As you no doubt have learned, infants are the excretory masters of the universe. Many a parent has mused, “He’s so little. He doesn’t eat that much. How can one little human create so much poop and pee in a day?”

Relentless, inexorable, remorseless – infants and toddlers regularly unload fluid and solid matter from every orifice. Who would have thought your life – which held such promise – would take such a turn, endlessly obsessing about the color, the consistency, the frequency, the odor of a squirmy little organism’s effluvium? Who would have thought that when a scatological toddler cleverly calls you a “poopyhead,” you would nod your head in weary agreement?

A Brief History: The Scoop on Poop

It is the rare parent who is not anxious to turn this particular task of parenting over to the child post haste. Throughout human history the only question has been when and how.

Little is known about toilet training before the 18th century. Apparently enemas and purgatives were used to control and regulate the process. Since there were no bathrooms, no disposable diapers, no washing machines (that would be mom), most infants were left naked from the waist down and allowed/encouraged to let it rip outside, often after parental prodding.

In the 18th century, the focus shifted to the indoor potty. Toilet training began to be invested with emotional significance for the child and/or as a test of the battle of wills within the family. The struggle for cleanliness led to this description of the ideal infant: “one…who cannot bear to have any dirt on his body or dress or surroundings for even the briefest time.” (I have to say, in my 20+ years as a pediatrician, I’ve yet to meet such a paragon.)

With this as an ideal, you can imagine that sometimes harsh methods were employed, such as the ever-popular infant “soap stick rectal conditioner” (use your imagination). As late as 1930, parents magazines claimed that most healthy babies could be trained by 8 months of age.

In the 1940s, pediatric experts like Benjamin Spock advised parents to delay toilet training until they had observed signs of developmental readiness. They believed that rushed and rigid training would be unsuccessful and, worse, lead to behavioral and emotional problems. In 1962,T Berry Brazelton published his hugely influential “child-oriented approach” to toilet training. His method was to shift the control to the child, to look for signs of readiness, and then to gently coax the child into mastering this developmental task without coercion and with a sense of self-satisfaction and pride.

In the other corner was (and is) the so-called “parent-oriented approach,” which sees no benefits in waiting for the child to become motivated and ready. It’s an adult world and the child – ready or not – must be taught to accommodate. In 1974, the still popular book Toilet Training in a Less Than a Day was published, offering an intensive, fast method to teach the component skills.

Who’s Right?

The debate rages to this day, even taking on moral and religious overtones. Some believe the mollycoddling permissiveness of a “child-oriented” approach to child-rearing has led to all that’s wrong with today’s kids and society. When Dr. Brazelton advocated pull-up diapers for the 3 and 4 year old who “wasn’t yet ready,” the howls of indignation were deafening and America’s most beloved pediatrician was criticized as he never had been before.

Despite the fact that most U.S. pediatricians currently subscribe to the child-oriented approach, there has been precious little research as to which works best. A recent analysis of all the research in this area (there isn’t much) declared it a tie: both work and there is no information to say either leads to better or worse long-term outcomes.

What’s the Big Deal?

It’s incredible to me how nasty and intense and divisive this debate has become, and how much emotional energy and anxiety parents sweat in this process. It’s viewed as life-or-death issue: one false move and your child is on the psychiatrist’s couch for a lifetime or perhaps due to spend eternity in Hell or you are unmasked as an inadequate parent.

Is such concern really justified? Here’s where the advice-givers have let you down, leading you to believe that the long-term consequences of inappropriate toilet training (especially not using their method) can be dire. Certainly Dr. Spock – an unrepentant Freudian to the last – believed that rigid toileting could lead to a compulsive “anal” personality. Others feel the process can set up long term feelings of self-loathing or an inflated sense of power.

Poppycock! Hogswallop! Balderdash! With rare exceptions, all developmentally typical kids will – one way or another, one day or another – get the job done (when is the last time you saw a child walk off to college in a diaper?). And there is not a shred of evidence – both in research and in real life – that the method used to achieve that goal has anything to do with long term personality or emotional traits.

Therefore…

As a parent (and the true ‘expert’ when it comes to what works best for your child and family), you should feel free to choose whatever toileting methods best fit with your goals and values. If you want to go slow and practice “toilet learning,” why not? What’s the rush? If you want to try to achieve independence real fast, by all means try to do it in a day or so. (In fact, some parents are now harkening back to to old days in working on toilet training in the first months via the “elimination communication” method.)

As far as I’m concerned, any method is pretty much OK, as long as the process isn’t experienced by your child as punishing and demeaning, as long as it enhances and not hurts your relationship with one another, as long as your child’s self-esteem doesn’t go down the toilet with his poop, as long you don’t see it as a competition or a sign of your abysmal parenting prowess, and as long as you maintain your sense of humor about the whole thing (hey, poop i
s funny, at least when you aren’t cleaning it up all the time).

As you might guess, I lean to the child-oriented approach (then, again, I’m not changing your darling’s diapers for 2-3 years!). So, for those of you who do too, here are Dr. P’s top 14 signs of developmental readiness to start toilet training (not all of which need to be met to give it a try), usually achieved somewhere around 24 months of age:

Language skills

1. Able to follow two-step independent commands (e.g., “Take off your pants and go to the bathroom”).
2. Uses two-word phrases (e.g., “bye-bye poop,” “go potty”).

Cognitive skills

3. Imitates your actions (e.g., sweeping the floor).
4. Understands cause and effect (i.e., is capable of understanding the reasons for mastering the actions involved in toilet training).

Emotional skills

5. Usually wants to please you by complying with your requests.
6. Shows diminishing oppositional behaviors and power struggles.
7. Shows drive for independence and autonomy in self-care activities (e.g., insists on feeding self, tries to take off own clothes).
8. Shows pride and possessiveness toward belongings (“my car” and eventually “my poop”).

Motor skills

9. Can walk with ease.
10. Is capable of pulling pants off independently.
11. Can sit still for 5 min without help.
12. Can somewhat control urinary/anal sphincter (e.g., urinates large amounts occasionally, rather than constant wetting).

Body awareness

13. Shows awareness of wet or soiled diaper.
14. Shows signs of the urge to pee or poop (e.g., facial expression, goes off into a corner).

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You’ll make your own poop culture, the one that works for you and your family. Remember the odds are stacked way in your favor: you will be successful – sooner or later. As with all parenting, know your child, learn a few tricks of the trade, then follow your heart and your gut and, as best you can, enjoy the ride.

Related Topics:

• WebMD Video: Potty Training Problems?
• Toilet Training Your Child

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