Tag Archives: potty

From the desk of Doc Smo: A Constipation Conversation (Article)

How many ways can constipated children come to the doctor?
I am totally amazed at the myriad of presentations that constipated children present to their doctors. I remember listening to MANY complex lectures in medical school and residency about recurrent abdominal pain and trying desperately to memorize the LONG list of conditions that present as recurrent abdominal pain in children. After all these years of clinical practice, common sense has finally taken precedence. Hold onto your seats for this DocSmo pearl: “Common things are uncommonly common.” In other words, don’t look for exotic illness when, most likely, everyday maladies are probably at work. Humans have two “common” reasons their stomachs hurt:

1. A lower intestine that is not completely emptying (Constipation)
2. An overly acidic stomach that doesn’t empty well and may actually reflux (send contents backwards) into the esophagus.

Let’s take a moment to talk about the first cause, constipation. Little kids—and even big ones—sometimes find pooping unpleasant. At some level they avoid it, and it catches up with them. When it does, they come to the doctor complaining of cramping pain (hollow organ trying to empty), feeling sick after eating (nowhere for food to go from the stomach), gas (excess fermentation in the colon), burping (slow gastric emptying), back pain (referred pain), vomiting (no room in the Inn), bloating, leaking stool, rectal pain, prolapse of the rectum… and the list continues. I am sure that another 30 years will bring many new variations on the same theme.

I really think we may have been better off when we lived outdoors, pooping wherever and whenever. I doubt children growing up in those conditions ever had stomachaches for the reasons we do now. Everything has to be so perfect for our children. They need to poop at the right time (when an adult says it’s ok), only in “approved” places, and quickly and cleanly: the so called Demand Poop. No wonder all the fuss!


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Potty Training- “Let’s get started right” (Pedcast)


For those new listeners, Pedcast are podcasts where we discuss parenting topics ranging from the basinet to the boardroom; they are informational in nature and not intended to give medical advice about a specific child.  For that, see your child’s doctor.


In today’s Pedcast, we are going to discuss the burning parental questions “When can we stop buying diapers?”  “When should I potty train my child?”  “Are pull-ups useful?”  I’m going to give you the DocSmo view of potty training young children.  I think I am going to convince you that success with potty training is more about your child than about your parenting skills.  Hopefully I am going to give you an understanding of where a child needs to be developmentally to master potty training.  Finally, in this episode, learn from the experience of generations past.


Most parents start thinking about potty training when their toddler gets to be about 18 months old, when language starts to emerge.  Once it is clear that Johnny can talk, it is logical to think that he can be coerced into urinating in the toilet.  Physiologically speaking, he does have control of his sphincter muscles by this age; they are under his control!  So, if he can control his muscles and can talk, why not be potty trained?  Well, lets think it through.  What does he have to do in order to be trained?



  • Step One: notice that his bladder is full, stop what he is doing, and be motivated to take action.
  • Step Two: tell someone that he needs to go pee.
  • Step Three: have the physical skills to pull his pants down (undress)
  • Step Four: now he gets to control his sphincter muscles
  • Step five: resume play as before


I don’t know about you, but this doesn’t sound like many of the toddlers that I know or have lived with.  Developmentally this sounds more like a 2 to 3 year old.  I counted 7 things Johnny had to do to have success at the potty. Remember, most 18 month olds barely have any expressive language, very short attention spans, have great difficulty transitioning between activities, and are not concerned about the consequences of their actions…but they do have control of their sphincter muscles!


Let’s let history be our guide on this one.  There was a time when children were forced into potty training around 18 months.  Until the invention of the modern disposable diaper, children were expected to master the “potty thing” by 18 months.  Most actually did to some degree but many either couldn’t, refused, or rebelled.  These rebellious children used the potty for a while and then began refusing, much to their parent’s dismay.  Think about it: after using the potty for a while, these children just refused to take over responsibility for this function.  Their parents at this point knew they were capable but unwilling.  The child was mad at being made to do something they were not ready to take responsibility for, and the parent was mad that the child “could” but “wouldn’t!”  The perfect recipe for friction.  And boy was there friction.


I have been told that famous pediatrician Dr. Benjamin Spock (no, not the Star Trek character, but the most famous pediatrician of the 20th century) came to the conclusion that many children were simply not ready to potty train at 18 months.  He thought that too much training by 18 months in many children put too much stress on the parent child relationship.  I happen to agree.


Conclusions and advice: should parents wait until 2 to start?  Toddlers have the physical skill to control the muscles of pottying.  They often do not have the other “READINESS” things necessary to be successful at taking control of their bodily waste:


  • Awareness of the need and willingness to stop what they are doing when bathroom time is needed
  • Language to tell someone they need help
  • Physical agility to take off their clothes
  • Judgment to limit their toileting to the toilet
  • And the ability to transition back to play


Once your child has reached the proper developmental level as described, potty training is usually easy.


During the training process, remember:

  • Reward not punishment is best.
  • Praise any and all success…your attention and approval is the ultimate prize
  • Provide them with some cool underwear to get started
  • Once you have decided that they are ready and training has begun, don’t go back and forth between underwear and diapers….bad message.  Stick with the underwear even when they are having accidents.
  • Don’t force your child to sit on the toilet if they are fearful
    • Provide a low toilet if they prefer it …toilets are high for young children.  Let them play with it or sit on it and even pretend with it.
  • Potty should be their friend
  • Teach them the vocabulary of potty
  • Bath time is a great time to begin learning
    • Most bladders empty every 3 hours, so try every 2-3 hours to have your child visit the toilet during the daytime.
  • Don’t over-react to accidents no matter how much you love that oriental carpet.
  • I have to tell you, I am not a fan of pull ups…diapers with a different design.  Useful for overnight dryness but in my opinion, not for training.
  • Finally, relax: keep in mind that all developmentally normal children will eventually be trained…be patient.

Thanks for joining me today.  Feel free to check out any and all of the other Pedcasts on Docsmo.com.  It is my privilege to spend a few minutes with you today giving you my perspective on child health issues.  If you have insights or comments you would like to share, feel free to join the discussion at my blog, DocSmo.com.  This is Dr. Paul Smolen, your host, broadcasting from studio 1E in Charlotte, NC.  Hoping your child feels free… to have success controlling his or her  pee!


Until next time

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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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*By listening to this pedcast, you are agreeing to Doc Smo’s terms and conditions.

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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.