by Miriam Kauk
Back when my one and only child was 20 months old a neighbor lent me a book by Azrin and Foxx called Toilet Training in Less Than A Day.
Two years later I was ready to train Mary who has Down syndrome and who was 2 years, 8 months at the time. Mary was nowhere near as easy as her brother, and in fact didn’t get the bowel training completed until after she started TNI (Targeted Nutritional Intervention) almost two years later. But she was 50% trained at the end of a day, and 90% trained by the end of a week.
A year and a half ago I tried to train another two-year-old son, Ernie and that was a miserable flop. He just wasn’t getting it. And I was too busy and too distracted by other children to give him the continued attention he needed. This method requires focussed attention for one complete day, and then consistent follow-through for several more. Ernie was three and a half and still in diapers because I could not carve out the day to be totally his.
At the same time I also had an eager 25-month-old, Danny. Though 3 year old Ernie was “wise” to this and determined to keep those diapers, Danny was ready. So, I used this method to train Danny 25 months old. Since failing with Ernie, I had learned some reasons that some are more difficult to train than others, and confidently predicted that Danny would be trained by noon. I was wrong. It took until 1:00 in the afternoon. Ernie was then jealous of all the positive attention Danny was getting, and was trained just as soon as I focussed on him for a morning. In all I have trained eight children with this method, one with Down syndrome.
I have read Azrin and Foxx’s book once, and all my references to it here are from a 10-year-old memory. I recommend that you get the book.
| Contrasting the Methods | Before Beginning Toilet Training |
| Getting Ready | Potty Training Day |
| After Potty Training Day | Miscellaneous |
Contrasting the Potty Training Methods
The usual method trains the mom instead of the child. The usual methods of potty training have mom putting the child on the toilet at prescribed times and hoping to catch the pee. Mom is responsible to keep the child’s pants/diaper dry. The child is dependent on mom to get her to the toilet, get the diaper off, or if there is an accident, to clean up the mess. Mom says, “Tell me when you have to go.”
In contrast, this method trains the child. The child learns the sensation of when she has to go, she is responsible to get herself to the toilet, do her thing, and get her pants back on. If she makes a mess, the child is responsible to clean it up, properly dispose of her dirty clothes, and find clean clothes. Instead of the monkey being on mom’s back, it is on the child’s back.
This is an intense method. For at least one whole day you will do nothing else but potty train your child. Nothing else. It is exhausting for mom, (or the designated trainer). The key to the method is that during that day you pump your child with liquids so she has to go every 10 minutes or so. In NACD parlance this is frequency. In the usual method, you try to potty a couple of times a day. In this method, you child will actually have to pee 30 or so times in that day. You pack a lot of training into this day. For an entire day you will be cheering, and encouraging, cajoling, coaxing, long after you want to wring your little sweetheart’s neck. You will be exhausted.
This method introduces a major change in the child’s life routine. When you decide she is ready to be trained, be sure, because there is no looking back. On this day you say good-bye to diapers. In NACD parlance this is duration. From now on, and forever, your child will experience a negative consequence every time she pees in her pants (it goes running down her leg). If you back off and put her back in diapers, or pull-ups, then she knows this pottying business is optional, and will take advantage of that option. This is not optional. You are the mother, and you have decided that she will wear pants and not diapers, and she will experience consequences for not going to the toilet.
The goal of this method is to have dry/clean pants. The goal is not to produce in the toilet. That is just a necessary step to dry/clean pants. And dry/clean pants are their own reward.
This method is not for the faint hearted. If you can’t bear to wipe up pee from the floor, or the carpet, keep her in diapers. If you are unable to cope with poop in underpants, keep her in diapers.
Description of this Potty Training Method
This method is based on that written by Azrin and Foxx in their book Toilet Training in Less than a Day. I believe it is still in print, so a bookstore would be able to order it for you. Or ask your library. If they don’t have it they can probably get it interlibrary loan. I read this book once, 12 years ago, and in my experience with training 8 of my children, have modified their method based on my experiences. I recommend that you get the book.
This method incorporates several elements.
1) Training a doll
2) Lots of fluids
3) Positive practice
4) Wet pants checks/dry pants checks
5) Peer pressure
6) Prompts that get increasingly less direct
7) Rewards
First I’ll talk about getting your child ready, then I’ll address each element of the method.
Before Beginning Potty Training
Beginning when I am changing the diaper on a baby, I start talking about it being wet or dry. I want my baby to be able to feel the difference. This is easy for me, since we use cloth diapers. If you use disposables, you might want to switch to cloth for a while before beginning training, just to help teach this concept. When my toddler is pooping, I call it to his attention, name it, “poop,” and then we change the diaper. I freely talk about bodily functions to my toddler.
When the baby begins to walk and follow me into the bathroom, I allow him/her to come in. They are so curious about what I do in there, and are fascinated with the mystery of the toilet. Give her input. Teach her during these times. Let your child watch.
NACD has taught me that you can’t get the desired actions from a child without putting the right input into the brain. I use these early toddler months to give lots of input on how the body poops and pees, and much of that input is by allowing my child to watch. Ideally, they could get this learning by watching themselves, but we parents put those diapers on purposefully so they can’t!
If you have a boy, you have to get your husband into the act, and get your son into the bathroom with dad to watch.
Auditory Processing: Digit Spans and Potty Training
Evaluate your child’s digit span. A child successful potty training will be possible with a digit span of 2-3. I did not learn this until after I trained (with difficulty) Mary whose digit span at the time was probably 1-2, and after I failed at training Ernie, whose digit span was also just barely 2. When I trained 25-month-old Danny last week, I knew his digit span was 3-4 and so I confidently predicted a three hour training time, and in fact it took all of four!
Obedience
Your child must have a habit of obedience. When you say “sit down” you must be getting obedience. At first, you will say “sit down” and put the child down. Then you will progress to placing your hands on the child and pressing down, to get them down. Then maybe you will progress to slight pressure on the shoulder after the command. But you are not ready to begin potty training with this method unless you usually have obedience with a command and without a physical touch. If the child is reluctant, you must use increasingly stronger touches until you get the action you are requiring. Because, by the time you are done with your potty training day, you will assuredly have had times when your child was very opposed to obedience. It will help you greatly if you have been practicing requiring obedience. (Realize that a lack of obedience may only be a reflection of a low digit span or poor auditory processing, meaning that the child really doesn’t quite understand what you want.)
For example, when you say “run to the toilet” and she just stands there. You may get obedience with just a light nudge and just an encouraging, “Come on.” Or you may need to put your hands on her shoulders and propel her. But once she is going on her own, take your hands off and let her obey on her own power. During the time before your training day, you should get her used to obeying every command, every time. This method will not work without an obedient child. This means diligence from you. You have to follow through on every command until you have gotten obedience.
Before training day, begin teaching your child to pull up her pant/slacks. Use the “you pull up the front, I pull up the back” routine. If they can’t pull up the front of their own pants, they are not yet ready to potty train. Teach them.
Getting Ready
Get a large supply of underpants. Lots and lots. If you have older children, commandeer theirs. Borrow. The underpants should be a bit large so they are easier to pull up and down. Time enough for tight ones later when she has more skill. Twelve is the minimum number you should have. Twelve is for an ideal day, which you won’t likely have. Get lots.
Have a warm house. Summer is best for this, since your child can just wear pants. If she must wear a shirt, pin it up so that the bottom is not in the way of the underpants at all. On potty day, have underpants only on the child’s bottom. Nothing else in the way.
Put your potty in a large enough room for you to work in. You will have lots of pee on the floor, so consider that. I use the kitchen. I don’t want to spend my day in a cramped bathroom.
Get everybody else out of the house but you and the trainee. No other siblings. You can not afford to be distracted today.
Potty Training Day
Training a Doll
Get a doll, large enough to sit on the potty. (The book recommends a certain kind of electrical potty that has an alarm. This is not necessary.) The book recommends a doll that pees. Not necessary. Just any doll or teddy bear that is of appropriate size will work. Put underpants on the doll. Have some tasty treat ready for a reward. Get some kind of squirting implement. I use one of those nasal aspirators that you get from the hospital for your newborn. Fill it with water and put it upside-down in a pocket of a large apron that you are wearing.
Tell your child that the doll is wearing big girl pants and is going to go to the toilet. Have your child check the doll’s pants. Yup, they are dry! Good Doll! Sit the doll on the pot. Inconspicuously, without your child seeing, squirt some water into the pot. With my potty, the aspirator squirts nicely into it from the back.
Have your child discover that the doll has peed in the potty. Go ballistic. Cheer and shout.
Good Dolly! Offer the doll a treat. When it doesn’t eat it, offer it to your child. What a good doll we have. Pee in the toilet! Get the doll off the toilet. Help your child pull up its pants.
A while later squirt some water on the doll’s pants. Have your child discover it. Go ballistic with your disapproval (directed of course at the wet doll). Have your child shout, “NO, No” and scold the doll. Wet pants! Yucky! Pee goes in the toilet, not in our pants!
Do wet pants checks on the doll. More details are below. Have your child touch the doll’s pants, declare that they are wet, and have your child shake her finger at the doll and scold, “no, no, no!” Do ten repetitions of this.
Now have your child help you do positive practice runs with the doll. For details, see below. The idea is that you are running the doll through all the paces that you will be running the child through in a few minutes. You take the doll and have it practice going to the potty, for 10 repetitions. Have your child pull down and pull up the doll’s pants.
Fluids
Meanwhile, you are giving your child lots to drink. Forget about nutrition for the day. What you care about is liquid. Stock up on juice boxes, caffienated colas (makes ‘em pee more), make Jell-O, etc. Get a variety, and get stuff you know will be seen as a treat. Forget about milk. Mixing milk with so much other juice gives them an upset stomach. Serve a light breakfast, mainly fruit. Get a bunch of very salty treats. That store-bought popcorn is great. It is so salty that they are often willing to take another sip of juice. Have a goal of getting at least 8 ounces (one cup) of liquid in them every hour.
When they are reluctant to take another drink, try these ideas:
Take turns. Put the glass to your lips, then to dolly’s lips, then to the child’s lips. My kids will usually take just one sip since it is their turn. Go around again: Mommy, dolly, child. Or try using a straw in a juice box. You can squeeze the juice up, and often when they taste it, they will swallow a bit. Or switch drinks for variety. Or offer some salty food. When they rebel at even one more sip, then start offering Jell-O. Last week I got an entire cup of Jell-O into my child after he absolutely refused another drink of any liquid.
All this fluid will create the need to pee every 10 minutes or so once they get going. And the need will be strong. Intensity.
Positive Practice Runs
This is the part the child will hate, yet it is the part where you will be giving the most input. It is behavior modification, pure and simple.
When your child has an accident on the floor, she must practice. She must practice what she should have done instead of peeing on the floor. You take her to the scene of the crime. You ask where she should go pee. You answer for her, “in the toilet” Make her say it. “In the toilet.” Then you go through this litany:
“When you have to go pee, you run to the toilet.”
“Run to the toilet! Quickly! Run! Run!” (You use as much physical pressure as necessary to get her to start running.)
“Turn around.”
“Pull your pants down.”
(You help her get her thumbs in in-back to get it over her rump)
“Sit down” (for just a half-second)
“Stand up”
“Pull up your pants.” (This is the yucky part, because they are wet!)
Throughout this practice you guide her hands and body to obey you. You pull your hands back whenever she is doing it on her own. Pulling up and down wet pants is hard, and she will need more help with this, but you must get her hands doing it. No fair doing it for her. You didn’t pee on the floor, she did!
Do not let her stay on the toilet during the positive practice trials. Just get down and up quickly.
The book says to do 10 positive practice trials for each time she has an accident. My experience is that this takes so long that they have another accident before we are done. Or the child is crying so much that I relent, softy that I am, and quit after about six practice runs.
After taking the child to the scene of the crime for two or three trials, take the child to other areas in the room/house and begin the practice run from there. “When you have to go pee, where do you go? To the toilet? Show me!”
After the practice, you have the child wipe up the pee, and put on clean pants. By this time it will be time to pee again.
Do not run the child through the positive practice for peeing until after she has had at least one victory on the toilet and experienced the exuberant praise you have in store. I made this mistake with my oldest, and since she peed on the floor right after I put her underpants on, I made her practice. It took a long, long time to recover from that negative start. This is why, I think, that her training took several days to complete.
Wet/Dry Pants Checks
You will train your child to be aware of whether her pants are wet or dry. Whenever she wets her pants, you will express strong disapproval. Then have her touch her wet pants. Ask, “Are they wet or dry” Make her answer, “wet.” Have her touch your pants in the crotch. (I told you this method is not for the faint-hearted.) Ask if mommy is wet or dry. Make her say dry. Do 10 repetitions of this.
Later, when she is dry, ask her to touch her pants. Have her say “dry.” Give abundant praise. Give lots of praise throughout the day whenever the pants are dry. Later this will become your prompt to remind her to go to the toilet. And later this will be the reason you give treats, for discovering that she has dry pants. (This is in theory. In reality, I usually end up giving treats for producing in the toilet long after the book says I should have stopped.)
Peer Pressure
Make a list of everybody in the world that the child cares about. Include family members, teachers, Bert and Ernie, everybody. You see, they all have dry pants. Use this to fill your lulls while you are waiting for her to have to pee. Keep up a banter about all her friends and their dry pants. “Daddy has dry pants. Mary, touch your pants. Dry! Good Girl. Just like daddy! Sister has dry pants. Mary, touch your pants. Dry! Just like sister! Sister will be so proud of you.”
When she wets her pants, use the peer pressure again. “Does daddy have wet pants? No! Touch your pants. Wet! Your pants are wet. Does mommy have wet pants? Grandpa has dry pants! Your pants are wet. Teacher has dry pants. Touch your pants. Wet! No, NO! Keep your pants dry”
Increasingly Less Direct Prompts
At the beginning of the day you will be commanding the child, “Go sit on the toilet.” Once your child has had success after this prompt, go to a less direct prompt and then one even less direct. Notice how the following prompts get less and less direct:
Do you have to go pee?
Where is the toilet? Show me the toilet?
Are your pants wet or dry?
Your pants are still dry. You are a good girl!
Rewards
You will begin with some very intense reactions to every success. You will offer the tastiest junk food for success. You will jump up and down and cheer. You will praise the child for every little thing they do right. If they start to run in the right direction, you praise. If they get their thumbs into the waistband of the underpants, you praise, even if you had to put the thumbs there. You praise, and praise and praise. Carry on a constant banter of praise. Done well, this is a very positive day for your child.
After Potty Training Day
Never go back. Duration. Diapers are only for nighttime now. Forget the pull-ups. The child needs to experience the consequences of peeing. The monkey is now on her back. The child should wear underpants for naps. I told my oldest daughter that “big girls” always slept on bath towels on their beds.
Take a potty with you wherever you go. If you are going on a trip, have a potty in the car. Don’t resort back to diapers! Whenever you go into a new building, take an excursion with your child to find their toilet. If the child is afraid up on a big toilet, or can’t get up there, take your potty with you. The child cannot be responsible if you don’t provide the means.
Some moms on the MOMYS Digest (a great list for Mothers of Many Young Siblings) suggested lining the potty bowl on trips with a plastic bag. Put in a bit of Kitty Litter. The mess is easy to clean up, and your child can still be responsible for staying dry.
Bowel Training
Poop is a huge problem. Mary, (Down’s syndrome), 2.5 years old, could poop in the toilet, but was afraid to. She just knew it would hurt. So she would hold it in for days, and then, sure enough, when she finally did go, it would hurt! For a while I was giving a teaspoon of castor oil, to keep her soft, every other day or so. Just so she could experience pooping without pain. I learned to recognize a little catch in her breath whenever she was resisting a poop, and I would run her to the toilet.
Seven of my eight children, for whom I’ve used this method, have pooped in their underpants for a while after being bladder trained. But to put them in diapers to catch the poop would mean to give up the bladder training. Only two did this for long. They don’t like poop in their underpants! Mega-yuck! Mary did it until we started her on TNI, then was consistent with bowel movements in the toilet shortly after that. My belief is that her problem was related to a serotonin deficiency (serotonin is responsible for gut motility), and the tryptophan in NuTriVene-D solved her problem.
Definitions
The usual definition of a toilet-trained child is: The child gets his pee and poop in the toilet. The definition in this method is: A potty-trained child takes care of his own toileting, without reminder, without help, and takes care of his own accidents. This is how we expect a mature child or adult to act. You and I do it all by ourselves, and if we have an accident, we just take care of it.
Emptying the pot
In the book, the authors take this a bit farther than I am willing to do with a two-year-old. They want you to have the child empty the pot in the big toilet. I tried this with my oldest daughter. Mistake!
This advice was obviously written by men and not mothers. What an unnecessary mess! It is not so bad if it is just pee in the pot, but it is not always just pee. Just have your child leave the pot alone, and you can deal with it at your convenience.
Toilet paper
The authors want you to teach the child to wipe on this day. Skip it. A two- or three-year-old’s arms are not long enough to reach far back and do a proper job. Mom, you just have to do this chore for a little while longer.
Miscellaneous
Potty Training Boys
I have trained four boys. None had Down syndrome. Two were under two years old. I trained two at the big toilet and they were the fastest of all my little trainees. With Charlie, after he had had two cups of liquid I stood him on a stool in front of the toilet and kept feeding him juicy grapes to get him to stay there. He stood there 45 minutes, peed, and understood.
During that morning, Charlie needed to poop. He didn’t announce it, but worried that he would poop on the floor, he climbed up on the big toilet, maneuvered himself around, straddled his legs over the width of the toilet, and pooped. This is a rosy scenario. It doesn’t usually happen this way. I think it worked so well, because he had observed daddy and knew how this was supposed to work.
Last week I trained Danny by standing him in front of the big toilet on a stool. He resisted an extremely full bladder for over an hour (16 ounces of juice plus 8 ounces of Dr. Pepper), but finally couldn’t resist any longer and peed into the toilet.
Some little boys do better to climb up on the big toilet backwards, and straddle the seat. This way they can hold on to the back of the seat and lean forward. Generally I think I like the big toilet better for boys.
Colds
All of my children seem to have accidents when they have colds. I am not sure the relation. Maybe sneezing makes them incontinent.
More on this site about Toilet Training
Originally posted on the DS-Nutrition email list in 2000. Copyright Miriam Kauk
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