Goodbye Diapers - It's Potty Training Time

Podcast Transcript

Dr. Richard So:

Welcome to Little Health, a Cleveland Clinic Children's podcast that helps navigate the complexities of child health one chapter at a time. In each session, we'll explore a specific area of pediatric care and feature a new host with specialized expertise. We'll address parental concerns, answer questions, and offer guidance on raising healthy, happy children.

Now, let's talk Little Health. Potty training! It's a big deal. You might be excited, you might be nervous, and that's okay. I'm Dr. Richard So, a pediatrician at Cleveland Clinic Children's, and today, as a part of our season on primary care, we're talking about ways to make potty training easier. We want you to feel good about it and help you know when your child is ready. My guest today is Dr. Shannon Thompson. She's a pediatrician, and a mom who's currently potty training her little ones.

Welcome to Little Health, Dr. Thompson. Tell us about yourself.

Dr. Shannon Thompson:

Thank you so much for having me. I'm really happy to be here. I am a board-certified pediatrician, and I have been in practice for several years. I did my training at Akron Children's Hospital, so I've been in the area for quite a while, and grew up here. I am a mom of two little ones, both girls, two and four, so we have definitely been in the potty training for a little while now.

Dr. Richard So:

So, this is a perfect conversation for you. You got your 2-year-old who's learning how to be continent in urine, and the 4-year-old should be learning how to stool on the potty. Tell me what's working.

Dr. Shannon Thompson:

Absolutely. So, it's been an interesting journey for us, because my 4-year-old was actually a little bit difficult to train and a little bit resistant. My two-year-old has been, been quite easy. What's worked for us, starting with, with my oldest, is waiting for them to tell us that they're ready or to show us signs of readiness. Because my oldest took a while and we tried too soon, and then ended up with some, some resistance and some issues there, and that's something that I think is really important.

Dr. Richard So:

Yeah. I think the earlier you start, the longer it takes, and the more frustration there is as being a parent because diapers are expensive.

Dr. Shannon Thompson:

Absolutely.

Dr. Richard So:

You know, and knowing what readiness is, you have to be... Developmentally, you have to b- have, like, the cognitive ability, you have to understand the physiology of feeling wet, you have to have the motor part to get up on there, and there's an emotional component. Tell us, like, the methods that you used, or what was different between your kids and what you know now?

Dr. Shannon Thompson:

Absolutely. So, we initially started with kind of the traditional recommendations, and when our oldest was letting us know she was wet, you know, she's even taking off her diaper. You know, one time she walked in the kitchen with a diaper that was full of poop and said, "I'm done," and we were like, "Oh, goodness."

Dr. Richard So:

But that's at 15 months, usually, when kids will do that.

Dr. Shannon Thompson:

She was 15, 18 months. She was a little bit later, but what we started initially was, like, our- our rewards. So, we got a, you know, a potty training chart with stickers, and if you sit on the potty, was how it started, we will give you a sticker, you know.

Dr. Richard So:

Getting a reward for sitting?

Dr. Shannon Thompson:

Yeah. Mm-hmm.

Dr. Richard So:

Wow.

Dr. Shannon Thompson:

We did. We, we had to get there with her. And, you know, eventually, of course, if you pee in the potty, you get a sticker, you know, and then if you poop in the potty, you get two stickers, and sometimes bigger rewards depending on what it was. And it took quite a while for it to catch on with her.

Dr. Richard So:

Take a step back. So, you started that at 15 months?

Dr. Shannon Thompson:

No, not 15 months. It was closer to 18 months, I think.

Dr. Richard So:

Wow. For me, personally, in my practice, when I like to potty-train, when, when I define readiness in, in my practice world is, I like two things. Number one, you gotta have the speech.

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

"I need bathroom."

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

And number two, I like the kids out of the crib.

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

And I don't-

Dr. Shannon Thompson:

Absolutely.

Dr. Richard So:

... at 18 months. Because if you're in the crib and parents want to potty-train, from a kid's perspective, "Wow. They want me to go to the bathroom overnight. I see it over there, but I'm in jail. I'll just wet my bed till I'm 11 years old."

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

And you and I have a bunch of those kids in our practice that do that.

Dr. Shannon Thompson:

Uh-huh. Uh-huh.

Dr. Richard So:

So, going back to, like, when you talk about potty. What do you think about the little potties that you can buy versus the big toilet?

Dr. Shannon Thompson:

Very good question, and kind of a very controversial topic. So, we used the little potties. Just for the ease of being able to sit down, you know. We're trying to make things as easy as possible with our oldest, because we made some mistakes, you know, trying to train. I think probably starting with the bigger potty and, like, a step stool, or, you know, way to get into that potty. Kind of teaching, "We go to the bathroom in the bathroom." You know, "This is where the potty is," is long-term gonna be more helpful. Um, but the little potties can be easier, especially if you have a tough trainer.

Dr. Richard So:

In my practice, I don't use the little potties.

Dr. Shannon Thompson:

Yeah.

Dr. Richard So:

I think they're filthy-

Dr. Shannon Thompson:

That's true.

Dr. Richard So:

... you know, and then you have to train twice.

Dr. Shannon Thompson:

That's true.

Dr. Richard So:

So, I always skip the middleman, and I wait till they're a little bit bigger. Like I said, the earlier you start, the longer it takes.

Dr. Shannon Thompson:

Right.

Dr. Richard So:

But then, you have to train twice. You have to train to sit on the little potty, where your baby not, your kid might not be ready. And what I don't like about the thing, it doesn't flush.

Dr. Shannon Thompson:

Right.

Dr. Richard So:

Think about how many times you poop and you pee during the day, then you have to clean that.

Dr. Shannon Thompson:

Right.

Dr. Richard So:

And then they wanna play with it.

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

They want to... They're very intrigued by it

Dr. Shannon Thompson:

Right. Yeah, and my oldest started trying to clean it herself. You know, she'd take out the thing and... It wasn't the best.

Dr. Richard So:

Yeah. Go through your process a little bit more.

Dr. Shannon Thompson:

So, we did do the little potty, and after we had some false starts, we... You know, we took a break, and, and that's what a lot of times will tell you is, you know, she was not taking, it was frustrating, she was upset. And we were also trying to-

Dr. Richard So:

Weeks? A month?

Dr. Shannon Thompson:

Oh, gosh, months. Yeah, months. And then when we took a break, we probably took a good two, three month break.

Dr. Richard So:

So, do you think you started early?

Dr. Shannon Thompson:

I think we started too early, and she took a long time to train. We also had added pressure of her going to preschool, you know, so-

Dr. Richard So:

That's huge.

Dr. Shannon Thompson:

That stressed her out. You know, that stressed us out, because she couldn't go if she wasn't potty-trained. And so we ended up backing off, you know, and letting her signals guide the way, and, and that ended up helping. Um, eventually, we ended up doing, which, I'm sure you've heard of this, the weekend, naked potty training thing.

Dr. Richard So:

Yeah. There's a lot of books out there.

Dr. Shannon Thompson:

Yeah, yeah.

Dr. Richard So:

Like, there's Commando Style.

Dr. Shannon Thompson:

Right.

Dr. Richard So:

Where you just follow 'em. You set timers

Dr. Shannon Thompson:

Right.

Dr. Richard So:

In your practice, like, you've had parents pull out the different books.

Dr. Shannon Thompson:

Uh-huh.

Dr. Richard So:

You know, but I think, like, starting around two-ish. Yes, every 15-month-old will put their hands in their diaper. They'll say, "Poo poo." They'll take it off.

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

And everyone thinks they're ready, but they're still in the crib, but they're really not ready yet.

Dr. Shannon Thompson:

Yeah.

Dr. Richard So:

But once two, when they can verbalize, "I need bathroom," you know, "I go pee pee, I go poo poo." Because they're, they're little echoes at two-year-old, developmentally, where their speech is exploding, and it's so much fun.

Dr. Shannon Thompson:

Absolutely.

Dr. Richard So:

And I think that's a great time to start the potty training, like around two, but I always start with, like, a regular potty book.

Dr. Shannon Thompson:

Yeah. I think traditional kind of positive reward system and, and helping them to learn their body cues is probably the best way to go. There's tons of ways to do it now. There's tons of, you know, new ideas and gimmicks and things like that. But I think at the end of the day, trying to teach that, how to listen to your body, how to go to the bathroom, and then when you're successful, celebrating that success, is gonna be the best bet.

Dr. Richard So:

Yeah. I like some of those books because it, it, it gives the kids the introspective feelings of what "yucky" is.

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

All right. Once the kid knows that that's yucky, that's dirty. And parents need to understand, when they're potty training their kid, is that they feel like their body fluids, whether it's their pee or their poop, are a part of them, and th- they don't know how to share yet and they don't know how to let go of those things.

Dr. Shannon Thompson:

Sure. Yeah.

Dr. Richard So:

So, kids feel that, like, their bodily fluids is a part of them, and inherently, they don't know how to share, and they don't like to let go of things.

Dr. Shannon Thompson:

That's true.

Dr. Richard So:

One of the hardest things is, you said, is that you can get the kid to sit, but what is that magical "aha" moment where kids, you, you get parents to say, "Hey, you can go pee."

Dr. Shannon Thompson:

That is definitely a tough one, and it's very individualized for kids. I think when you have a kiddo that is consistently going when prompted, it's okay to let go and give 'em a chance. They'll often run to the bathroom at the last minute. And, you know, there are gonna be accidents and that's normal, but I think until they know what that feels like, even to have an accident or to be full. Um, they don't always know without being prompted by their timer, or their potty watch, their mom and dad. You have to give 'em a little bit of freedom there.

Dr. Richard So:

So, two-year-olds, they copy each other. They copy their parents, they're little echoes. They're saying... Do you let them watch you pee?

Dr. Shannon Thompson:

I do, but, you know, I can't get away from them. So, even if I didn't want to, they would get in there. My husband does not. Um, you know-

Dr. Richard So:

Because you have girls.

Dr. Shannon Thompson:

Correct.

Dr. Richard So:

I have boys.

Dr. Shannon Thompson:

Exactly.

Dr. Richard So:

I have boys, and believe it or not, since they're copying and they're little echoes, yeah, uh, I... I'll go to the bathroom, and out of curiosity, my boy will go, "What are you doing?" I go, "Oh, I'm making yellow bubbles," and I'll go, "Your turn."

Dr. Shannon Thompson:

Yeah.

Dr. Richard So:

And then, I just keep on pushing that little prompt out there, "It's your turn." Because they're learning how to take turns-

Dr. Shannon Thompson:

Uh-huh.

Dr. Richard So:

... when they're they're, and then it's like, "I'm making yellow bubbles."

Dr. Shannon Thompson:

Yeah.

Dr. Richard So:

What kind of rewards do you use? I'll get into mine, but tell me about yours.

Dr. Shannon Thompson:

We're sticker chart people. We love stickers. Sometimes we'll do the occasional M&M, or things like that. We try not to tie it too much to sweet treats, though. And, of course, a lot of celebration, right? When they go in the potty, "Oh, my gosh, you went in the potty. You're a big girl," you know. Picking out underwear can be a good reward. Like, "What kind of undies do you wanna get? Do you want, you know, Princess undies or Paw Patrol undies?" Things like that, to let them know that, that this can be an exciting time, and not necessarily all scary.

Dr. Richard So:

Yeah. There's all different ways to do potty training, as there's multiple books, but believe it or not, I do use sweets.

Dr. Shannon Thompson:

Yeah.

Dr. Richard So:

It's... Actually, potty training is the only time I use food as a reward for good behavior. I don't do it later on. I know... Like, I don't reward, like, with desserts, with meals, because that was part of the meal. You get it no matter what. I don't make my kid clean their plate.

Dr. Shannon Thompson:

Sure.

Dr. Richard So:

As long as they gave me a good effort and they've tried things, you still get your dessert. Otherwise, you- you created an emotional component on food. But back to potty training, I do use rewards. So, when I'm starting potty training, what I'll do is, I'll show a handful of M&Ms and MS and a handful of little marshmallows. And I'll go to the kid, I go, I go, "Hey, Sully, come over here. I want you to try something," and then he'll come over and he'll taste one. I go, "Which one do you like better?" He goes, "I like the M&Ms," and then I go, "You want some more?" And he'll go, "Oh yeah." And I go, "Well, next time you go pee pee on the toilet, I'll give you one." And it works.

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

All right? They, they learn that behavioral, just like Pavlov's dogs. I go, "You do something good, you get the prize."

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

But what happens in parenting is that, after three days, that gateway M&M doesn't work anymore.

Dr. Shannon Thompson:

Right.

Dr. Richard So:

'Cause they built up a tolerance-

Dr. Shannon Thompson:

Right.

Dr. Richard So:

... and they need something stronger.

Dr. Shannon Thompson:

Uh-huh.

Dr. Richard So:

So, I think the whole secret of potty training is: when your reward doesn't work, you have to find something that your kid values. And... That's just not with potty training. That's how you change behavior in kids in general. So, when your M&M worked, that means your kid knows the game. He knows the value that he does something right, he gets a prize. So, what I did with my son is that, okay, the, the one M&M. He goes, "I don't want M&Ms anymore." I go, "Okay. If you go pee pee, I'll give you two," and then he goes, "Okay!" And that worked for a couple more days. You just have to change your reward. Sometimes it was stickers. You know, sometimes it was a marshmallow. Sometimes it was a big marshmallow. Sometimes it was the star marshmallow. So, the secret in potty training, I think, too, is if your rewards aren't working, "Oh, I've tried that Dr. So-

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

... you just have to figure out what your kid values. So, you talked about, like, buying underwear.

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

And when we go through nighttime training...

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

So, what we know as pediatricians, it's always day before night, and then you learn pee before poop.

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

What do you do to get your kid to potty-train overnight?

Dr. Shannon Thompson:

That is tough, and that's something we're still working on.

Dr. Richard So:

So, do you just wear pull-ups and you get the covers for the mattress, or you do a little bit more?

Dr. Shannon Thompson:

We- we've done both, and we're kind of going back and forth, but we do pull-ups, and if we have a dry pull-up in the morning, for a couple mornings in a row, we try undies. You know, we kind of keep giving it a try. My oldest will intermittently go to the bathroom in the night, but often, she won't. There are different schools of thought, like, "Do you just put them in the undies, and they, you know, have the accident, and you clean everything up and try it again?" I'm not sure that that works.

Dr. Richard So:

Yeah. I, I think parents pull the trigger too early with the pull-ups, you know?

Dr. Shannon Thompson:

Yeah. And I think it's important to know, too, that it can be developmentally normal to have overnight accidents much later than to be potty-trained.

Dr. Richard So:

Yeah. Part of, part of our philosophy of care here is to give the most up-to-date care and save you money at the same time. So, I think if you pull the trigger on pull-ups too much, you're wasting your money because, number one, they cost more.

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

And number two, there's not as many in the box.

Dr. Shannon Thompson:

That's true.

Dr. Richard So:

You know?

Dr. Shannon Thompson:

Yeah, especially the bigger they get.

Dr. Richard So:

But, but, but parents, they don't wanna do laundry.

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

You know, they protect the mattress. They don't want to do the laundry. One thing that I do in my practice that I think parents are very surprised at is: if you buy big girl underwear or big boy underwear, I still like them to feel like a big kid at night, so I put the pull-up over the underwear, so they feel yucky.

Dr. Shannon Thompson:

Okay, that makes sense.

Dr. Richard So:

And-

Dr. Shannon Thompson:

That makes sense. I've never heard of that.

Dr. Richard So:

And what, and what I tell them is, is that we're responsible for our own messes. So, we teach that early in our house. If you spill something, we'll clean it up. And also, too, with potty training, I think it's teaching your kid the responsibility of taking care of themselves and cleaning up after themselves. So, what I tell them to do, 'cause it's, it's awful when you just wear underwear alone and you gotta wash the sheets.

I do make the kids help clean up the sheets, you know, put them in the, in the laundry. But I think it's easier to clean little underwear that are under the pull-ups than it is to do laundry, so what I do is: I go, "You know how mommy will be very proud of you? Is if you have an accident, you always acknowledge that it's okay."

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

There's no shame with potty training. You say, "Okay. If you take your little underwear off, you wipe yourself down, you put the underwear in, like, the bathroom sink, and you change in your potty, we'll be so proud of you in the morning." I think that's a good step to getting dry.

Dr. Shannon Thompson:

Mm-hmm. And then it also triggers their brain, you know, right? The whole brain-body connection to, "I'm awake, I peed, I have to go to the bathroom." You know, maybe go sit on the potty, wash your hands. Like, start to get that routine embedded in their body, and that can help for the long run.

Dr. Richard So:

Yeah. Another thing I do to get my kids dry overnight... I'm huge on rewards, okay? Just like with getting pee-pee during the day, I go... I go to my son, I go, "Hey, Sully, come over here. I want you to try something," and I took the can of ready Whip. That was when we were into the Belgian waffles and the waffle makers.

Dr. Shannon Thompson:

Ooh, that sounds delicious. Yeah.

Dr. Richard So:

Yeah. And like, and I squirt it in his mouth. Who doesn't love that-

Dr. Shannon Thompson:

No.

Dr. Richard So:

... squirted in your mouth? So, it was like...

Dr. Richard So:

So, he got that every single morning when he was, he was there. These days, too, I think to get your kid dry overnight... What time do you wake up in the morning?

Dr. Shannon Thompson:

Six o'clock.

Dr. Richard So:

Okay, and what time are the kids out of bed?

Dr. Shannon Thompson:

That is variable, 6:00 to 7:00.

Dr. Richard So:

Good. So, say- say it's, like, seven o'clock. What I tell my parents in my practice is, as soon as you wake up, whether it's you or dad, okay? Before you go to the bathroom yourself, wash your face, brush your teeth, you check that pull up. Because in my experience, what I've noticed is that the kids are lazy. Is they wake up and then they pee.

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

And, you know, they, they just don't want to go to the bathroom to pee, so what I tell my parents, "Go in there." If you go in there, and it's five o'clock in the morning, and that pull up is dry, your kid made it.

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

And then what you do is, you wake them up, you do the dance, you give the prize, and then if he wants to go back to sleep, they can.

Dr. Shannon Thompson:

Yeah, that makes sense. And I think that happens a lot in our house, um, that we're dry, and then we're awake and we go to the bathroom, you know?

Dr. Richard So:

I think that that's how you gotta do it.

Dr. Shannon Thompson:

Uh-huh.

Dr. Richard So:

Yeah. Sometimes they're so busy watching their shows, they wanna do that. So, even my... One of my partners, he had a three-year-old, and he came home from work, and there was pee on the floor. And we knew it was pee, and we go, "Hey, what happened here?" The kid looked up at the ceiling like it was dripping.

He goes, "I don't know, Dad." So, he was, he was, like, lying about it.

Dr. Shannon Thompson:

Yeah, yeah.

Dr. Richard So:

And, and I don't know if it's shame-

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

... that, that he was doing it, or with potty training and there's shame. Let's talk about lying a little bit, you know? What do you do when that kid says like, "I, I don't have to go."

Dr. Shannon Thompson:

Mm-hmm. I think that's very common in potty training because, one, I think there is some shame. I think they know they're, what they're supposed to do and what we've taught them to do, and then I think, sometimes, it depends on how we have reacted in the past, right? Like, if they get into trouble when they have an accident, or they get into trouble when they won't sit on the potty, or there's frustrations with potty training and, and a lot of... You have to have a lot of patience. That's when we start to see the lying, is when they don't wanna tell you because they're afraid of one thing or another.

Dr. Richard So:

So, a term that, uh, I learned from Mrs. So, my wife, is like, before you leave the house, you know, because you don't want to go to the public bathrooms, it's like, "I know you don't have to go. Let's just try."

Dr. Shannon Thompson:

Uh-huh. Uh-huh.

Dr. Richard So:

Then if they try, then you might get some success.

Dr. Shannon Thompson:

Right.

Dr. Richard So:

But you- you're, you're successful at home. You're doing everything, but now you're on the go.

Dr. Shannon Thompson:

Right.

Dr. Richard So:

Right?

Dr. Shannon Thompson:

Right.

Dr. Richard So:

How do you train your kids to go, and what... At the store, what do you tell your parents of those routines? Or, are you still going through it?

Dr. Shannon Thompson:

We... Well, both. So, one thing, you know, public potties are very loud, so sometimes, those sensory things can be even worse when you're in public. Other people are going to the potty. I don't know you've had this experience? Your toddler walks in, "It stinks in here," you know, and you're like, "Oh, my gosh."

Dr. Shannon Thompson:

Setting those expectations. You know, "This potty might be loud. We can cover our ears." You know?

Dr. Richard So:

Yeah. I think it's, I think it's hard for parents too-

Dr. Shannon Thompson:

Yeah.

Dr. Richard So:

... because... You know, I used to work in a restaurant. The girl's bathroom, sometimes it looks like a typhoon went through there.

Dr. Shannon Thompson:

Right.

Dr. Richard So:

And you're like, "Don't touch anything."

Dr. Shannon Thompson:

Right.

Dr. Richard So:

And then... You don't want to create anxiety, but you want to keep your kid clean.

Dr. Shannon Thompson:

Right.

Dr. Richard So:

What do you do in those parts?

Dr. Shannon Thompson:

That's really tough, and I'm still struggling with that.

Dr. Shannon Thompson:

Um, I'm the mom, "Don't touch anything. Don't touch, don't touch the potty." You know, my oldest actually does it pretty well herself now. She'll get up on the potty and, you know, we make sure we wash really good. We have, like, a little travel seat that we carried around for a little while.

Dr. Richard So:

I carry the ring.

Dr. Shannon Thompson:

Yeah. Oh, yeah.

Dr. Richard So:

You bring your own ring. It's easier to clean than bring the box when you're going to Florida on a road trip.

Dr. Shannon Thompson:

Yeah. I think talking, and this is t- true of all toddler things. Talking them through it, right? Like, "We're gonna go in the big potty. There might be other people there. It might be loud. We're still gonna go potty." You know, just focus on what we're doing. I've even covered my little one's ears, you know, when we flush, or when she's sitting there, things of that nature.

Dr. Richard So:

I think kids are scared of the toilet.

Dr. Shannon Thompson:

Mm-hmm. It's big.

Dr. Richard So:

Especially if those toilets flush louder.

Dr. Shannon Thompson:

Uh-huh.

Dr. Richard So:

One of the big tips I give my parents is that when you have your diaper bag and you have everything, when you're potty training your kid, carry a pack of post-its with you.

Dr. Shannon Thompson:

Okay.

Dr. Richard So:

All right? And what you're using for the post-its, all right? Is you cover the magic, red-eye flusher.

Dr. Shannon Thompson:

Oh, that's smart. Yeah.

Dr. Richard So:

Because I think kids are afraid of public toilets, because sometimes, when they sit down-

Dr. Shannon Thompson:

It flushes.

Dr. Richard So:

... the red-eye flushes, it roars. They haven't started yet, or in the middle of it, and the water splashes them.

Dr. Shannon Thompson:

Oh, that's the worst.

Dr. Richard So:

And you just told them it was filthy, not to touch anything.

So, I think carrying post-its in, while you're going to a public potty.

Dr. Shannon Thompson:

Mm.

Dr. Richard So:

Especially with automatic flushers, where they're at the rest stop. I think that's a good, little parenting tip.

Dr. Shannon Thompson:

I mean, that's happened to all of us, right? It's scary when you're grown up, like, so-

Dr. Richard So:

Mm-hmm.

Dr. Shannon Thompson:

Like, "What's happening?"

Dr. Richard So:

It's like, "Ugh!"

Dr. Shannon Thompson:

I know. Oh, yeah. Well, that too, yeah. I'm like, "Can't believe that just happened." Yeah.

Dr. Richard So:

What about poop? Are you, are you poop training your four-year-old?

Dr. Shannon Thompson:

Oh, she's trained. Um-

Dr. Richard So:

How'd you do it.

Dr. Shannon Thompson:

Okay, so she... And this is a top- a different topic, but she has some, some pooping issues, so it took us a very long time to get there. Um, and I think that's important too. If your kiddo, you know... As a general idea, in toddlers, constipation is not uncommon.

Dr. Richard So:

Yeah. It's impossible to potty-train a kid who's constipated.

Dr. Shannon Thompson:

Exactly. So that would, I would say, would be my number one step if you're having trouble, is make sure that they're not. And so we have to, we have to work with that a little bit with her. We still have a little trouble, but now she recognizes her signals and will sit down for us. Same thing, though. Reward systems, you know. Trying to be patient when there's an accident, you know. For a while, she'd, she'd ask for a pull-up for bedtime, then she would go poop. You know, 'cause she knew it was more comfortable. So, setting them up for success, making sure that the potty is comfortable. If they need a stool to put their legs on, 'cause little dangling legs makes it hard, and then a book, a story. We had like a long, like, running story, like, that we would use when we were going to the bathroom. Like-

Dr. Richard So:

And what was the story about?

Dr. Shannon Thompson:

It... Well, it was called the Princess story, but it was always-

Dr. Richard So:

It had nothing to do with potty?

Dr. Shannon Thompson:

No.

Dr. Richard So:

Oh, okay.

Dr. Shannon Thompson:

Nothing to do with potty, yeah. And that was just like a little, "Tell me the Princess story," so that we would sit there for longer. We do have some good books at home, though. Like, Daniel Tiger has a great little book about trying and stuff.

Dr. Richard So:

Gotcha.

Dr. Shannon Thompson:

But-

Dr. Richard So:

Yeah. When I'm training kids to, to poop in the toilet, you know, I explain to parents that, number one, from a kid's perspective, poop is part of their body, and they have a hard time letting go, and they're not what it's going. And it's actually in my practice the only time I tell the parents to tell a little white lie. So, I have two actually stories that I tell parents. Number one, I use the poo poo party.

Dr. Shannon Thompson:

Okay.

Dr. Richard So:

Is that I'll, I'll write on, write on the, on the examination table. I'm a visual learner, and most kids are too. So, I'll draw a picture, and I'll draw... "Hey, what do you think this is," and if he goes, "Oh, that's a house." And I go, "What's this?" "Oh, that's the door." And I'm a pretty good artist. I drew a picture of a toilet. I go, I go, "What's that?" She goes, "That's the potty." And I think to get kids to release or let go, they need to know where their stool is going, and I believe if they know that it's going to an altruistic place, they'll let go. Just like sharing.

So, what I do is: I draw a picture of a toilet, and then underneath the house, like, it goes to the pipes. Like, "When you flush a toilet, do you know where your poop goes?" I go... They go, "Where?" I go, "It goes to the poo poo party." And I'll draw hats, I'll draw cakes.

Dr. Shannon Thompson:

Oh, wow.

Dr. Richard So:

I go, "Do you wanna make, do you wanna make your poop happy?"

And they all say, "Yes," because everyone wants to be happy. "We sent our poop to the poo poo party, and every time you go to the poo poo party, you get the prize."

Dr. Shannon Thompson:

Interesting. Yes.

Dr. Richard So:

That's one thing that I do. Another little story that I use is, is that I'll draw the picture of the house. And if, if they don't buy into the poo party, I go, "Do you know where your poop goes? When you flush the toilet, it goes to the ocean or the sea, and it feeds Nemo and all his friends. And when they're there, they get really happy." And I go, "And they grow big and strong. Do you wanna help Nemo's friends?" They go... As soon as you get that kid to say yes, then, then they get the buy-in. So, I never say to the kid, "Hey, let's go poop in the potty. Let's go to a potty." I go, "Let's send our poop to the poo poo party," or, "Let's send our poop, so we can feed Nemo and his friends."

Dr. Shannon Thompson:

Yeah.

Dr. Richard So:

So, if they know that it's going to an altruistic place, they're more likely to let go of that intrinsic feeling of, "This is my body, part of my body. How do I let it go?" Because kids don't like to give things away.

Dr. Shannon Thompson:

Right.

Dr. Richard So:

They don't like to share. But if... Just like how we learn sharing it too-

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

... if they know that it's going to help Nemo, or it's going to a happy place, they'll let go. I've had a lot of success with that.

Dr. Shannon Thompson:

That's interesting. Yeah. I... The poo poo party. I'm gonna have to use that.

Dr. Richard So:

You draw the picture underneath.

Dr. Shannon Thompson:

Yeah.

Dr. Richard So:

And then you have to get the prize. And then I see parents spend too much money on pee pee toys, but I think there's a difference between a pee pee toy and a poo poo toy. One of my favorite things to do with my kids is I, I walk in the store and I let them free-range in the toy aisle. And I- I'm just imagining how, where they put them on the top shelf, the bottom shelf, where, where everything's at and h-... 'Cause there's such a science behind that.

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

Of like, what they do and how tall your kid is. And it's the time, it's like, "Okay. My boy stopped at the trucks," right?

Dr. Shannon Thompson:

Mm-hmm.

Dr. Richard So:

And I buy the five-pack of trucks.

Dr. Shannon Thompson:

Uh-huh.

Dr. Richard So:

And I go, "These are your new poo poo toys. Next time you send the poo poo to the poo poo party, I'll give you one. Every single time." But even before I get there, in the car, I go, "Here, play with these." And you give 'em a little taste-

Dr. Shannon Thompson:

Yeah.

Dr. Richard So:

... just like the M&Ms when we went pee.

Dr. Shannon Thompson:

Yeah.

Dr. Richard So:

You give 'em a little taste, and then you take it away right away. "Nope! That's all you get. Next time you go pee, poo poo, if you feed Nemo," I go, "We get a car."

Dr. Shannon Thompson:

Yeah.

Dr. Richard So:

I think that's a good thing to try.

Dr. Shannon Thompson:

Yeah. That's another good idea. Um, I think, too, realistically, for moms and dads, thinking about how it feels weird or different to poop, you know, so helping with that patience, and I, I think that is something to let them know, um, while they're working on the poo poo party.

Dr. Richard So:

Yeah. There's so many different ways to potty-train your kid. It was so different for my first one. You know, when you have your first child, you, you don't know what you're doing.

Dr. Shannon Thompson:

Oh, man, yeah.

Dr. Richard So:

All right? So... It just so happened that w- we invited another kid over to have a play date with our child, because that's what parents do. You know, these days play date just means parents are just gonna have wine together.

Dr. Shannon Thompson:

Yeah (laughs). That's true.

Dr. Richard So:

All right. But what happened is, we invited that other kid because that kid was already potty-trained. And what happened was, is we told his parents, "Hey, we'd like my child to see your child go to the bathroom." And what happened is, is that the other little girl, she goes, "I have to go potty, mom." And I go, I go, "You can use Savannah's potty," and all of a sudden, my daughter didn't wanna share. She goes, "That's my potty," and then all of a sudden, my daughter went pee that day.

Dr. Shannon Thompson:

(laughs) That, that works.

Dr. Richard So:

Yeah.

Dr. Shannon Thompson:

Yeah.

Dr. Richard So:

So, it was almost that peer pressure-

Dr. Shannon Thompson:

Uh-huh.

Dr. Richard So:

... part of... And those two-year-olds, they don't know how to share developmentally, you know?

Dr. Shannon Thompson:

Uh-huh.

Dr. Richard So:

In the grand scheme of things, parents out there with normal anatomy, every kid gets potty-trained, eventually. Dr. Thompson, uh, when do you think parents should seek out their pediatrician for a little help?

Dr. Shannon Thompson:

For more help? And that's so important, because it can be a wide range. Um, I think if you're having problems, you know, certainly by age six, you know, if you're still having trouble with potty training. Or along the way, if you're meeting barrier. It's... You're having more bad days than good days. Um, you need a little help. You know, we're always here to help.

Dr. Richard So:

Why six years old?

Dr. Shannon Thompson:

Uh, that's a good time to come in and be checked to make sure that there's not anything else going on. Check a urine sample and, and make sure things are looking good from a kidney standpoint.

Dr. Richard So:

No, that sounds great.

We hope this episode gave you some good potty training tips. Every child learns at their own pace, so hang in there and celebrate the small wins. If you have any potty training worries, schedule an appointment with the Cleveland Clinic Children's Pediatrician by calling (216) 444-KIDS.

And Dr. Thompson, how can our audience specifically reach you?

Dr. Shannon Thompson:

Yeah, thank you. Um, I am down at the Akron General Health Center, um, and our number is (330) 344-KIDS.

Dr. Richard So:

Thanks for listening to Little Health. We hope you enjoyed this episode. To keep the Little Health tips coming, subscribe wherever you get your podcasts, or visit clevelandclinicchildrens.org/littlehealth.