June 7, 2004 -- Understanding your child's temperament may be the key to potty training success, according to a new study.
Researchers found children who have a hard time with toilet training are more likely to have difficult temperamental traits, such as negative moods and less persistence.
That doesn't mean that children who experience difficulty during toilet training are necessarily difficult children overall, says researcher Researcher Allison Schonwald, MD, an instructor at Harvard Medical School in Boston. But she says they did not have what most parents would consider an easy-going attitude.
The study also showed that differences in parenting styles were not associated with toilet training difficulties. Instead, the biggest factor affecting potty training difficulties appeared to be the child's temperament.
"Understanding that it has to do with your child's temperament helps you understand where the pitfalls are," Schonwald tells WebMD. "You may have to change your parenting style around toileting to fit better with this child's temperament."
The results of the study appear in the June issue of Pediatrics.
Temperament Linked to Toilet Training Difficulty
Researchers say children are typically toilet trained by age 3, and the process usually takes about a year to successfully complete. But some children may experience persistent difficulties that require additional attention.
To better understand children who have difficulty toilet training, researchers compared 46 children who were referred to a specialty clinic because they had difficult toilet training with 62 same-aged toilet-trained children. The children and their parents were evaluated using standard temperament and parenting scales and from questions about their toilet-training history.
"Our comparison children had a normal distribution of temperaments: a proportion that was easy, intermediate, and difficult," says Schonwald. "Yet among our difficult toilet trainers, none of them were easy."
Although the overall temperament of the difficult toilet trainers did not meet the definition of "difficult" based on a behavioral style questionnaire used in pediatrics and psychology, the study showed that they displayed significantly more difficult temperament traits than the other children.
Specifically, children who had potty training difficulties were more likely to be:
- Less adaptable and had more difficulty adjusting to new situations even with exposures
- Have more bad/negative moods
- Less persistent and more easily frustrated and more likely to give up
- Wary of trying new things
Timothy Schum, MD, associate professor of pediatrics at the Medical College of Wisconsin, has conducted several studies on toilet training and says the results of this study aren't surprising.
"I think people have suspected that children who have difficult toilet training may also have difficult temperaments, and this study lends some support to that theory," says Schum. "Parents need to be aware that children who have these temperamental traits may take longer to toilet train.
"Temperament traits can't be changed very much, but if you are aware of them, as a parent, you can become more tolerant," says Schum.
Constipation Is a Common Problem
The study also showed that constipation was a common problem among all the children, but it was much more prevalent among those with toilet training difficulties (78% vs. 55%).
Although the study was not able to determine whether constipation was the cause or result of difficulty potty training, a related study in the same journal showed that constipation often precedes toilet training problems and may cause children to refuse to have bowel movements on the toilet.
Schum advises that parents and pediatricians closely monitor children for signs of constipation during toilet training. Rather than waiting for a child to complain of pain associated with bowel movements, he recommends that parents take notice of what their child stools look like. If they become hard or unusually large, it could be an early sign of constipation.
"They should preemptively improve the child's diet and make sure they are getting enough liquids and fiber so they don't progress to the painful part," says Schum.
If it does become painful, the child should be evaluated and treated for constipation by a pediatrician.
Understanding Potty Training Difficulties
In addition, the study showed that many difficult toilet trainers were likely to hide stools or dirty underwear and ask for pull-ups or diapers in which to pass stool.
Schonwald says that when a parent encounters that type of behavior it may help them to understand that it means that the child already has a lot of the developmental skills necessary to toilet train but isn't quite there yet.
That way, parents can recognize the things that the child is learning and doing right rather than focusing what they're not doing, and it gives parents an opportunity to work on those items in a step-wise fashion.
For example, if a child asks for a pull-up it means he or she is gaining control of their bowels, but may not be ready to use a toilet. Schonwald says the parent may then suggest that the child take the pull-up and take it to the bathroom to have a bowel movement but not use the toilet.
"That takes off a lot of the pressure," says Schonwald. "Then when they start feeling more success and they do it in the bathroom; it becomes a lot more manageable."
Strategies for Potty Training Success
Experts say these findings show that recognizing a child's temperamental traits can help parents overcome common toilet training difficulties.
Schonwald says children who have a hard time staying on the toilet may have a problem with persistence and may need a special toilet time activity to keep them interested.
Other children who don't want to go into the bathroom may be reluctant to try new things, and the parent may have to find a way to make the bathroom more welcoming, such as scheduling brief play times in the bathroom.
Schum says it's also important for parents to remember that no two children are alike, even within the same family, and what worked for one child may not necessarily work for another.
In an editorial that accompanies the studies, David R. Fleisher, MD, of the University of Missouri School of Medicine, says more research is needed to learn about the many psychological, physiological, and social factors that may affect potty training success.
But he says it's clear that toileting skills are acquired through several distinct and simultaneous processes: toilet training and education by the parents, and toilet learning by the child.
"From a child's point of view, 'poo-poos' can be nice or scary," writes Fleisher. "Parents need to understand that toilet training differs from training in most other areas of behavior because they cannot oblige their child to perform bodily functions their way."