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Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels.

Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And joining me today is Dr. Alison Austin. She's an instructor in Pediatrics at Weill Cornell Medical College, Cornell University, and an assistant attending pediatrician at New York Presbyterian Hospital Weill Cornell Medicine, and she's here to highlight common issues when potty training our little kiddos and tips on how to help.

Dr. Austin, thank you for joining us again. So, this is always one of my favorite kinds of topics because it's something that parents, especially those new parents, really sit there and fret over. So, tell us a little bit about when we start potty training our little guys.

Dr Alison Austin: Well, thank you so much for having me. I think this is such an interesting topic. The best time to start potty training really can vary depending on your child. And you know your child best, right? So, you may be seeing those signs and starting to think about it and talk about it with your child. But generally, we say from the range of 18 months to two, two and a half years of age is kind of the best time to maybe start. Your child should have more of an awareness about his or her own bodily functions, and we can talk a little bit more about what that might look like. But usually, I say around 18 months to two and a half years.

Melanie Cole (Host): So then, why don't you expand on that with readiness signs? We know our kids, as you say, they've got to have a little bit of an awareness of what's going on with their bodies and certainly when they need to do things like that. But what are those readiness signs? How do we know?

Dr Alison Austin: Yeah. So, you might start to notice your child going to a different area of the home when he or she needs to pass a bowel movement or urinate.

Melanie Cole (Host): I don't mean to laugh, but they do. They go hide in corners and stuff.

Dr Alison Austin: They're so sneaky signs, right? That private moment where they sneak away. Or perhaps, they may take off their diaper, be very irritated and uncomfortable when sitting in a dirty diaper. So, that could be a sign that they're just more aware. Some children are more verbal about it and might tell you like, you know, that they're interested in wearing underwear. There's like an older sibling perhaps or might be going into the bathroom more and checking out the potty. So, those are some of the more subtle signs.

And sometimes children can just go for longer stretches during the day. They seem dry for longer periods of time. And so, that could be a sign that they're able to kind of retain urine or stool a little bit better and have better control over those bodily functions. Those are the major things.

Melanie Cole (Host): They are. So, sometimes we hear boys and girls train differently. How long should it take? And is there something we're supposed to do different when we're training boys and girls?

Dr Alison Austin: I'm not so sure that it's the case that they respond differently to different techniques, but I think that there are important nuances when potty training males versus females. For little girls, it's very important to emphasize proper hygiene and just wiping from front to back in order to prevent irritation or infection, which sometimes we see during the potty training years. So, just providing an emphasis and learning moment for that for little girls. And for little boys, of course, just practicing aiming in the potty. But sometimes it's easiest to actually start by having the little boys sit on the potty first. And then when they feel comfortable, trying to aim in the potty. And then also, sometimes experts recommend that a role model in the home, a close caregiver, kind of models the toileting behavior, so the full routine. And so, having a role model of the same biological sex kind of modeling those behaviors can be helpful for children too, to see how it's done.

And as far as your question how long it should take to potty train, it really depends on the child. There's no real rush in doing it, right? And so, sometimes it can take a couple weeks, sometimes it can take longer, a couple months, or even over the course of a year or two. Some children aren't fully potty trained overnight until age five or six, and we know that that can be normal. So, just kind of approaching it patiently.

Melanie Cole (Host): So, I remember, Dr. Austin, when my son begged me at night, "Please, can I wear underwear? I promise." He said, "I won't pee in my bed. I'll get up if I have to go to the bathroom, please." Oh, it just sent my heart into little flip flops and I was like, "Of course." And on the underwear he put and nothing ever happened after that. So when in the course of that potty training do we take off the pull-ups and start with the underwear? Do we do it right away at the beginning or do we kind of leave the pull-ups on in case of mishaps?

Dr Alison Austin: It sounds like your son was really confident and was able to kind of verbalize his confidence and the skills that he at least learned already. So, that's great. You know, once you kind of see those exact signs, a child is verbalizing interest, and maybe they've mastered the skill during the day. So, sometimes it's easiest if we know that we're able to do it for most days, stay dry in underwear, then trying it overnight. So, doing the underwear during the day and pull-ups at night to start, and then moving more towards underwear overnight, that could be a good process for a lot of families. But sometimes it helps to fluid restrict a little bit, like an hour or two before bedtime. Avoid chugging a glass of water, milk, and just making a bedtime routine out of using the toilet and washing our hands and brushing our teeth every night. So, those are some small, helpful things to get a child to be ready.

Melanie Cole (Host): Well, they are helpful. I mean, all of this is helpful. And parents, I hope you're writing it all down, but you know you can always listen to the podcast again. Now, one of the big questions is how do we know when to back off? You know, sometimes kids get frustrated with this. It's not always that easy to learn for all kids. When do we back off and say, "It's okay, we'll wait a month or two or another couple weeks and we'll try again"? How do we know that?

Dr Alison Austin: I would say if there becomes a time in your child's life where there's a major life change or a major life stressor, then I would probably hold off on aggressively potty training during those times. If your child seems very frustrated or there are negative feelings or feelings of shame around potty training, then I would probably back off and maybe reassess in a month or two to kind of see what's happening with that, or if there's any medical reason to stop potty training. So if your child is displaying behaviors of withholding urine or stool and it's causing issues with urinary tract infections or constipation, then I would talk to your doctor at the time and maybe we just put the diapers back on if needed. So, those are some reasons to sort of back off.

Melanie Cole (Host): Constipation's a whole 'nother podcast, Dr. Austin, and one that I dealt with with my son. My goodness. Okay. So, other tips as they're doing that and sometimes kids have relapses and they have accidents. When that happens, how do we reassure them that it's just normal, it happens? You know, because now they're going to start maybe kindergarten or preschool and they're really worried that maybe they're going to have an accident at school, they don't want to wear training pants because those show. So, how do we reassure them when those little relapses happen?

Dr Alison Austin: I think that's an excellent question. All experts agree that one of the most important approaches for potty training is just keeping things positive, right? And keeping any shame or negativity out of the process. And so, it's really important when those accidents happen to be just very cognizant of your response and kind of avoiding language that has any negative connotation with it, like words like "Yuck" or "Ooh, that was smelly or gross" or things like that. Even though that might be how you're feeling in the moment, just avoid saying that. And then, recruit your little one to just help maybe put the clothes in the laundry and just say, you know, "It's okay. Accidents happen." And then, allow him or her to choose, "Would we like to try to wear the underwear again or do we want to put on our pull-up?" And just try it again, right? It's not absolute defeat, it's just part of the process. So, just keeping that in mind.

Melanie Cole (Host): Well, this is all really great information. So, wrap it up for us. Nighttime potty tips, because that's just a little bit different than nighttime. You know, it's a longer period and whether we wake them up or they wake themselves up to go. Or they're afraid of the dark, so they don't want to go by themselves. There's all those kinds of things that happen. Boy, I remember it all very fondly. Those times go so fast, Dr. Austin. Give us your best advice to wrap up our potty training tips of the day here from Weill Cornell Medicine.

Dr Alison Austin: I think I would just like to say that the confidence that comes overnight follows after the child is really confident with routines during the day. And so, I think working on those daytime routines with potty training really solidifies the foundation for them to be confident to go on their own overnight if they need to get out of bed and go to the bathroom.

So, things like starting each day by putting the child on the. potty and even if they just sit for one or two minutes, just a lot of positive reinforcement and praise, and getting good routines with it. But just keep in mind that this really should be a fun process and, for the child, it's a really big deal. This is kind of their first coming of age moment where they really can feel the importance of how this kind of impacts their coming of age, like I said, and just integrating into society. ,So it's exciting for them and there's a lot of pressure sometimes it seems, but just kind of sticking with the process and, again, positivity always.

Melanie Cole (Host): Positivity always. And it is an exciting time when you're a parent. It is that time, it's like a first step. It's something that, wow, this child is out of diapers, and they can do this all on their own. And I just think it's adorable when they let you know they have to go and they go sit on that little potty, it's so cute.

Thank you, Dr. Austin, for all of that great advice. And parents, remember to share these shows with your friends and family on your social channels. We're learning from the experts at Weill Cornell Medicine together.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify, and Google Podcast. And for more health tips, go to weillcornell.org and search podcasts. And don't forget to check out our Back to Health, so many great podcasts there as well. I'm Melanie Cole. Thanks so much for joining us today.

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