Toilet training age:
Initiation of toilet training prior to 24 months and later than 36 months is associated with dysfunctional voiding (Hodges 2019)
• Interesting fact: Children potty trained before the age of 2 years, had triple the risk of developing constipation and daytime enuresis compared to those trained between the age of 2 and 3 (Hodges 2019)
Dr Hodges’s rules for potty training the constipated child:
1. Wait until your child is ready to potty train, not when you or your pre-school are ready!!
2. Ideally the child needs to be:
• Dressing and undressing without help
• Showing interest in using the toilet
• Noticing when they have a dirty diaper
• Telling you they need to poo or pee
• 2 hrs between each pee
3. Explain to your child why it is important to poop daily and pee often and that everybody poops
4. Help the child recognise, and act on the urge to pee and poop.
5. Send the message of:
• “Use the toilet when your body tells you it’s time “rather than it is important to stay dry
• I got the feeling in my body I needed to pee, so I went right away
6. Point out where the toilet is when you are in shops/friend’s house or playground
7. Keep a potty in the car
8. Prompt to pee every 2hours. Establish pee schedule that fits easily into the day. Prompt first thing (breakfast) and last thing (before bedtime) and then every 2 hours or when you see them doing the potty dance
9. Watch out for wee holding e.g. crotch grabbing, squirming, curtseying, squeezing legs together
10. Boys must learn to pee sitting on the loo. Avoids them tilting pelvis forwards to pee, which activates the pelvic floor muscle and gluteus muscles.
11. Girls must have legs apart. It relaxes the pelvic floor muscle and prevents urine pooling in the vagina and staying wet (which can cause urinary tract infection especially if constipated)
12. Always provide a high stool to support their feet
13. Relax on the toilet and “let it all out”. No strain to wee, no red face or hard tummy muscles. Breathing in and relaxing until fully empty. Entertain with books, puzzle, egg timer.
14. Never shame or blame for accidents. If still having accidents after a month, the child was either not ready or needs constipation investigations
15. Do not ever stop asking children how aften they poop!