According to the American Academy of Pediatrics (AAP), encouragement and praise are both very important throughout the toilet-training process. Parents and caregivers need to remain relaxed and calm. Accidents will happen and punishing the child will not help prevent them. It is best to treat toilet training in a calm, matter-of-fact manner.

The child’s temperament, including attention span and how the child acts in new situations, must be taken into account. For example, shy or withdrawn children may require more initial encouragement and direct questions. Children who are very sensitive or easily frustrated may need more soothing and constant encouragement. It is also important that all caregivers (e.g., day-care providers) know about the child’s toilet training and the methods that the parents are using.

Toilet training is a gradual process that requires time and attention. Bladder control usually, but not always, occurs before bowel control. According to the AAP, bladder training takes an average of 5.8 months for girls and 6.4 months for boys. Bowel training, the AAP reports, takes an average of 6.3 months for girls and 6.9 months for boys. However, many children are trained much faster (e.g., as little as three months) or take much longer (e.g., over a year). Staying dry during the night typically takes months or years longer, especially for boys.

It is beneficial to consult a child’s pediatrician before beginning toilet training. The physician can help determine whether the child is ready and can give advice and information. If any concerns arise during or after toilet training, another visit to the pediatrician can help.

Parents and caregivers can teach the child about the toileting process before toilet training begins. The child should learn words to describe the body parts, urine, stool and other important concepts. To prevent confusing the child, these words need to be simple but proper. It is important to use simple sentences and concepts that the child can understand and to avoid negative terms.

Parents and caregivers can look for signals that the child is urinating or having a bowel movement and ask the child about them. This helps the child to recognize these sensations. It also helps if the parent or caregiver recognizes the child’s bowel patterns. The child can be encouraged to tell when he or she has urinated or had a bowel movement or is in the process. Eventually, the child learns to tell a parent or caregiver before urinating or having a bowel movement.

Parents and caregivers who are toilet training their children can choose from child-sized chairs and seats. A “potty chair” is a separate chair designed for small children to use as a toilet. It is sized especially for small children and can be emptied into the toilet. This is generally the preferred option because it is easier to use and more stable than seats and less frightening than a full-sized toilet. However, these are typically not used in daycare facilities in order to prevent contamination and infection.

The seat is sized for young children and fits over the toilet seat. It helps a child to feel secure and stable. These seats need to fit securely on the toilet and should not wobble. When a seat is used, a stepping stool is recommended to help the child reach the seat and securely place the feet.

A child-sized potty chair or seat should be placed in every bathroom. It is also recommended that a potty chair be kept in the car for emergencies and traveling. It may also help to keep a chair in the child’s bedroom for convenient or emergency nighttime use.

It is important to let the child become familiar with the potty chair. If the child shows interest, allow him or her to pick out the potty chair. Treat the potty chair as the child’s personal property. Allow the child to personalize it (e.g., with stickers) and keep the chair in a play area before toilet training begins. The child can begin sitting on the potty chair clothed, like any other chair. Then, he or she can sit on it in a diaper. Eventually, the child will be comfortable sitting on the chair bare-bottomed.

Disposable training pants can be useful as a transitional step and for nighttime protection. When the child begins to remain dry for several days or nights, it may be time to switch to underwear. However, some children may consider training pants to be a different form of diaper and use them accordingly instead of going to the toilet.

It is typically recommended that boys sit to both urinate and have a bowel movement at first. This is generally easier and less confusing. The child can learn to urinate while standing later.

Toilet training steps and tips include:

• Soothe toilet anxieties. The loud sounds and flushing away of materials may frighten some children. It may help to allow the child to flush pieces of toilet paper or to say goodbye to his or her urine or stool as it is flushed.
  
  
• Dress the child appropriately. Use simple clothes that the child can remove and put on by him or herself.
  
  
• Demonstrate toilet use. Place stool from the child’s diaper into the potty seat or toilet. Parents and caregivers can also allow the child to watch while they or others (e.g., siblings) use the toilet. The child can also be encouraged to sit on the toilet chair while watching.
  
  
• Set routine potty time. Have the child sit on the potty chair or toilet as a part of the everyday routine. If the child shows signs of or actively says that he or she needs to use the toilet, this is also a good opportunity for toilet time. However, do not force the child to sit on the toilet.
  
  
• Consider a reward system. Offering rewards (e.g., stickers, activities) for successfully using the toilet can help to motivate a child. A chart may help keep track of successes. Even if a reward system is not used, the child should be praised after every success.
  
  
• Consider time without a diaper. Bare-bottom time or time in normal underwear may help the child recognize the feeling of needing to use the toilet. This is because some diapers and training pants are designed to draw moisture away from the skin, so children do not feel them as well.
  
  
• Keep hygiene in mind. Teach the child how to wipe correctly. For example, girls need to wipe from the front to the back. This prevents drawing bacteria from the rectum towards the vagina and urethra. Washing hands after every use of the toilet is also very important for both genders.

Accidents happen both during and after toilet training. However, frequent accidents throughout the training process may indicate that the child is not ready for toilet training. Children who have been trained may relapse during times of stress, such as the arrival of a new sibling, a move to a new home or childcare facility, or periods of familial stress. It is not recommended to begin toilet training during stressful times because the process may be affected.