Sunday, 18 June 2017

Thoughts on Potty Training

I am going to try to tread lightly as I write this post. I have discovered that discussing potty training among parents is as sensitive a subject as religion or politics. Please accept that this piece is merely the mussings of a Mom who read one book on potty training (The Tiny Potty Training Book by Andrea Olson) read the blog of a prominent potty training author (Jamie Glowacki of Oh, Crap! Potty Training fame -both are outspoken advocates of earlier potty training) and has spent six weeks potty training her only 22 month old child (N=1). I respect that not all training methods will work for every child and every family has unique needs for potty training. I'm just finding that I'm suddenly very passonate about a topic I never thought I'd give a crap about (pun, intended).

About 12 years ago, when having kids was the furthest thing on my radar, I received a Christmas card from my cousin in Washington state. She included a family newsletter and went into vivid detail discussing her younger son's potty training. He was a month away from his 4th birthday and I thought that seemed rather late. I did a lot of baby sitting in the 80s and early 90s and I couldn't recall ever diapering a kid older than the age of 3, with the exception of a 6 year old girl with Down Syndrome who needed a night time diaper. My other cousin's sons weren't potty trained until they were nearly 4 years old. Little Myrtle was still using Pull-ups by her 4th birthday and she finally was able to poop on the potty after spending a weekend with her grandmother. Knowing Mrs Myrtle as I do, I suspect she declared that she wasn't going to diaper a 4 year old kid and took the bull by the horns. I just knew I didn't want to be dealing with diapers for that long.

Long before Kate was ever a frozen embryo in the lab, I decided I would use cloth diapers. The decision was motivated by a desire to be environmentally conscious, a throwback to the fact that I was cloth diapered, but I had also heard that babies who wear cloth diapers have an easier time with potty training as they know when they are wet. What I didn't know is that historically, children who were cloth diapered were potty trained at a much younger age. Prior to the debut of disposable diapers in 1959, nearly all kids in the United States were fully trained by the 18 months. As of 2001, the national average in the US was 35 months for girls and 39 months for boys. The time frame has nearly doubled in 50 years. Larger sized diapers that used to be available only by prescription for older children with special needs are now available in almost every store, while it's nearly impossible to find underwear or training pants in a size less than 2T. This fascinates me. It doesn't make sense from an evolutionary perspective for children to regress in their ability. What has changed in that time? Disposable diapers became very convenient for parents and as their technology improved over time, they are keeping kids drier. Jamie Glowacki cites disposable diapers as the sole reason for the increase in the age of potty training. The shift to working moms also explains a lot as well. More so, attitudes and perceptions have changed over time. Recently a Facebook friend inquired about a potty for her 18 month old daugher, and the first person to reply commented that she's "too young". Too young? In 1959 it would be considered late to be starting at that age.  
Shortly after disposable diapers were being sold on the shelves of every local supermarket, in 1962 a prominent pediatrician T. Berry Brazelton published a research paper entitled A Child-Led Approach to Toilet Training, which suggested that mothers wait for kids to show signs of "readiness" before trying to potty train. However, the piece was largely the opinion of Dr Brazelton and it used retrospective data from the charts of 1,170 children over a ten year time period. Oh, and Dr Brazelton was a paid consultant for the Pampers Institute. I admit I'm a sucker to beleive a conspiracy theory, but it's not too hard to connect the dots. If parents wait longer to train, they'll spend more money on expensive disposable diapers. It's promotion of consumerism. One of the reasons I was so emotional about leaving our cloth diaper service is that they were encouraging me to train earlier and be done with diapers sooner, even thought it meant they would be loosing a client. I feel few businesses still have that integrity.

What exactly does it mean for a kid to be 'ready'? In her blog post, Jamie described a conversation she overheard at a playground.
Mom A: My son is really interested in the toilet. He loves watching everyone pee. It's so cute!
Mom B: You should start potty training!
Mom A: Oh No! I'm going to wait until he's ready!
Jamie's point: That IS him indicating that he is ready!!!

Both Jamie and Andrea refute the notion that you need to wait for readiness, and Andrea actually turns the question around; Are you [the parent] ready to potty train? A few points that they make: Some children actually never show any signs of interest or readiness. Others may show interest at an early age (sometimes deemed too early) and parents may wait for that interest to cumulate, but it may not. Very few children self-iniitiate toilet training. Those who do are the exceptions, rather than the norm. It may be hard to tell as their parents are likely to brag very loudly.They both share from their experiences that it actually becomes harder to train, the longer you wait. Children begin to exert their independece and respond with the word NO. However, I know of two friends who had experience potty training another child, and needed three good attempts with a second child before the child was 'ready' for it to take. Perhaps, rather than 'wait for readiness' before trying to train, maybe the message should be; 'try to train and see if your child is ready.'

Both authors teach the naked training method. Let your kid run around naked and when you see him or her starting to pee or poo, air-lift them to the nearest potty, so you can teach that pee-pee and poop go in the potty. Kids' brains will progress from No-clue, to I-peed, then I-am-peeing, and finally I-need-to-pee. As it starts to click with their minds and bodies, you start adding layers of clothing and work on prompting them to pee at transition times such as outings and bedtimes. Andrea argues that Pull-ups should not be used from training as they are essentially diapers. They are diapers that are easy for your kid to push off and pull up, but they are still going to keep him dry and may keep him in the No-clue stage. This really resonated with me as I felt it mirrored Whole 30 Rules that you cannot recreate treats with approved ingredients during a Whole 30. To your brain, eating faux soft serve with frozen bananas is the same as eating ice cream. Whole 30 refers to it as trying to have sex with your pants on (SWYPO), which is maybe not the most appropriate analogy for potty training, but I appreciate it when aspects of my adult life overlap with my mom life.        

Andrea in particular, disputes the need to have kids practice sitting on the potty to 'get used to it'. This is in contrast to what I heard a pediatrician tell parents when I did my clinical rotation in 2001. "Have them sit on the potty for a while, brings books and make it a fun and inviting place." Andrea argues that sitting on the potty just for practice teaches nothing and may even be counterproductive. I think this makes a lot of sense, and as an added bonus it defies conventional wisdom. There isn't really need to practice. It's not that different from siting on a chair. Also, we don't do it at any other time. We put our babies in a high chair and fed them their first solids. Does anyone strap them in to allow them to adjust to the chair while the baby is left wondering what is going on? Do we let our kids get used to their new car seat before we put them in and drive? Let them get used to the stroller before going for a walk? It seems much more effective to show them what to do on the potty. One other aspect I appreciated from Andrea and Jamie is that their training styles do not involve rewards. I was fearful of using rewards because...when do you stop? My colleage admitted she bribed her son with a Star Wars Lego set. The little girl who went viral after she defended her choice of a black doll to a Target clerk is going to be mortified when she grows up and learns that it was because she pooped on the potty for a full month. Jamie admits that some parents do have success with rewards, but in her experience she has seen more diasters with rewards and makes her case with this post. I do have to admit that sometimes do a celebratory 'pee-pee-in-the-potty!' dance for Kate when she is successful.

Kate and I went to a picnic this past weekend and there were two other children present, both less than a year older than Kate. One Mom noticed that Kate was wearing training pants and asked if we were potty training. As I described our journey from doing well at home, complete disaster on our first trip out and to my discovery that IKEA is a great place to practice, she simply replied "Oh, I don't want to push my son." I didn't know how to reply at that moment, and it's probably best that I didn't say anything, but so many thoughts came flooding through my head. Why is potty training perceived as such a negative experience that we feel the need to protect our kids from it? Maybe I'm too green and nieve, but I don't think of it as pushing as much as you're giving your kids an opportunity. I get it that no one wants to be forcing a screaming and crying child onto a potty. Yet how many kids resist and cry when they try any new activity? We teach them to overcome their fears and discover that soccer, swimming, art lessons can be fun. It's a skill they are going to need to know one day. At some point in time they will need a nudge of encouragement from the parents.

 So much of the concern about pushing a child or training prior to readiness stems from a perception that we may be pyschologically damaging our childen by potty training too early. Both Andrea and Jamie explain that there is some historical background associated with this notion. In the 1940s it was common practice to strap a child to a potty and use soap suds enemas to adhere to a rigid pooping schedule, which was abusive, coersive and potentially pyschologically scarring. That was not normal potty training. Normal potty training is not damaging. Looking at the timeline of the potty training age, it would imply that all babies who were potty trained by 18 months prior to the invention of disposable diapers are pyschologically damaged. As would be all the people in many other parts of the world where potty training is completed earlier. Andrea shared her experience of visiting a village in West Africa where no one uses diapers and noted that there was not an abudance of mentally ill people. Jamie used to work as a social worker and shared her experience that she worked with a lot of children with severe psychological disorders. Not a one was associated with early potty training. Andrea also notes that once potty trained, kids have an enhanced sense of self esteem and can even feel more confident approaching social interactions.  On the flip side, could we ever see any effects on the esteem of those who are potty trained later? As older children become more self aware, how will they react to seeing younger children who are out of diapers before they are? Some children have been dismissed from preschool and even kindergarden due to incomplete training. It does happen. Talk about applying pressure to the training process. A former day care worker shared with me that she had a three and a half year old kid in her class who had to ask his mother to hide the diapers in his room when his friend came over for a playdate.

I fully acknowledge that there is no one size fits all approach to potty training. I also admit it's not easy. Andrea describes that the learning curve with potty training it's not a straight line and I repeat that to myself quite often. Kate quickly grasped how to announce that she needs to pee and can make it to the potty in time, but she still needs lots of practice. Challenges such as outings and Day Care still need to be conquered, as well as naps and overnight, which we'll get to at a later time. We're
off to a good start, but I'm constantly reassessing my tactics. Am I overprompting? Maybe I need to give her a little more space. She's had a few misses today; maybe I need to be more vigalant about directing her to the potty. She hasn't peed in a while; is she improving her bladder control or avoiding the potty? The one thing I'll conclude from my limited research and short time experience is that one shouldn't be fearful of potty training and shouldn't delay training due to fears. It's not as bad as you may think.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          

Kate was a little skiddish the first time I brought out the potty;
so we started putting dolly on the potty first.
Now they go potty toghether.