What to do if your child is a ‘potty refuser’ (Pedcast)

Weaning children off of diapers isn’t always an easy task. Doc Smo helps parents potty train these so called “potty refusers” by enrolling them in his school of natural consequences. Listen to this pedcast to glean practical tips for getting reluctant toddlers to use the toilet.

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It is an almost everyday occurrence that I see in the office an otherwise normal three year old who comes for his checkup and is wearing diapers. Let’s face it: for a three year old, life is good in diapers! It’s all play, no interruption, and Mom or Dad takes total responsibility for keeping him clean. Well, when I see these 3 year olds in diapers who are otherwise developmentally normal, it’s time for Potty Boot Camp. It’s time to enroll them in the “School of Natural Consequences.” I love the School of Natural Consequences; it’s tuition-free, and the learning comes fast. Sort of “in-your-panties learning.”

Today’s episode of Doc Smo addresses the question of what to do when your child refuses to transition from diapers to underwear during the day. Before we get into today’s talk, let’s preface by saying that this discussion assumes a child who is both developmentally and physically normal; they have no problems with control of lower part of the body, and they have no intellectual or developmental delays of significance. Johhny is just refusing to keep himself dry while he’s awake. Or worse, nobody has even asked him to do so during the day.

So how do we approach this situation?

Let’s take a look at the tools we have in our parenting toolbox:
• The first and most obvious tool is rewards. Rewards for appropriate potty behavior include stickers, stars, parent’s praise, candy, and potty presents. Reward is a powerful motivator, and I definitely recommend that you use this tool.
• Let the natural consequences happen…don’t get in the way. Let your child deal with it. Let them deal with their inaction. Make the potty waste their problem!!!! They will quickly learn that it is in their best interests to use the potty.
• The final tool, which I don’t recommend you use in this situation, is punishment. I don’t think you should force your child to sit on the potty, I don’t think you should yell at them, and I don’t think you should belittle them. Remember, your message is lost once you emotionally charge a situation with young children. You don’t want to create negative associations with the toilet. You want your child to want to please you, you want them to take responsibility, and you losing control or creating anything that they find punishment is not going to help with their toilet behavior.

Doc Smo Pearl: “Children learn quickly when consequences of their actions (or inactions) matter.”

Corollary to that Pearl: “Once your child has taken ownership of a problem, they will find a solution.”

So what should you do if you have a three year old (or older) who is clinging to diapers?
I recommend the powerful 1-2 approach to dealing with the Potty Refuser. We are going to use the combination of rewarding good potty participation with enrollment in the School of Natural Consequences. This approach is a powerful combination of motivators. How can they refuse?

Here are the details of this approach:
• Step 1: get them on board mentally with the idea that they will be wearing big-kid undies. Give them some warning, get them pumped. Show them fun underwear, get some pretty panties, talk it up. Create excitement about the process.
• Step 2: Set up some rewards, and make sure they are comfortable with the potty setup. These rewards could be stickers, stars, check marks, presents, or even candy. At the same time, make sure your child is comfortable with the potty itself and with the words they’re going to use.
• Step 3: When the big day comes, get out of the way. Let them be responsible for what happens. Don’t chase them around the house reminding them to use the potty; only say something to them about the potty when they will be leaving the house and be away from the potty.

When they have an accident, don’t get mad. Remember, you change the subject completely when you get angry. Your response should be…”Oh honey, YOU HAVE A PROBLEM. You need to clean that up.” Your child should then be responsible for:
• Cleaning up the mess with paper towel
• Taking their dirty clothes to the laundry
• Taking care of washing with a cloth
• Getting clean clothes

Your attitude throughout this process needs to be matter of fact. The theme here is, “This is your problem, not mine.” Children don’t like to clean the floor, do laundry, clean themselves, or stop playing for anything. While this whole process is going on, explain that if they had used the potty, they would have gotten a gift AND be playing already.

As I said before, this is a powerful approach. It is a good lesson for the future as well: this is your problem, you craft a solution, I’ll help.

I personally have never seen an otherwise normal child not be effectively potty trained in 2 weeks. Most children transition in few days, unless parents make one of the following mistakes:

• Don’t make the big mistake…changing back and forth between pull-ups and underwear to avoid inconvenience (such as preventing accidents in public). Give this new approach a reasonable trial.
• Don’t chase Johnny or Janie around watching for clues they are about to pee. They need to take the initiative. This is their problem remember.
• Don’t inject emotion into the learning process. When you yell or belittle, it changes the subject. Learning new things, especially something big like this, is hard. Expect that there will be accidents, and it’s okay.

Do use your most powerful weapon—your praise—even for the least bit of success. Deep down, your child always wants your love and affection.

This approach usually works great for urination, but many children rebel about pooping between 3-4 years of age…That’s a whole other episode of DocSmo.

Understanding Your Child’s Ear Infections Step by Step (Pedcast)

Ear infections, or otitis media, are a painful part of childhood. Understanding the biology behind the development of ear infections can help parents see the warning signs and take preventative measures. Thus, in this pedcast, Doc Smo walks you through the stages of ear infections and provides listeners with ways to help prevent them.



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By some estimates, 40% of visits to pediatricians are for ear infections.

Most children have otitis before the age of 2 years.

I Thought today, we would talk about why children get them, should they be treated, and can they be prevented?

Parents have these questions all the time.

So lets get started with our discussion with a trip down, you know where, science lane.


There are loads of germs in our nose that can cause ear and sinus infections…all the time!  That’s right, sinus and ear infections are usually an overgrowth of germs we already carry.

So why don’t we have ear infections all the time?

To understand the answer to that question, need to know how our noses work.  That’s right, our noses.

Remember the structures that are attached to our noses, our sinuses in every direction around our nose, our ears through the Eustachian tubes, our eyes up through the lacrimal ducts, and our throat pulling up the rear.  

Normally every time we take a breath through our nose, we put fresh air into our sinuses and ears. If our noses are working properly, each breath opens the windows and lets in fresh air into our sinuses and ears and at the same time equalizing the pressure with the ambient pressure around us.

In addition, the cells that line our nose, sinuses and ears secrete a steady trickle of mucous that is kept moving by our cilia, little brooms that constantly sweep the mucous into our throats.  A gentle river of mucous flows through our noses, sinuses, ears and bronchioles all the time cleaning and moving away dirt and germs away from our healthy respiratory system.

The combination of moving mucous and fresh air keeps germs from ganging up on us.


Now think of a child, especially a baby.  A cold means a swollen nasal passage without air moving and loads of extra mucous. Babies don’t blow their noses, remember! This is the recipe for a sinus and ear infection.

Stagnant mucous in airless places.

Here is the sequence of events:

Virus attaches itself to the nasal membrane causing swelling lining cells.  The medical jargon for this is apoptosis or swelling of cells.  We can feel that at the beginning of a cold.

The children’s tiny sinus and ear Ostia become obstructed from airflow causing a VACUUM to form in the ears and sinuses.

Your body doesn’t like a vacuum and fills up these spaces with mucous (when your child’s doctor says, fluid in ear…this stage).

Remember that bacteria in the nose, now it has warm, sugary pockets of stagnant fluid to grow in and BAM, a hot ear infection.

Since bacteria grow so fast, it can be only a matter of hours between fluid in the ear and a raging infection.

The body’s natural defenses, moving mucous and fresh air are not there to keep the germs from taking over.

Children who carry the allergy gene have all the same events occur but the swelling inside their noses is from both dust and pollen allergy and viral infections.  These children are especially prone to ear infections.

So what’s the perfect storm for ear infections?

Under 2 years of age….Promotes…Small nose and no blowing.

Remember this Doc Smo pearl, “Rivers that don’t flow are nasty!”

Being in an environment where infection with respiratory viruses is frequent…..  Being around a lot of other young children.

Remember this Doc Smo pearl…. “Infectious diseases are contagious!”


Being a child with eczema, food allergy, or recurrent wheezing…  having the allergy gene which means lots of swelling in the nose and loaded with mucous.


If your child is prone to ear and sinus infections…practical tips that might help.


1. Avoid crowds of children to play with especially when they are very young and put things in their mouths.  Touch is the method of spread.

2. Be especially careful with group care if your child exhibits signs of allergy.

3. Play with other children outside whenever possible, even when it is cold.  Unlikely to transfer germs outside.

4.Unless your child has clear allergy, Avoid cold medicines with antihistamines, which can make nasal mucous thicker… poor flow means more infections.

5. If your young child has loads of otitis media, try a milk free diet for 2-4 weeks to see if it helps.

6. Hose those little noses with saline a lot… water is a natural cleaner.  Use it!

7. Try and avoid treating ear infections in children older than 2, after your child can talk.  More on this subject listen to “Bugs and Drugs”



That wraps up todays “Pedcast” Thank you for listening.  I hope your understanding of ear infections is better now.

If you enjoyed this talk, try some other DocSmo episodes which you can find at my website, DocSmo.com, at my face book page or on ITunes.

Comments are welcome.


This is Dr. Paul Smolen.

Recording in full digital sound from studio 1E in Charlotte, NC.

Wishing your children noses full of warm breezes and years without sneezes


Until next time
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Swimming, A Basic Life Skill All Children Need to Know (Pedcast)

Swimming lessons are a crucial for every child’s safety–drowning is one of the leading causes of death for children. As parents, you can help protect your children and lower the number of needless drownings by teaching them water safety skills. In this pedcast, Doc Smo emphasizes the importance of child swim lessons and gives parents some practical advice about teaching their children to swim.

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Shaping Your Child’s Character, Leading by Example (Pedcast)

Children are easily influenced by who and what’s around them. Thus, their characters are shaped not only by their peers but by you, their parents. As Doc Smo says, you create your child’s reality, and the reality you choose to create helps mold your child into the person he or she is going to become. So, learn some practical tips for shaping your child’s character through your own actions.

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