Five Tips for Toilet Training from Wake Forest Baptist

June 17, 2013

When it comes to toilet training, there is no shortage of advice for parents. From mothers-in-law to the internet, everyone has a favorite tip. Despite all of the information, though, it turns out that children are often trained incorrectly, leading to potty problems that range from bedwetting and daytime accidents to urinary tract infections. 

Steve Hodges, M.D., a specialist in pediatric urology at Wake Forest Baptist Medical Center, says there are five common mistakes that parents make when toilet training their children.

1. Training too early. While early toilet training is popular, children younger than three don't have the mental maturity to make good toileting decisions, says Hodges. "They don't understand how essential it is to get themselves to a bathroom when nature calls. Instead, they hold their urine and feces, which can lead to numerous problems, including bedwetting."

2.  Train their child but don't follow up with their toileting habits. Many toileting problems - from urinary tract infections to bedwetting - are often related to children holding their urine or feces. "Holding urine leads to smaller bladder capacity and sets a child up for accidents," says Hodges. He recommends having children urinate on a schedule, about every two hours. To help make the bathroom trip "successful," Hodges suggests having the child count to ten while on the potty and having some favorite books and puzzles nearby.

As for "pooping," a high-fiber diet can make elimination less painful, so that children aren't as apt to avoid it.

3.  Ignore school bathrooms or bathroom policies. Unreasonable toileting requirements, restrictive bathroom policies and dirty bathrooms in schools compound children's potty problems, says Hodges. He recommends that parents be aware of day care and school bathroom policies and advocate for their children. Suggestions include touring school bathrooms to identify potential issues, making bathroom cleanliness a PTA issue, and advocating for policies that allow children to use the restroom when they need to.

4.  Miss signs of constipation. Up to 30 percent of children between two and 10 are chronically constipated. "Many parents mistakenly believe that if their child has daily bowel movements, they are not constipated," says Hodges. "But in kids, there's a different definition of constipation known as 'poop burden.' It refers to poop backed up in their rectum that can press on the bladder and cause bedwetting and other problems."

Symptoms of constipation in children include having extra-large bowel movements or bowel movements that are very firm, rather than mushy, like pudding or a milkshake; poop accidents; poop-stained underwear, and mild belly pain with no obvious cause.

5.  Ignore signs of bladder trouble.   Common problems in children that shouldn't be ignored are painful urination, frequent urination and blood in the urine. These symptoms are sometimes due to an infection or other problems and should be evaluated by a physician. Often, however, the culprit is constipation - one more reason to opt for a high-fiber diet.

In addition, accidents of urine or stool should not be seen as normal and ignored.

"Often, parents have the impression that wetting, like throwing temper tantrums, is just something kids do," said Hodges. "But accidents aren't normal and potty-trained kids shouldn't have accidents any more often than adults do."

Hodges is the co-author of a book for parents on toilet training and other potty issues, "It's No Accident: Breakthrough Solutions to Your Child's Wetting, Constipation, UTIs, and Other Potty Problems," and blogs about the topic at

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Karen Richardson:, 336-716-4453