From Potting to Potty Training: Toilet Training Advice throughout History

   

​   When have parents started toilet training their children?
   How have they gone about training?
​   What have the experts said?

   This article explores the history of toilet training and explains
   how the timing and methods for training have changed over
​   time. 

---

I’ve been starting to think about toilet training as of late, and my default plan was to do whatever my mom did, but that doesn’t appear to be an option. Apparently, my siblings and I were all trained on weekend getaways with my grandma and a giant bag of M&Ms. This was an excellent strategy for my mom – send your kid off for the weekend, pick her up toilet trained – but it’s no help to me. I’m considering shipping my son off to his grandmother despite her lack of personal experience, but I’ve started to prepare for the probable inevitability that I will have to train my son, personally.
          Plan B: Survey the terrain. See what the medical historical literature has to say about the endeavor. When should I start? What should I do? What shouldn’t I do? Despite a paucity of evidence (and who can blame pediatricians? who wants to run toilet training studies?), I actually learned a lot. (It turns out M&Ms might be the linchpin.)
          To start, people talk about the pendulum swinging back and forth with toilet training in the U.S., but I see a different trend. I only see the pendulum swinging one way. In the early 1900s, mothers endeavored to train their babies very, very early. (Although, as later observers noted, “it was the mother who was trained” – I'll explain in a minute.) On the heels of that rigidity, “permissiveness” took hold, and parents in the mid-1900s started training their kids later (older than 1!).[1] Since then, the drift has continued – families are toilet training later and later. Maybe we’ll see a backlash to this in the coming decades, but the shift towards training at an older age has been stable since the 1960s – and it’s backed by current pediatric literature.
 
Your Great-Great-Grandma’s Method: Potting
          Advice-writers in the early 1900s were serious about toilet training. Except that what they were pressing for wasn’t really toilet training in the sense that we think of it today – it was more like parental-urine-and-stool-catching training.
          They started early – sometimes as early just a couple of weeks old. More often, experts recommended starting around two months. The training process was rigid. It involved trying to get babies on regular evacuation schedules, using some sort of bin or basin to catch their excrements – one author described it as “potting.”[2] Precision and routine were essential; the idea was that by placing a child over the bin at exactly consistent intervals every day, he would learn to respond to the stimulus and soon thereafter be “trained.”[3] (If things weren’t working, mothers read to resort to more drastic measures. Like soap stick enemas. Multiple times per day.[4]) Of course, this wasn’t really toilet training – the endgame was not independent bladder and bowel control, but much more Pavlovian: drilling a baby to void itself when prompted. This kind of approach is referred to as “parent-oriented” training because it is entirely determined and circumscribed by the parent.
          Through all this early training in the first half of the twentieth century, there was no expectation that a youngster would be able to reliably use the bathroom on his own until at least two years of age.[5]
 
Your Great-Grandma’s Method: Delayed Potting
          Into the middle of the 1900s, advice literature started to project more lax ideas. In the 1940s, the Better Homes & Gardens mothers’ handbook gave the option of starting training as late as about 6 months, by which point most babies can sit up on their own, and comforted mothers that they had no need to “get worried or desperate.”[6] In 1944, Dr. Dorothy Whipple observed that most parents began training at 8-10 months. Before this point, Dr. Whipple explained, babies weren’t capable of bladder or bowel control – their muscular development wasn’t matured enough.[7] Other experts told parents that kids were incapable of voluntary control before 15-18 months of age. Indeed, it is really interesting that even while health professionals talked about the ability to “condition” babies as young as a few months to use some sort of toilet chamber, they declared that children wouldn’t be able to go to the bathroom on their own until they were two or two-and-a-half.[8] So things started to loosen up as far as starting times, but the basic potting tactics stayed in place.
          Then, in the 1950s things really started to shift. A 1953 guidebook for parents (with the amusing title Your Child and His Problems) conveyed that there was no hurry, and that parents could more or less let their kids drive the ship. Mothers should be patient instead of urgent or insistent, guiding a child to the toilet when they were ready. Advice books started to talk about waiting until children were “ready to learn.” Apparently, the low-key approach might lead to success by age 2. Ideally, parents should wait until at least about 15 months, and avoid making too big a deal of toilet training. Placing amplified pressure on a child could backfire, professionals warned. “When toilet training becomes a battle, a mother cannot win,” wrote Joseph Teicher.[9]
 
Your Grandma’s Method: The Child-Oriented Approach
          Enter Spock and Brazelton – the renowned pediatric gurus of the 1960s. Both of them forwarded a “child-centered” approach to toilet training (TT). Both men’s writing on TT is considered revolutionary, and for good reason, but it’s clear from the shifts in literature in the 1940s and 1950s that their ideas were in vogue more broadly. (We’ll actually start discussing this as “toilet training” now because when these guys wrote about toilet training, they meant it in the way we consider it today – where the intended outcome was autonomous toilet use.) T. Berry Brazelton published “A Child-Oriented Approach to Toilet Training” in Pediatrics in 1962. It was based on more than 1,100 kids from his own practice over the previous decade (although, to be clear, it was not a formal scientific study).
          At its root, Brazelton’s method involved gradual, patient moves toward TT. A child’s interest in using the toilet, and his physiological and psychological readiness were essential. The whole idea was to orient TT around the child, rather than the parent.
          Not before 18 months, parents could introduce a potty chair and start talking about the toilet. Then the child could practice sitting on the chair, with his clothes on, according to some sort of daily schedule. The next step was to remove the diaper and continue with the daily potty sitting schedule. Parents could then let their child play naked for small bursts of time with access to the chair. Throughout all of this, praise was important (but criticism was to be avoided), and parents were instructed to keep their composure. Stay Calm and Carry On. Eventually, over time, the child learned. In Brazelton’s practice, most parents started the process around 24 months, and the average age of TT completion was around 28 months.[10]
          Benjamin Spock came out with a piece in Pediatrics in 1964 (“Parents’ Fear of Conflict in Toilet Training”). He recommended parents begin gearing up for TT around 18 months, and urged parents be optimistic rather than fatalistic about TT. “Many mothers today have come to see training too exclusively as a conflict,” he said. Like Brazelton, Spock advocated incremental training. For him, part of the problem was that mothers were so stressed and worked up about TT that the whole project often snowballed into a sort of epic mother-toddler clash. If mothers could “see that the balance is in favor of training,” he wrote, “they can go at it in a more assured and effective manner.”[11]
Ultimately, both men had a similar take – start slow, follow the child’s lead, be patient, use praise (and treats!), and maintain composure. Their relaxed approach took time – many months – but was intended to minimize stress.
          Other writers mirrored Brazelton’s and Spock’s serene approach to TT. Training “should be easy for both parent and child,” asserted Gordon Jensen in The Well Child’s Problems. “The most important point,” he stressed, “is that the child needs help and support when he is ready.”[12] In 1971, a pair of pediatricians observed the ongoing “trend away from aggressive training . . . toward the less hurried approach.”[13] The accepted age of TT completion was shifting later and later, as pediatricians reported that most kids didn’t accomplish true daytime TT until sometime after they were 2 years old.[14]
 
Why did this happen?
Probably, for lots of reasons. Including the overwhelming trend in pediatric and parental literature towards a more tolerant, forgiving kind of care. And changing ideas and expectations about babies. But also, likely, because of diapers.
 
Dirty Diapers
          Without doubt, the history of diapering dovetails with the history of TT. It is impossible to consider one without the other. Before you laugh off the subject, consider that to parents of young children, diapers are a big deal. The evolution of diapers matters a great deal to a great many people. (In 1987, the Children’s Museum of Holyoke, in Massachusetts, actually featured an exhibit called the “Diary of a Dirty Diaper.” It displayed all kinds of diapers throughout history.[15] I couldn’t find any records indicating its popularity.) In any event, having tried-and-failed with cloth diapers (shortest experiment ever), I know I am thankful for all the perks of my Pampers: the super-absorbent nighttime soaking mechanisms, the Velcro straps, the wicking capabilities . . .
          The history of the diaper has been greatly shaped by the minutiae of everyday life. In the 1800s, for example, westerners increasingly turned toward diapers (where they hadn’t used them much previously) as owning furniture became more common – diapers protected personal property. In the late 1800s, the invention of safety pins made cloth diapers easier to use. Cleansing agents made their mark on diapers: in their initial incarnation, cloth diapers presented health challenges such as rashes and irritations in babies, and the problem worsened as harsher cleaners came onto the market. The societal changes inflicted by WWII also influenced the diaper scene: in the 1940s, as women entered the workforce in droves, diaper services emerged – they exchanged soiled for clean diapers and did all the laundering.[16]
          And new scientific developments, especially paper and water technology improvements, made new things possible.
          In the 1940s, the first disposable diaper designs showed up. It took years before any product was ready for a mass market (Pampers didn’t hit the shelves until 1961), but the disposables, primitive as they are compared to twenty-first century models, completely revolutionized diapering. Since the first prototypes, diapers have changed drastically – they’ve become more absorbent and smaller, they fit babies better, they’re better at preventing leakage, and they’re better at wicking away moisture to keep babies’ skin dry.[17]
          It’s no secret that the trend towards delayed TT coincided with the mass production of disposable diapers. Most observers think disposables have played a key role in moving back the average age of TT – by their description, parents in the first half of the twentieth century who were washing tons of cloth diapers had a greater incentive to get their kids out of diapers sooner, so they started training sooner. On the flip side, parents in the 1960s and later, with access to an abundance of disposable diapers, might have had fewer motives. (Although, interestingly, today, the onset of TT also tends to correlate with income – parents earning more money report beginning TT later (around 24 months) than parents earning less, who often begin TT earlier (by 18 months). This is just another correlation, but it could point to the significance of diapers’ cost as a driving factor in TT.[18])
 
Another Option in the 1970s: TT in a Day
          The so-called Azrin and Foxx TT method (popularized in the book Toilet Training in Less Than a Day) was an outgrowth of an original study (run by Nathan Azrin and Richard Foxx, both behavioral psychologists) that involved mentally disabled institutionalized individuals. It is highly structured and intensive, a rapid conditioning approach. The goal is success after just a couple of days – and it does seem to work. And stick.
          The Azrin and Foxx method is an accelerated TT program; it is all-inclusive and all-encompassing for a couple of days. The method itself was highly specific, but here are the basic components and ideas: ideally, training occurred in a single, distraction-free room, beginning with a parent taking a child through the motions of using the toilet (dolls were used here, too). After the initial demonstration, the child was pumped with fluids (juice!) to make them need to use the toilet as much as possible throughout the training period. The parent-trainer was 100% focused on the child at all times, constantly showing the child how to use the potty. The child was reminded of the potty every several minutes, and praised for correct usage and reprimanded or put in time out for accidents.[19] The very few studies that have evaluated this method have found that “success is relatively high and achieved soon after training,” (sometimes as soon as 1 day) and that “success was maintained” months after the training.[20]  
 
TT in the Twenty-First Century
          In the 2000s, research indicates that parents are beginning, and finishing, TT much later than in previous decades. This delay has been gradual, as we’ve seen, over time. In the earlier 1900s, the onset of TT was very early; that began to shift later beginning in the mid-1900s and has continued to trend towards older ages ever since. Now, most parents don’t start TT until around 2 years and many don’t finish until 3 years or even later.[21] (This trend has also been occurring in other western developed countries, not just the U.S.[22])
          The two predominant “methods” are still the Brazelton-Spock approach (aka the child-centered approach) from the 1960s and the Azrin-Foxx approach from the 1970s (aka TT in a day). (If anyone has any better ideas, we’re about due for a new method, right?)

• Which One is “Better?”

          The short answer is “we don’t know.” The slightly longer answer is “we don’t know, but . . . ”
There isn’t a ton of good data on either method. (As one team snidely noted: “Toilet training is not a subject that invokes passion among researchers”).[23] And both tactics are “equally capable of achieving toilet-training success in healthy children.”[24] The American Academy of Pediatrics formally recommends a gradual, child-oriented approach. The child is introduced to the potty and gets accustomed to sitting on it with his clothes on. Then he sits on it without his clothes; then he’s placed there after diaper changes. The last stage involves short periods of diaper-free play with lots of encouragement to use the potty. This whole process takes place over a period of many months, and there is ample potty talk throughout. But there really isn’t much evidence that shows this method is necessarily “right.”[25]
          In 2006, a team of authors working for the U.S. Agency for Healthcare Research and Quality published a review of TT methods. They considered 26 studies and 8 randomized-control trials, some of which involved healthy children and some of which involved handicapped children. (The studies weren’t perfect, because they didn’t directly compare both methods, but this report is the best we have at the moment.) The review authors found that “for healthy children, the Azrin and Foxx method performed better than the Spock method.” To be fair, the crash method and the gradual, child-oriented approach both worked. They both “resulted in quick, successful toilet training.” But the crash course was slightly better – it yielded “rapid success rates at relatively young ages” – and maintained results.[26]
          As the authors summarize: “It appears from the literature that parents who want quick results should consider the Azrin and Foxx method of toilet training but must be prepared for a regimented approach and should use positive reinforcement. For parents who are not prepared to put as much focus into attaining confidence, the child-oriented approach can be successful but may take somewhat longer.”[27] Importantly, recent studies of the Azrin Foxx method indicate that rewards or praise (verbal or culinary) help with training, while reprimands or time outs probably work against you.
There are tons of spin-offs and variations of the Azrin Foxx method out there – the best and most approachable one I’ve found (and the resource I plan to use when I give this whole thing a go) is written by Meg Collins at LuciesList – you can find it here.
           

• When Should I Start?

          The literature varies in terms of what it says about “readiness.” Some authors indicate that most kids are ready to start TT around 18 months (and virtually no one suggests that kids are ready before this), but some suggest later, noting that “mastery of the developmental skills required for toilet training occurs after 24 months of age.” Most authors reason that children can complete TT by 24-36 months of age.[28]
          In reality, readiness is going to vary from family to family and child to child. It’s all relative. These choices depend on your goals and priorities as a parent, not to mention your time and personal “best strategies.” Plus, there are a host of different behaviors cited as “readiness indicators” in children. (One study cited 21 signs of readiness, only to explain that “there is no consensus” on how many or which signs to rely on. That’s super helpful.) The visible TT readiness signs that consistently show up in the literature include the abilities to: walk/sit/stand up, pull underwear/pull-ups up and down, follow simple directions, signal for the potty, say no, and recognize a dirty diaper.[29]
          Hsi-Yang Wu, a pediatric urologist on faculty at Stanford who’s written about toilet training methodologies, explains that the multitude of readiness markers proposed occur at widely varying ages and offer “no guidance to physicians or parents on when to start TT.” “At a minimum,” he says, “the child must be able to signal to its parent that he or she needs to urinate.” For most western children, this occurs quite late – around 28 months on average for girls and 33 months on average for boys. For Wu, a “reasonable approach” is for parents to think about TT once their child can: 1) communicate the need to go to the bathroom and 2) stay dry for a couple of hours during the day.[30] (Here’s the link if you are interested in checking out Wu’s article. Word of caution: academic toilet training literature is a dense thicket, but Wu’s piece is one of the most approachable.)
          Based on what researchers report, it seems like if parents aren’t sure whether to start, it’s best (most efficient, anyways) to wait a little bit. “Although earlier initiation of intensive toilet training is associated with earlier completion, overall training duration increases.”[31] Studies bear this out – starting TT earlier doesn’t necessarily mean finishing TT earlier (although it can), but it almost always means longer TT. Most of all, it’s not worth it to get too hung up on the exact timing – as Wu states, “there is currently no evidence that a specific timing or method of TT is more effective.”[32]
 
So – all in all – parents and pediatricians don’t have a ton of good evidence they can rely on for help with TT questions. But, as usual, there are some points of continuity. Here are my takeaway nuggets:

• Doctors have been increasingly stressing that children are incapable of autonomous toilet use until later than previously thought
• Parents have been continuously training their kids later and later
• Timing is somewhat important, but it’s not an issue worth stressing over
• Whatever TT method you use will eventually work

 
 
Do you know how you were toilet trained? What’s your experience with toilet training your kids?
 

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[1] Gordon D. Jensen, The Well Child’s Problems: Management in the First Six Years (Chicago: Year Book Medical Publishers, 1962), 156.
[2] Carolyn C. Van Blarcom, Building the Baby: The Foundation for Robust and Efficient Men and Women (Chicago: Public Service Office of the Chicago Tribune, 1929), 86–87; R. K. Van Wagenen et al., “Field Trials of a New Procedure for Toilet Training,” Journal of Experimental Child Psychology 8, no. 1 (August 1969): 147–59.
[3] The Better Homes & Gardens Child Care and Training Department, Better Homes & Gardens: A Handbook for Mothers, from Prenatal Care to the Child’s Sixth Year (Des Moines, Iowa: Meredith Publishing Company, 1943), 84; M. W. deVries and M. R. deVries, “Cultural Relativity of Toilet Training Readiness: A Perspective from East Africa,” Pediatrics 60, no. 2 (August 1977): 171.
[4] Van Blarcom, Building the Baby: The Foundation for Robust and Efficient Men and Women, 112.
[5] The Better Homes & Gardens Child Care and Training Department, Better Homes & Gardens: A Handbook for Mothers, from Prenatal Care to the Child’s Sixth Year, 130.
[6] Ibid., 84, 129.
[7] Dorothy V. Whipple, Our American Babies: The Art of Baby Care (New York: M. Barrows and Company, Inc., 1944), 32, 108.
[8] Ronald S. Illingworth, The Normal Child: Some Problems of the First Five Years and Their Treatment (Boston: Little, Brown and Company, 1957), 277.
[9] Joseph D. Teicher, Your Child and His Problems: A Basic Guide for Parents (Boston: Little, Brown and Company, 1953), 54–58; Illingworth, The Normal Child: Some Problems of the First Five Years and Their Treatment, 280, 283, 285.
[10] T. B. Brazelton, “A Child-Oriented Approach to Toilet Training,” Pediatrics 29 (January 1962): 121–25.
[11] B. Spock and M. Bergen, “PARENTS’ FEAR OF CONFLICT IN TOILET TRAINING,” Pediatrics 34 (July 1964): 115–16.
[12] Jensen, The Well Child’s Problems: Management in the First Six Years, 154, 159.
[13] J. A. Stehbens and D. L. Silber, “Parental Expectations in Toilet Training,” Pediatrics 48, no. 3 (September 1971): 452.
[14] J. A. Stephens and D. L. Silber, “Parental Expectations vs Outcome in Toilet Training,” Pediatrics 54, no. 4 (October 1974): 494.
[15] Carolyn Lumsden, “Children’s Museum Displays Diapers of Many Cultures and Years Gone By,” Associated Press, March 2, 1987; Associated Press, “Museum Show Traces Toilet-Training History,” Houston Chronicle (TX), March 8, 1987, 2 STAR edition.
[16] Bernice Krafchik, “History of Diapers and Diapering,” International Journal of Dermatology 55 (July 1, 2016): 5, doi:10.1111/ijd.13352.
[17] Ibid.; “Smaller,” The New Yorker, accessed May 24, 2017, http://www.newyorker.com/magazine/2001/11/26/smaller.
[18] Ivor B. Horn et al., “Beliefs about the Appropriate Age for Initiating Toilet Training: Are There Racial and Socioeconomic Differences?,” The Journal of Pediatrics 149, no. 2 (August 2006): 168, doi:10.1016/j.jpeds.2006.03.004.
[19] Diane M. Howell, Karen Wysocki, and Michael J. Steiner, “Toilet Training,” Pediatrics in Review 31, no. 6 (June 1, 2010): 263, doi:10.1542/pir.31-6-262; N. H. Azrin and R. M. Foxx, “A Rapid Method of Toilet Training the Institutionalized Retarded,” Journal of Applied Behavior Analysis 4, no. 2 (1971): 89–99, doi:10.1901/jaba.1971.4-89; R. M. Foxx and N. H. Azrin, “Dry Pants: A Rapid Method of Toilet Training Children,” Behaviour Research and Therapy 11, no. 4 (November 1, 1973): 435–42, doi:10.1016/0005-7967(73)90102-2; RICHARD FLASTE, “Toilet Training: Searching for a ‘Correct’ Method: A Reaction: Less Than a Day New Awareness of Communication,” New York Times, 1977, sec. Family/Style; Melinda Wenner Moyer, “Slate’s Definitive Guide to Potty Training,” Slate, July 8, 2013, http://www.slate.com/articles/double_x/the_kids/2013/07/potty_training_tips_how_to_get_your_child_out_of_diapers_by_high_school.html.
[20] Terry P. Klassen et al., “The Effectiveness of Different Methods of Toilet Training for Bowel and Bladder Control,” Evidence Report/Technology Assessment, no. 147 (December 2006): 1–57; Beth A Choby and Shefaa George, “Toilet Training,” American Family Physician 78, no. 9 (November 1, 2008): 1062–63.
[21] Nathan J. Blum, Bruce Taubman, and Nicole Nemeth, “Why Is Toilet Training Occurring at Older Ages? A Study of Factors Associated with Later Training,” The Journal of Pediatrics 145, no. 1 (July 2004): 107, 109, 110, doi:10.1016/j.jpeds.2004.02.022; Howell, Wysocki, and Steiner, “Toilet Training,” 262.
[22] E. Bakker and J. J. Wyndaele, “Changes in the Toilet Training of Children during the Last 60 Years: The Cause of an Increase in Lower Urinary Tract Dysfunction?,” BJU International 86, no. 3 (August 2000): 250; Karolien van Nunen et al., “Parents’ Views on Toilet Training (TT): A Quantitative Study to Identify the Beliefs and Attitudes of Parents Concerning TT,” Journal of Child Health Care 19, no. 2 (June 1, 2015): 265, doi:10.1177/1367493513508232.
[23] Klassen et al., “The Effectiveness of Different Methods of Toilet Training for Bowel and Bladder Control”; Choby and George, “Toilet Training,” 1060; Kelly Russell, “Among Healthy Children, What Toilet-Training Strategy Is Most Effective and Prevents Fewer Adverse Events (Stool Withholding and Dysfunctional Voiding)?: Part A: Evidence-Based Answer and Summary,” Paediatrics & Child Health 13, no. 3 (March 2008): 201–2; D. A. Kiddoo, “Toilet Training Children: When to Start and How to Train,” Canadian Medical Association Journal 184, no. 5 (March 20, 2012): 512, doi:10.1503/cmaj.110830.
[24] Choby and George, “Toilet Training,” 1063.
[25] Horn et al., “Beliefs about the Appropriate Age for Initiating Toilet Training,” 165; Choby and George, “Toilet Training,” 1061; Alexandra Vermandel et al., “How to Toilet Train Healthy Children? A Review of the Literature,” Neurourology and Urodynamics 27, no. 3 (March 1, 2008): 163, doi:10.1002/nau.20490; Moyer, “Slate’s Definitive Guide to Potty Training”; FLASTE, “Toilet Training”; Foxx and Azrin, “Dry Pants”; Azrin and Foxx, “A Rapid Method of Toilet Training the Institutionalized Retarded.”
[26] Klassen et al., “The Effectiveness of Different Methods of Toilet Training for Bowel and Bladder Control”; Choby and George, “Toilet Training,” 1060–61.
[27] Klassen et al., “The Effectiveness of Different Methods of Toilet Training for Bowel and Bladder Control.”
[28] Horn et al., “Beliefs about the Appropriate Age for Initiating Toilet Training,” 165; Choby and George, “Toilet Training,” 1059.
[29] Choby and George, “Toilet Training,” 1060, 1063; Nore Kaerts et al., “Readiness Signs Used to Define the Proper Moment to Start Toilet Training: A Review of the Literature,” Neurourology and Urodynamics 31, no. 4 (April 1, 2012): 437–40, doi:10.1002/nau.21211.
[30] Hsi-Yang Wu, “Can Evidence-Based Medicine Change Toilet-Training Practice?,” Arab Journal of Urology 11, no. 1 (March 2013): 16–17, doi:10.1016/j.aju.2012.11.001.
[31] Choby and George, “Toilet Training,” 1060.
[32] Wu, “Can Evidence-Based Medicine Change Toilet-Training Practice?,” 14, 16, 17.