You’ve probably heard the arguments in favor of early potty training. They train early in Europe! Toddlers are more compliant than three-year-olds! Diapers are bad for the environment! Perhaps you’ve even read scientific studies concluding that children who train later are more likely to end up having accidents. But, potty training too early can hurt your child.
As a pediatric urologist who specializes in toileting problems, I’ll tell you this:
Children under age 3 should not manage their own toileting habits any more than they should manage their college funds.
Preschools that require 3-year-olds to be potty trained – like the one in Virginia that suspended 3-year-old Zoe Rosso for excessive potty accidents – are harming kids.
Infant Toilet Training or Elimination Communication
Infant potty training, promoted in Mayim Bialik’s book Beyond the Sling, is just plain nuts – unless, like Bialik, you monitor your child 24/7, feed your child a high-fiber vegan diet, and home-school your child. Babies need to experience uninhibited voiding, or elimination, without the expectation of using the toilet at such an early age.
It’s not that young kids can’t be potty trained. Sure they can. But knowing how to poop on the potty is not the same as responding to your body’s urges in a judicious manner.
Let’s fast-forward two or three years. That’s when potty prodigies show up at my clinic – one of a handful specializing in dysfunctional voiding – with the sudden onset of pee and poop accidents, urinary tract infections (UTIs), urinary frequency, and/or bedwetting.
“I don’t get it,” a mom will tell me. “I didn’t push her – she basically trained herself.”
Problems Arise When Potty Training Too Early
To understand the risks of early training, it’s important to know that virtually all toileting problems – pee and poop accidents, bedwetting, urinary frequency, and urinary tract infections – are related to chronically holding pee or poop or both.
Children – and I mean all children – don’t like to interrupt their lives to use the bathroom.
Once kids learn to put off peeing and pooping, essentially the definition of potty training, they tend to do so often and for as long as they can. This is a dicey habit. Each time you squeeze your sphincter to prevent the release of pee, you create resistance in your bladder. What happens when muscles go up against resistance? Exactly what happens when you train your hamstrings at the gym: They get thicker and stronger.
But unlike muscular hamstrings, a thicker bladder is a bad thing. It has a smaller capacity and its sensation mechanism goes awry. When a child habitually delays peeing, over months and years, his bladder wall becomes more muscular and eventually the bladder can get so strong and irritable that it empties without any input from the child.
Chronically holding poop, a problem exacerbated by our kids’ low-fiber diets, compounds the damage. A mass of poop forms in the rectum, right behind the bladder, and can stretch the rectum from about 2 centimeters in diameter to 10 centimeters or more. There’s only so much room in the pelvis, so the bladder gets squeezed out of the way and can’t hold as much urine. What’s more, the nerves controlling the bladder, which run between the bladder and the intestines, can get irritated when the intestines are enlarged, causing unexpected and unwanted bladder contractions – in other words, mad dashes to the toilet and accidents.
Chronically holding pee and poop also causes urinary tract infections. The less often a child pees, the more opportunity for infection-causing bacteria to creep up to her bladder. And if this kid is also hauling around a hefty load of poop, she’s harboring about a gazillion (to be precise) more times the bacteria than when her rectum has been emptied. Since the bladder is only a couple of inches from the rectum, the offending bacteria have a short trip to make, crawling through the perineal skin and into the vagina and the area around the urethra.