As a physician of a significant pediatric population, I am often asked questions about potty training… when it goes well, it goes well. When it does not, parents think/talk about it for years.

When to start potty training? More than 2/3 of US children achieve what is considered the cognitive and emotional development necessary for toilet training by 18 to 30 months of age. This also means that as many as 1/3 of children are NOT ready until nearer to age 3 or afterwards.

How do parents assess a child’s readiness? They need to walk, put on and remove clothes, follow simple instructions and have social awareness including an interest in using the toilet. Children may also show awareness of the need to urinate or defecate and discomfort sitting in soiled diapers. Other signs of readiness are asking to wear “big kid” underwear, regular predictable bowel movements and nighttime bowel control, stays dry for 2 hours at a time or during naps.

What if the child can urinate into the toilet, but refuses to defecate in the toilet? This happens in about 20% of children. The causes are many: pain from constipation, fears regarding defecation or using the toilet, local sin irritation. This is more common in children who bgin training after 3 1/2 years of age. First, your physician should rule out organc causes. Once that is done, avoid any advances in training for a few weeks and just observe to identify psychosocial issues causing the child to not want to defecate into the toilet. Some children will only defecate in a diaper or will hide to defecate. These issues will resolve. Rarely, your physician will refer your child to occupation or physical therapist, behavioral therapists or developmental pediatricians. Children with Down syndrome, autism or cerebral palsy may have more issues with toilet training.

I hope this helps.