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When should parents start toilet training their children, and how does it work? 

It's only natural that parents want their toddlers to learn to use the toilet. Lately, however, many pediatricians are seeing parents who push kids to potty train before their bodies are ready for it.

When is the right time to start? Dr. Lewis First, head of pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care, says potty training should never become "a contest between neighbors" with toddlers. Kids will go when they're good and ready — not when their parents tell them to. Here's his advice for parents eager to ditch the diapers.

KIDS VT: At what age can kids physically control their bodily functions?

LEWIS FIRST: The developmental readiness in kids usually begins between ages 18 months and and 2 years. At 18 months, most kids recognize that feeling of fullness and can begin to hold their urine or bowels. By age 2, they've usually developed enough language and cognitive skills to understand "cause and effect" and know that if they go into the bathroom, they can urinate or defecate there. But it's not so much the age as the developmental readiness.

KVT: What are the signs to look for?

LF: I ask four key questions: Does the child know the difference between urination and defecation? Is there a usual time that the child urinates or defecates? This is a good time to slow down activities and head to a potty. Is the child interested in watching an adult use the toilet? And finally, is the child uncomfortable with something in his or her diaper? If the toddler couldn't care less, he or she isn't ready yet.

KVT: Are there risks to starting too early?

LF: Mostly, the risk is the enormous wear and tear on the parents, a lot of accidents, and increased anxiety and stress on the child, especially if parents start before the child is ready. We know that the later a child is toilet trained, the quicker the process goes. If you're toilet training before the age of 1, it's an endurance contest with lots of accidents. If children get overly stressed about their bowel movements and bladder habits and expect to be punished for having an accident, they're going to hold onto their bowels or bladder. This can lead to problems of chronic constipation — and then the unpleasantness of not wanting to void or defecate because it hurts so much. Just don't force the situation.

KVT: How should parents get started?

LF: If this is your first-born, invite your little one to help pick out a potty or child's toilet seat. Obviously, visit the store in advance so you're not obligated to get the most expensive one with the GPS system, IMAX screen and safety helmet. You don't need all that!

KVT: What else?

LF: Once you make the decision to use a potty or child's seat, all diaper changes should occur in the bathroom. This associates bathroom habits with the bathroom itself. If the child does anything in the direction of the toilet, parents should praise the child to reinforce that behavior. Parents should also work with their childcare provider to use consistent techniques and language for body parts and bodily functions. I'm a proponent of using anatomically correct terms. But there's no one formula that works for everyone. Take your cues from your child rather than force them to sit and use the potty.

KVT: How long should it take?

LF: The average time in this country ranges from six weeks to three months, with girls learning a bit faster than boys. And the recommendation is that boys and girls both learn best by sitting down first. Bowel training usually precedes urine training because it's easier to hold solids in than liquids. Accidents will still occur as much as six months after a child is "toilet trained," and parents should understand that and not punish their child for it. By age 5, between 15 and 20 percent of otherwise healthy children will still have accidents.

KVT: When should parents be concerned if their child isn't toilet trained?

LF: If all the readiness indicators are there, and the child is over the age of 3 and is oppositional or deliberately not going in the potty, that's the point when a parent may want to talk to the child's doctor. On the other hand, if the child has special health needs, the process may just take longer. In many cases it doesn't mean he or she can't toilet train. For example, if a child is visually or hearing impaired, it may take longer for language skills to develop to describe what the child is seeing and feeling. The same is true with a neurological disease. It can take longer than two or three years for these children, but for many can still be accomplished.

KVT: Any benefits to toilet training early?

LF: The age of toilet training varies by culture, and there are some that start training their children from the moment they're born. But I can't show you any data proving that an early start leads to a better quality of life, a smarter person or better athlete. We all get there eventually, and the goal is to minimize the amount of family stress, so that when the child is ready, everything comes out fine in the end.

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