Toilet training methods
When it comes to toilet training many people may ask a friend for advice or refer to a book, however science-based methods also exist and may help you. We understand that toilet training a child is a complex process that can be affected by behavioural, economic, cultural or health factors. There is no one method which will be suitable for all. We have summarized the key principles of the most common science-backed methods below. If you need more information, you can also refer to paediatricians and health care professionals in your country [1].
Elimination communication method
Elimination communication [2], also known as assisted infant toilet training [3] can start at the earliest between 2-3 weeks of age, with an average starting age of 4-6 months. Responsible adults should be attuned to the child's elimination needs and be able to recognise and understand the signs of their child’s need.
Step 1: When the baby is going to urinate or poo, they are placed in a special position (in the responsible adult’s arms) and the responsible adult makes a signal or cue such as a noise that can be associated with the act of urinating or pooing.
Step 2: When the baby eliminates in this way, the adult responds with positive signals.
Intensive method
To follow the intensive method [4], you need a potty.
Step 1: Regardless of the child’s readiness, the responsible adult sits the child on a potty or toilet for 5 minutes at regular intervals.
Step 2: The responsible adult should check for dryness every 5 minutes and praise the child if they are dry.
Step 3: When the child eliminates successfully in the potty and are dry in the interval, the adult positively reinforces the behaviour usually with praise. Accidents can be reinforced negatively through lack of positive attention.
Azrin and Foxx method
The Azrin and Foxx method [5] is sometimes used for intensive training. To follow this method, you need a potty and a self-wetting doll.
Step 1: The Azrin and Foxx toilet training usually starts around 20 months of age or when the child shows signs of readiness which include:
- Physiological readiness with periods of dryness and physical ability to perform tasks related to toilet training.
- Psychological readiness with ability to understand and follow instructions.
Step 2: The responsible adult should familiarise the child with the potty and it’s function by using a self-wetting doll to show how the child is to use a potty.
Step 3: The child should be well hydrated throughout the day. The responsible adult should encourage the child to pull pants down and up, and to sit on the potty regularly every 15 minutes. Once the potty has been used, the responsible adult should show the child that the potty contents are emptied, and a clean potty is placed back.
Step 4: When the child eliminates successfully in the potty, the adult positively reinforces the behaviour usually with praise. Transition to use the toilet can follow when the child is safe and trained to use the potty.
Brazelton child-oriented approach
To follow the Brazelton child-oriented method [6], you need a potty.
Step 1: The Brazelton toilet training usually starts around 18 months of age when the child shows signs of readiness which include:
- Dry nappies for at least an hour or two.
- Understanding when they are urinating and may tell you they are doing it.
- Recognising when they have a wet or dirty diaper and may pull at it, take it off or ask for a change.
- Showing visible signs of needing to go to the toilet like fidgeting or going somewhere quiet or hidden.
- Knowing when they need to urinate or poo and may say so in advance.
Step 2: The responsible adult should familiarise the child with the potty and it’s function by encouraging the child to interact (touch and look at) with the potty.
Step 3: The responsible adult should encourage the child to sit on the potty and should show diaper contents being put in the potty.
Step 4: When the child eliminates successfully in the potty, the adult positively reinforces the behaviour usually with praise. Transition to use the toilet can follow when the child is safe and trained to use the potty.
Daytime wetting alarm method
To follow the daytime wetting alarm [7] method, you need a potty and a wetting alarm.
Step 1: This toilet training usually starts between 18-36 months of age. The responsible adult puts a wetting alarm on the child and should be ready to place the child on the toilet or potty when the alarm rings.
Step 2: Dryness and correct toilet behaviours should be positively reinforced. Bladder control can be achieved within days with good explanation of the wetting alarm to the child.
Find out more:
[1] Example health care advice website from the UK: https://www.nhs.uk/conditions/baby/babys-development/potty-training-and-bedwetting/how-to-potty-train/
[2] Thorpe, M., The Psychological Advantages of Enhanced Sensitive Attunement Through Nappy-Free Elimination Communication. Ata: Journal of Psychotherapy Aotearoa New Zealand, 2014. 18(2): p. 127-139.
[3] SUN, MIN Ph.D.; RUGOLOTTO, SIMONE M.D.. Assisted Infant Toilet Training in a Western Family Setting. Journal of Developmental & Behavioral Pediatrics 25(2):p 99-101, April 2004. [DOI]
[4] Vermandel et al., How to toilet train healthy children? A review of the literature. Neurourology and Urodynamics 27:162–166 (2008) [DOI]
[5] Foxx RM, Azrin NH. Dry pants: a rapid method of toilet training children. Behav Res Ther 1973;11:435–42 [DOI][Google Scholar]
[6] Brazelton TB. A child-oriented approach to toilet training. Pediatrics 1962;29:121–8 [Google Scholar] [DOI]
[7] Vermandel A, Weyler J, De Wachter S, et al. Toilet training of healthy young toddlers: a randomized trial between a daytime wetting alarm and timed potty training. J Dev Behav Pediatr 2008; 29:191–6 [DOI] [Google Scholar]