- The Washington Times - Sunday, November 12, 2000

When Mindi Maline set out to toilet train her son, Jeremy, she gleaned information from child-rearing books and from friends with older children. As Jeremy approached his third birthday, Mrs. Maline put the process in motion, buying Jeremy Teletubbies underpants and a Cookie Monster potty. Both went unused by the toddler, who declared he would graduate to them when he was 3.
"I would get all kinds of nonsense from my mother," says Mrs. Maline, a Fairfax resident. "She claims my brother and I were trained at age 2. 'Why isn't that kid trained?' and 'He is so smart, why isn't he trained?' were two things I heard a lot."
A few days after he turned 3, Jeremy donned the Teletubbies pants and never looked back.
"Once he said he was ready, he was ready," Mrs. Maline says. "I'm not going to get anxious when it comes time to train my [14-month-old] younger son."
Mrs. Maline's story is typical of the experience of many parents. Parents can choose from an array of approaches in the toilet-training process, including letting the child run around naked, offering rewards, charting progress with stickers, taking the slow-and-steady route or optimistically tackling it in a day.
Add to that the grandparents' concerns over a child heading to kindergarten in diapers, and it is enough to make even the best parent feel inadequate.
"Parents need a little more guidance," says Charles E. Schaefer, a New Jersey child psychologist and co-author of the book "Toilet Training Without Tears." "They are getting conflicting advice, like they do about most child-rearing issues."

Children are training later

Grandma isn't making it up. Decades ago, children were trained earlier.
In 1961, the American Academy of Pediatrics estimated that 90 percent of children nationwide were potty trained by age 2 1/2. In 1997, doctors at the University of Pennsylvania looked at the issue. In their study of 482 children, 22 percent were trained by 2 1/2, and 60 percent were trained by age 3.
Physically, children haven't changed in the past 40 years, Mr. Schaefer says. They generally show signs of toilet-training readiness (such as staying dry for two hours or more, telling parents when they are wet or soiled and following simple directions) between 18 and 24 months.
What has happened in the past 40 years is a change in lifestyle factors and parenting philosophies. While a vast majority of mothers of small children were home with their children in the 1960s and '70s, more than half work outside the home today, according to the U.S. Census Bureau. That has made the toilet-training process a longer road because there can be inconsistency between parents and day care providers or teachers.
"Twenty or 30 years ago, you could dedicate a week and change a child's behavior," says Dr. Beth Edgerton, a pediatrician at Child-ren's National Medical Center in the District. "It is a different environment today. Having a child in diapers, in some ways, is more convenient than a child who is potty training."
Even when parents are at home, they are likely to be busier than people used to be, says one pediatric nurse practitioner.
"If you have a family routine, children can be trained earlier," says Ann Stadtler, who runs a toilet-training clinic at Children's Hospital of Boston. "But if you have a busy schedule, it is not convenient" to devote time to toilet training, she says. "I don't want to blame parents, though. If they are having a problem, it is up to doctors and teachers to be supportive and help problem-solve with them."
Mr. Schaefer says more permissive parenting experts have become fashionable recently. Experts such as Harvard pediatrician T. Berry Brazelton, who writes a weekly syndicated column for Sunday Family Times, urge parents to take their developmental cues from the child and not pressure the child when it comes to milestone changes. Some parents take that advice quite seriously and back down when a child might be ready, Mr. Schaefer says.
"If a child is not interested, try and motivate him, reward him and offer modeling behavior," Mr. Schaefer says.
Disposable diapers share some of the blame, some say. These superabsorbent garments, which are worn by more and more children, make being wet not that unpleasant and, in fact, sometimes barely noticeable.
Dr. Edgerton has the same criticism of disposable training pants.
"If a child doesn't know he is wet, he has lost the motivation to go to the bathroom," she says.
Two popular brands of disposable diapers, Pampers and Luvs, recently began manu-facturing diapers for children who weigh more than 35 pounds, the size of the average 3 1/2-year-old.
The size 6 diapers were created in response to parent demand, says Tami Jones, a Pampers spokeswoman.
"We had input from professionals and parents," she says. "They complained that the diapers out there were not big enough for their children. They said, 'My child is not ready. Can you make a bigger diaper?' We know that children show signs of readiness between 18 and 30 months, but some children exceed that, so with size 6, they have more time to train."

Which way is the best way?

Mrs. Maline's son trained quickly once he turned 3. Chantilly mom Madge Chetwynd did not read any books or show her daughter, Amelia, any videos. She threw out the diapers when Amelia was barely older than 2. After a half-dozen accidents, Amelia was trained within days.
Dayna Burnworth, a Dale City mother, took the slow-and-steady approach when training her son, Stefan. Using small steps and lots of praise, she had Stefan trained by around 3.
"I got him a potty at about 18 months," Mrs. Burnworth says. "He was making his first connection to what a toilet is for. At 24 months, I would occasionally take his diaper off and let him sit on the potty. Eventually he would go, because he was sitting there so long. It wasn't until about 2* that he could tell me he had to go and run to the bath-room."
All three mothers essentially went about training the right way because they knew what would work for their children.
"All kinds of methods can work," Ms. Stadtler says. "You can make a plan over time or train in a weekend, but the reality is if it worked for you, it was because your child was ready and the approach matched his temperament and schedule. You can get hints from other parents, you can get professional advice, but we need to value the fact that a parent is an expert on their child."
Role modeling, such as letting children see parents and older siblings using the bathroom, and rewarding, such as starting a progress chart or offering small rewards, can help the process, Mr. Schaefer says.
Ms. Stadtler says rewards are useful if kept in perspective.
"We want to reinforce what children are doing," she says. "Kids revel in praise, and small rewards such as M&Ms; or small toys can work. But we often see parents who up the ante and say things like, 'You'll get a bicycle when you are trained.' That is putting too much pressure on the child. Keep the reinforcements small, and don't keep on the reinforcement too long. Kids get bored with it."
Ms. Stadtler and Dr. Edgerton also remind parents about the differences in children even within the same family.
"Girls typically train earlier than boys," Dr. Edgerton says. "It is a biological difference. Boys have to learn to go standing up. That is why it is important to have fathers involved in the process."
It is important to look at what is going on in the child's life, such as a move to a new house or a new sibling on the way, and also at the child's personality, to know how to proceed, Ms. Stadtler says.
"I ask parents to think about their plan," she says. "If they are not having success because they set up a routine where the child is sitting on the potty at 5 or 7 p.m. when he is exhausted, maybe they should pick a more cooperative time of day to do that.
"Parents also need to know that different types of children will be difficult to train," she says. "A sensitive child or a child with a short attention span may have difficulty. A very bright and intense child might be more of a challenge. A child taking [medication] might be constipated, and that might make it more difficult. A child under-going outside stresses, such as starting school, may not be ready to make such a change."
Despite parents' best efforts, some child-ren resist training. In a child older than 3 1/2, it could mean a developmental, be-havioral or physical problem, so it is worthwhile to have a discussion with a medical professional, Mr. Schaefer says.
For younger children, it is all right to take a break and revisit the efforts later, Ms. Stadtler says.
"What does it mean if training fails?" she says. "It means the step was probably a little too big. It could be the timing was right, but it was too big a developmental step."

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