

New to potty learning? Check out past My New Life episodes on how to get started: The first with the author of “Oh Crap! Potty Training” and the second with Nicole Kavanaugh on a Montessori approach. Find additional tips on potty training on our Lovevery blog.

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