When and how to start toilet training

Most children are ready to start toilet training somewhere between 2 and 3 years, and readiness matters more than age.^1,2 Starting intensive training very early tends to make it last longer, without an earlier finish.³ Night dryness comes later, and wetting the bed is common until about 5 years.⁴

What age should toilet training start?

There is no single right age. In the US, most families start between 2 and 3 years, and most children are trained by 4.¹

Signs that the bladder and bowel are coming under control usually appear between 18 and 24 months.¹ In a study that tracked children week by week, most did not master the basic readiness skills until after their second birthday.² Girls tend to reach each step a little earlier than boys.²

In India, many grandmothers expect a child to be "clean" by 1 year, and some families begin holding babies over a basin from early infancy. That can work (see below), but please do not compare your 2-year-old with a cousin. The normal range is wide, and can differ by up to a year.²

What are the signs my child is ready for potty training?

Your child is probably ready when she stays dry for 2 hours, knows when she is about to pee or poo, and can follow simple instructions.¹

The AAP lists these signs of readiness:¹

• Dry for at least 2 hours at a time, or dry after naps
• Shows she is about to pee or poo, by grunting, squatting or going still
• Follows simple instructions
• Walks to the bathroom and helps pull her pants down
• Does not like a wet nappy and asks for a change
• Asks to use the potty, or to wear "big girl" or "big boy" pants

On average, interest in the potty appears at about 2 years, and saying "I need to go" at around 2 to 2.5 years.²

How long does toilet training take?

It varies a lot, from weeks to months. Children who start intensive training at a younger age usually take longer from start to finish.³

A study of over 400 children found that starting early led to a slightly earlier finish overall. But starting intensive training (asking a child to sit more than 3 times a day) before 27 months did not lead to earlier success, and it stretched training out.³

In the same group of children, those who finished late were more likely to have started late, to refuse to poo in the toilet, or to have constipation.⁵ The median age for staying dry during the day was about 32 months for girls and 35 months for boys.²

So pick a time when your child shows the signs, then expect weeks, not days.

How do I start potty training step by step?

Begin with a small potty, a regular routine and plenty of praise. Keep it calm and low pressure.

1. Choose your family's words for pee and poo, and avoid words like "dirty".¹
2. Get a potty where her feet touch the floor.¹
3. Let her watch you use the toilet and wash hands.¹
4. Make sitting on the potty a routine, starting first thing in the morning.¹ Many families add other set times, such as after meals.
5. Switch to cotton underpants once you begin.¹
6. Teach girls to wipe from front to back, and everyone to wash hands.¹

Make sure everyone who cares for her (parents, grandparents, a maid, playschool) uses the same words and routine.⁶ In the Kolkata summer, loose cotton clothes and a potty near the play area make life easier.

Should I give rewards or punishments for potty training?

Praise works far better than punishment. Children learn best when progress is praised and mistakes are not punished.^6,1

The AAP advises praising each success and giving calm, non-punishing consequences for accidents, such as helping to clean up.⁶ Their guidance also warns that power struggles, pleading and treats can distract from the real goal, which is your child taking charge of her own body.¹

A hug and "you did it yourself!" is often enough. The AAP's toilet training advice says to avoid treats and punishments.¹ Its toilet training plan does allow a hug, praise and perhaps a small tangible reward for progress, so some families use a simple sticker chart alongside praise.⁶ If you do, never take stickers away.

Is early potty training from infancy (elimination communication) a good idea?

It can work in families who are able to watch their baby's signals closely. It is a different method, not a better or worse one.

Traditional Indian families often hold a baby over a basin or the toilet at set times, with a sound like "shhh". A study from Vietnam, where a similar whistling method is used from birth, found that the children all used a potty by about 9 months and were fully trained by 2 years.⁷

The catch is that the adult does most of the work in the first year, watching cues and timing. It suits a household where someone is with the baby all day. If you go to work and the baby is in a crèche, a child-led approach after 2 years is usually more practical. Never force a baby to sit for long periods.

Why is my child scared to poo in the potty?

Refusing to poo in the potty is very common. About one in five children in one study went through at least a month of it during training.⁸

Many children happily pee in the potty but ask for a nappy to poo. Some think the poo is part of them, or fear the flush.¹ Letting her flush the toilet herself can give her a sense of control.¹

In that study, refusal was more common in children with a younger brother or sister, and in families who found it hard to set limits.⁸ When parents stopped training for a while and put the child back in nappies, most children (24 of 27) started using the toilet for poo on their own within 3 months.⁸

Can constipation stop my child from toilet training?

Yes. Hard, painful poo makes a child hold it in, which makes the next poo harder still. Constipation is one of the main reasons training gets delayed.⁵

Signs of constipation include fewer than 3 poos a week, hard or "rabbit dropping" stools, very large stools, pain or bleeding, and standing stiff on tiptoes to hold it in.⁹ The start of toilet training can itself set off constipation.⁹

If your child is constipated, see your doctor. NICE guidance says diet changes alone should not be the first treatment, and that children who are training should stay on their laxative until training is well established.⁹ Water, fruit, dal, vegetables and whole grains still help. Do not stop medicine suddenly, and never use enemas or soap sticks at home.

Why has my child started having accidents after a new sibling?

Going backwards when a new baby arrives is common and usually short-lived. Children need extra attention, not punishment.

The AAP suggests delaying toilet training if a new baby has just arrived or is due, or if the family is moving house or going through a crisis.¹ Skills a child has learnt can disappear for a while when life changes.⁶

If she was trained and starts having accidents, stay calm. Clean up without fuss, praise her when she uses the potty, and give her some one-to-one time each day. If a big change is coming, try to finish training a few months before, or wait until the baby has settled in.

When should my child be dry at night?

Night dryness comes after day dryness. Most children are expected to be dry at night by about 5 years, and wetting before that is very common.⁴

About one in five children aged 4 and a half still wet the bed at least once a week.⁴ Night control depends on a maturing bladder and on hormones that reduce urine at night, not on effort.

If your child has been dry in the day for more than 6 months, you can try 2 nights in a row without a nappy or pull-up.⁴ Put a waterproof sheet under the cotton one. If she wets, go back to nappies at night for a few months without fuss.

Is bedwetting at 6 or 7 a problem?

Bedwetting at 6 or 7 is common and not your child's fault. Treatment is usually offered from about 6 years of age.¹⁰

In a study from Kerala of children aged 8 to 12, nearly 1 in 5 had wet the bed in the past year, and about 4% in the past week.¹¹

The main treatments are a bedwetting alarm or a medicine called desmopressin, which reduces urine made at night.¹⁰ Most children do not need blood tests or scans, unless there are warning signs such as great thirst or trouble passing urine.¹⁰ Constipation should be treated, because it can make wetting worse.¹⁰ Never punish or shame a child for wet beds.

Should boys sit or stand to pee?

Boys usually learn sitting down first, and stand once they are more confident.¹

Sitting lets a boy learn both pee and poo in the same routine, and avoids mess at the start. Many boys copy their father or older brother and want to stand. That is fine once he can aim. A small step stool helps when he moves to the big toilet.¹

When should I see a doctor about toilet training?

See your doctor if:

• Your child is not trained by day by about 4 years¹
• She holds in poo, has hard or painful stools, or has blood on the stool⁹
• She soils her pants after being trained
• She was dry for months and suddenly starts wetting again
• She drinks a lot more than usual or passes a lot of urine (this always needs checking)¹⁰
• Peeing burns, the urine smells strong, or she has fever (possible urine infection)
• She has a weak stream or dribbles all the time
• Bedwetting continues after 6 or 7 years and upsets her¹⁰