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Twins won't stay still for diapering?
Q: I am the mother of 15-month-old identical twin girls who will not sit still for me during diaper changes. I understand this is typical for toddlers, but it has become stressful for all of us. They kick, twist and sometimes even hit me. It takes me twice as long as it should to get them changed or dressed.

As soon as I'm done they're happy, but I'm cranky! I have tried giving them toys, and I change them on the floor for safety. Do you have any other suggestions? They both walk. One daughter pats her diaper when she needs a change, so I think we are probably not too far off from potty training.
Kim Sydney
A: 'Mommy, Daddy—I went poopy in the potty!' Do you long to hear those precious words from your child? Some children and parents breeze effortlessly through toilet training while others experience more difficulty. When you think your child might be ready for toilet training, take a deep breath and muster up all the determination and patience you have to work on it for several months. And consider the following tips to help make toilet training easier for you and your child:

Know when your child is ready
Using the toilet is an important developmental step for your child. But your child's unique development and temperament will determine when she's ready and how she'll get through the process. To paraphrase a common saying, 'You can lead a child to the toilet, but you can't make him do it.'

Most children show signs they are physically and emotionally ready to use the toilet between 1 ½ and 3 years of age, although some may be ready earlier and some aren't ready until later. Girls are usually ready a little earlier than boys. Your child needs to have awareness and control of his urination and bowel movements, and needs to be willing to try using the potty. Look for these signs that your child is ready:
  • His bowel movements are regular and predictable.
  • Her diapers are dry for at least two hours during the day or dry after naps.
  • His facial expression or posture indicates when he is ready to urinate or have a bowel movement.
  • She seems uncomfortable in soiled diapers and fusses or asks to be changed.
  • He can walk to the bathroom, help undress himself, and follow simple instructions.
  • She asks to use the potty, toilet, or wear 'big girl' underwear.

Make sure the timing is right in other ways, too. Many parents favor toilet training in the summertime when children wear fewer clothes and it's easier to undress to use the toilet. It's also a good idea to plan toilet training when there are no other major changes in the family such as moving, the birth of a sibling, changes in childcare, a family vacation, or divorce.

Help your child learn to use the toilet
When you think your child is ready, cheerfully encourage this step to be a 'big boy' or 'big girl.' But don't pressure your child—let him know it's his decision and you're there to help. Ask his other caregivers (e.g., babysitters, relatives, childcare providers, and teachers) to follow the same approach. Be patient…you can expect the toilet training process to take from three-six months.

Be sure your child understands what you want her to do. Let her watch you, her older siblings, or her playmates go to the bathroom. It's helpful for mothers or sisters to show little girls, and fathers or brothers to show little boys what to do. Decide what words you'll use to describe your child's body parts, urine, and stool. It's best to use the correct terms (e.g., 'penis') or common terms (e.g., 'pee' and 'poop') to help avoid confusion. Show him that urine and stool go in the toilet, and let him help flush. Avoid describing them as 'dirty' or 'bad,' so there's no shame about going to the bathroom.

Go to the library or bookstore and get a children's book about toilet training to read together. Dress your child in loose pants that are easy to pull down and pull up, not overalls or shirts that snap at the crotch. Some parents find it easier to use pull-up diapers or training pants during this time.

Get a comfortable potty chair or use a toilet seat adapter and step stool. Some children fear falling into the toilet, and feel more comfortable on a low potty chair with their feet on the floor.

Introduce your child to the potty and allow her to sit on it with her clothes on a few times. Then encourage her to sit on the potty with her pants and diaper off. For boys, you can either start them urinating sitting on the potty or standing up. Have your child sit on the potty at the same time each day so it becomes routine. Try times when she regularly urinates or has a bowel movement, such as after breakfast and other meals, or after drinking; encourage her to try at other key times as well, such as before and after a nap, before her bath, and before bed. Try to catch her when you see signs that she needs to urinate or have a bowel movement. In all, ask her every couple of hours to sit on the potty.

Make the potty visits last at least a few minutes to give your child a chance to relax and go to the bathroom. Talk encouragingly or read a potty book, and let him leave when he's ready. Don't expect him to do anything right away, and don't show disappointment when he doesn't go. But when he does, reward him with praise and hugs. Other rewards and incentives can also be helpful. Some parents use a calendar and give one sticker for sitting on the potty, another for pee, and another for poop.

Some children learn to urinate in the toilet first, while others learn to have a bowel movement first. Over time, teach your child to do all the steps: walking to the bathroom, pulling down her pants and diaper, sitting on the potty or toilet, urinating and/or having a bowel movement, tearing off a little toilet paper, wiping her bottom from front to back (to prevent urinary and vaginal infections in girls), throwing the toilet paper in the toilet, pulling up her underwear and pants, flushing the toilet, and washing and drying her hands.

When your child consistently goes to the bathroom in the potty or toilet, celebrate by letting him choose some big kid underwear. For many children, the chance to wear underwear is a big motivation to use the toilet. Put him in underwear during the day and take him to the bathroom frequently. You should expect that he'll have occasional accidents, though, so be prepared with extra underwear, pants, diaper wipes, and plastic bags on-hand at child care and on outings. Although you may feel disappointed or exasperated by the accidents, it's best to keep a positive attitude—over time, your child will have fewer accidents and finally be toilet trained. Try to deal with accidents in an understanding and matter-of-fact manner, and don't punish your child for them. Tell your child, 'That's okay. Next time, try to let me know when you feel you have to go so you can do it in the toilet.'

For toileting difficulties, be patient and get help. While some children go from daytime toilet training to remaining dry during naps and nighttime shortly afterwards, many continue to need a diaper at night for another six months to a year or more. In fact, it's not uncommon for children to need a diaper at night until they're 6 years or older. Delayed bladder control tends to run in families, and often one or both parents had a history of bedwetting. Help your child not feel embarrassed about it, and try to prevent bedwetting by avoiding giving your child liquids in the evening and having your child urinate right before bedtime. If you're concerned about your child's bedwetting, talk to your pediatrician: it could be a sign of a urinary tract infection, diabetes, or emotional difficulties, and your pediatrician can help determine the cause and treatment.

Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician