Tag Archives: training

From the desk of Doc Smo- The “New” Face of Pediatrics

I must say I have had a wonderful career in medicine and pediatrics.  Not only is pediatric medicine intellectually challenging, but it also has tremendous personal rewards.  A day in the life of the pediatrician is filled with sore throats, injured ankles, ear infections, anxious parents, as well as new babies and teens getting ready to go off to college.  My days are full of noise, icky smells, and crying children but also moments of great triumph and pride.  Triumph when your doctoring skills are truly able to make an improvement in a child or family’s life, and pride when you know you got it right: you brought the combination of knowledge, insight, and communication skills together to diagnose your patient’s problem and resolve it.

 

With all this in mind, I read with great interest an article in the Academy of Pediatrics newspaper that boasted about how many young doctors are now choosing pediatrics as a career.  Pediatrics is a hot specialty again.  Imagine that.  This year, young doctors filled 98.7% of pediatric residency positions (training programs after medical school graduation) despite the fact that, year after year, pediatrics is the lowest paid specialty in medicine.  Additionally, more men are becoming pediatricians!  What is going on here?  Do these “guys” know something that I don’t, or does Generation Y have more wisdom than I realized? Could it be that the procedure based medical system I have known my entire career is changing to a more preventative, contemplative one in the near future?  Move over orthopedic surgeons, meet the next generation of physicians who are skilled with the use of  prevention and cognitive services    Time will tell how this will work out and I will be watching with interest. Until next time.

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


Transcript:

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

Subscribe on iTunes!

Subscribe on iTunes!

 

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

 

© All Right’s Reserved.