Intensive Toilet Training

Sometimes the 7 P plan is not enough. This often happens when continence is needed now or at least in the next week or two. Reasons for this range from parents simply being fed up with poopy pants and icky Pampers to ultimatums from day cares or preschools. Here's an example of what I mean. Years ago when I left the University of Nebraska, I turned my incontinence clinic over to another professor. He then became Dr. Poop and Pee instead of me. One day, he received a call from his 3-year-old daughter's preschool informing him that she was being expelled because she was having too many toileting accidents. This would be bad news for any parent, but it was particularly bad for Dr. Poop and Pee, if you catch my drift. He swiftly followed guidelines similar to those below and she was ​fully trained in four days. So if you are willing to spend a lot of your time toilet training and be consistent about following the guidelines, your child can be toilet trained in a few days.

A good time to begin intensive toilet training is a weekend when you are free from work and other chores. Okay, I know you are never free from work and chores. Just pick a time when all the things you have to do can be set aside for a while without too much of a penalty.

1. Increase fluids. Toilet training is really a form of plumbing, and to do it well, we need something to plumb. Said differently, good training requires multiple toileting opportunities, and the best way to achieve this goal is to have your child drink a lot. So let them drink as much of their favorite beverages as they want; you can even encourage them to drink more. And before I forget, stay home. Filling them full of fluid creates multiple urinations, and thus, multiple training opportunities - if you are home. If you are out and about, it creates either a big mess and large headache, or a lot of little messes and small headaches. Neither option is fun for Mommy and Daddy.

2. Give frequent prompts. Watch them carefully. When they begin to show signs of having to go, tell (don't ask) them to go to the bathroom and then take them there. When they really have to go, the signs are obvious (e.g., they grab themselves, cross their legs, and wince). If they have their shirt off, you will be able to see more subtle signs (e.g., minor to major movements of their lower abdomen). In a sense, this is like bombardier training - you need to get them over the target before they release their payload. Keeping a close eye on them reveals when the payload is near the bomb bay doors. A more structured way to do this is to merely tell your child to use the potty every 30 to 45 minutes.

3. Do dry pants checks. Every 15 minutes or so, check your child's pants to see if they are dry. If they are, praise your little trainee (see P #6 from earlier). Because this is intensive training, I recommend having a system for rewarding your child for dry pants. For example, you could make a chart where you record each pants check and give a star each time you find dry pants. Then, you can reward your child for, say, every 10 stars he or she earns. Or, you can arrange to spend "Special Time" with your child in the evening after a day of dry pants. Special Time means one parent spends 15 to 20 minutes with the child doing an activity the child particularly enjoys. Always follow through on promised rewards ("Give it up!").

4. Praise. You should abundantly praise and appreciate all toileting successes (once again see P #6). And if your child happens to go to the toilet unprompted, something big should happen. Have the glitter dome descend, the mayor call, and confetti spill from the ceiling. Or, if you are on a budget, a big hug will probably do.

5. Use positive practice for wetting accidents. Positive practice is an intensive practice of what should have been done instead of the accident. It can take various forms, but it generally involves multiple practice trips to the bathroom after an accident. (Because this practice can generate opposition from the child, I will cover it in another article. In the meantime, you can ask your health care provider to give you the guidelines on toileting accidents that explain positive practice.)

6. The cleaning bill. There will be accidents in the house - which is a nice way of saying there's a good chance your child will poop or pee on your floors and carpets. So set aside about $60 for the cleaning bill when you are all done.

Recommended Reading

Berk, L.B., & Friman, P.C. (1990). Epidemiologic aspects of toilet training. Clinical Pediatrics, 29, 278-282.

Christophersen, E.R., & Friman, P.C. (2004). Elimination disorders. In R. Brown (Ed.), Handbook of pediatric psychology in school settings (pp. 467-488). Mahwah, NJ: Lawrence Erlbaum.

Friman, P.C. (2003). Encopresis. In W. Odonohue, S. Hayes, and J. Fisher (Eds.), Empirically supported techniques of cognitive behavior therapy (pp. 51-58).New York: Wiley.

Friman, P.C., & Jones, K.M. (2005). Behavioral treatment for nocturnal enuresis. Journal of Early and Intensive Behavioral Intervention, 2, 259-267.

Friman, P.C., Hofstadter, K.L., & Jones, K.M. (2006). A biobehavioral approach to the treatment of functional encopresis in children. Journal of Early and Intensive Behavioral Interventions, 3, 263-272 .