Should I potty train my baby?

Well, that largely depends on your definition of baby, and of train.

If you mean putting your nine month old in pants, and expecting them to crawl to a potty, and getting frustrated when they end up with soggy pants, then no. No, you shouldn’t do that. If you mean putting your three month old on the potty when they do their poo face, then sure, if that’s what you want to do. If you mean getting your 18 month dry during they day, then maybe, if you’re sure they’re ready.

There’s a post from 2012 that seems to be doing the rounds at the moment: Don’t potty train your baby. It’s written by a paediatric urologist (a children’s wee doctor), and so I feel a bit under-qualified to respond. But, what I do have in my favour is that I’m used to focusing on the bigger picture, the population effects. As a urologist I’m sure the author sees many children with retention issues, and some of these problems may well be because they have been toilet trained before they are ready…but how does that play out in the general population? And what’s the science?

So what’s the theory?

The theory in the commentary above, is that children who are toilet trained early are likely to learn to hold their urine, as they’re too busy playing, causing long term damage. And that (contrary to a lot of other studies) those trained late only have accidents because they are constipated. He goes on to say that children going to nurseries and preschools are more at risk of developing these problems.

And the science?

Well, first, I found the authors most recent scientific paper. And, while an interesting description of some cases, it doesn’t provide strong evidence to back up the theory. While the methods talk of a case-control study, the results are analysed as a cohort, and there’s no controlling for confounding that I can see. That probably sounds pedantic, but it’s really important! I’m going to leave it there, in case I bore someone to death, though happy to go into more detail somewhere else! 

But aside from the methodological considerations, this is again focused on a small group of children. There’s no evidence that this is an “epidemic”, or that parents should be overly concerned. His findings showed that those trained early (under 2) or late (over 3) were both more likely to report constipation, and those trained early were more likely to still be having accidents. That’s it. That’s not what he concludes though:

“Initiation of toilet training prior to 24 months and later than 36 months of age were associated with dysfunctional voiding. However, dysfunctional voiding due to late toilet training was also associated with constipation.”

I don’t think the study shows that. At all.

As for the other bits of his theory, I assume the link to nursery attendance he mentions is anecdotal – his description bares no resemblance to my experience of childcare settings and toilet training, though that may be because he’s based in the US I guess (I’m not convinced). 

And as for holding their wee because they’re busy…I’m sure many of us recognise that. But that’s not about the age they learn, that’s just a small kid thing. They either hold it in, or wee all over your soft furnishings in my experience!

So should we be training early, or late, or not at all?

The science is mixed. There’s obviously the above claim, that training early may lead to problems. There is also some evidence that those trained late are more likely to have long term problems. However, as with any observational study, causation is a problem. Did potty training after three really cause these problems, or were a number of children trained after their third birthday because they had factors that would lead to long term problems? I suspect the latter. You can imagine that in the group trained after three, are those who just happen to be ready a bit later, those with developmental delays, those with physiological problems, those who are just very stubborn and prone to not cooperating. 

There are other studies that find age of toilet training has no effect on likelihood to suffer long term urinary complications.

And then there are other factors to consider. There is an interesting study, which suggests those with long term issues are more likely to have been asked to push or strain, that seems more intuitive to me than age, though again, there’s no evidence of causation. The same study also found more problems with kids who went straight to using the toilet and stresses the importance of a good toilet position (knees up, feet supported). 

Overall, the science is weak. What we do know, is readiness to be completely dry requires a mix of behavioural, anatomical and physiological factors. Here’s a nice review of the situation, though a few years old now.

And my own (largely anecdotal) thoughts on the matter

There have been several replies to the “Don’t toilet train your baby” piece. This one in particular breaks it down line by line! I’m not going to attempt to do that. I think there are some flaws in the assumptions made, that it is a bit of a scare-piece to drum up readers, and that he is trading on a sense of authority given his job title. I also don’t like the way he singles out one mum, albeit a particularly proud and maybe a bit boastful mum (we’ve all done it about something) and made her an object of his ridicule.

But here are my thoughts.

  • The advice at the end of the original article is sound: Don’t start toilet training if they’re constipated, remind your kid to go to the loo – get them to go every few hours at the beginning, keep an eye out for problems, don’t worry if they’re a bit late toilet training. This all sound like good advice to me.
  • But, I would add to that, don’t worry if your child happens to toilet train early. I am unconvinced there’s any science to say that you’re more likely to do harm,provided that they’re ready. It’s clear some children do develop bad habits, and wait too long to use the loo. This either results in them holding on and potentially causing problems, or creating a lot of puddles on your floor.
  • I would hazard a guess at what causes problems:
    • I am sure sometimes it’s the personality of the child. If you’ve got a little perfectionist on your hands, who likes to succeed, be mindful that he or she might not cope well if you start early and they fail. If your child is shy or stubborn, make sure you’re accounting for this as best you can.
    • I am also pretty sure that sometimes it’s the personality of the parent. As the original piece states, toilet training is not an academic exercise. Children will have accidents. Don’t push it, treat them with respect, read their cues, work it out together (easier said than done when they’ve wee’d on your leg in a cafe!! I speak from experience).
    • And I’m certain sometimes it’s just bad luck. Some kids will just end up with problems!
  • I think there probably is a “right time”. But it is probably fairly unique to the child. Try too early and you risk a lot of stress for everyone, possibly it’ll take them longer to crack it, and possibly there could be long term problems. Leave it too late, and maybe you’ve missed the boat. They’ve lost interest, decided nappies are easier and they’ll stick with them. Then you’ve got a battle on your hands. But I don’t think you can put an age on that. One child’s too early is another’s too late. 

What did I do?

Wel, I’ve only “done” one. Unusually for me I didn’t read any science. I did read a couple of webpages about readiness, but that was about it. We had one false start when Girlbug decided she was ready based on seeing other children using the loo. She wasn’t. It was messy. Then, on New Years Eve, at the least convenient time, she took her own nappy off, used the potty in the corner and never looked back. She was neither particularly early nor late, though we did move onto using the toilet quite rapidly due to Boybug’s blossoming fascination with all things water-like! Night times came much later. I was dutifully waiting for her nappies to go dry, but in conversation one day it became apparent that she was waking up, weeing in the nappy then going back to sleep. So we decided together to ditch the nappies.

Boybug will be next. I’m not trying that one until he stops chucking things down the loo – I’m not giving him a legitimate reason to be near toilets or potties for a while yet!

 

 

 

 

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