Difficult Diaper Changes?

Dear Dr. Rene,

I am the mother of twin (Boy and Girl) 20-month-olds. Since about the age of eight months, changing diapers and clothes has been very difficult. Both children move about during this process, which is normal, but they really scream and fight, and they are really strong, and I have a really difficult time changing diapers and clothes. I have tried giving them toys and little things as distractions, but that works for one day and then they are no longer interested. This also affects their childcare provider and she complains to me about how difficult it is.


I remember these difficult moments well.

There are lots of ideas for things to try. The answer is to try each, see how it goes, and use it as long as it lasts.

  • Before you start, be sure you have all your supplies gathered and ready to go.
  • When you know they need a change, set a timer for one minute and say, “when the timer rings, it is time to change your diaper.” For some children, this works surprisingly well. It takes you out of the argument.
  • In calm, firm language remind them to, “lay down,” and, “stay still.”
  • Some parents suggest that if laying down is the difficult part, try changing them standing up. I have heard of parents that have them stand in the bathtub or just on the outside of it holding onto the edge. Others suggest that the child leans against a wall. I did this just once and thought it was a nightmare, but others swear by it. My guess is this is a controversial approach. Maybe we needed more practice.
  • Provide distractions such as small toys or books. Better yet take a small bag and gather interesting objects from around the house. Go for things that your child doesn’t often see or have access to such as a kitchen whisk, a sand timer, small calculator, clean sponge or toe separators. Stash this bag next to your diaper changing area. When it’s time to change a diaper, hand the child one thing from the bag, lay them down and change them as fast as you can. When the change is over, the object goes right back in the bag. Rotate through items overtime.
  • You might give them related jobs as a distraction. This means making them the wipe holder or the diaper folder.
  • You might spend a few minutes before each diaper change giving a doll baby a diaper change together. Talk about how the baby is still and lays down. After each time, thank the doll baby for being cooperative.
  • You might distract them by singing a familiar song with lots of expression or a song with movements. Once you start the song, continue to sing as you change their diaper.
  • You might distract them with interactive word play like, “where’s your nose?” and, “where’s your ears?”
  • When they do cooperate, even if it’s only through distraction, be sure to give descriptive praise. This means to describe their behavior and label such as, “you were so still for a diaper, that was helpful!” To learn more about descriptive praise view: http://www.youtube.com/watch?v=rn2Ddh16xIY.

I hope something on this list is helpful.

Please comment below if you have other helpful ideas!

Sincerely, Dr. Rene

Will Only Potty at Home

Dear Dr. Rene,

We worked with our two-and-a-half year old daughter for three months on potty training with lots of ups and downs. She was finally trained and had been diaper free for one month. She started daycare two weeks ago, and she refuses to go to the toilet there. We had this problem before daycare, that she refused to go to the toilet anywhere except home, but we would only be out for maximum two hours. At the nursery, she stays from nine a.m. till two p.m. She sits on the toilet but she does nothing, and she doesn’t even have an accident. Please help.

Sincerely, Jessica Neaven

Dear Jessica,

For using the potty away from the house, I would first practice with your travel potty at home. If you are expecting her to use a folding seat or a potty ring on a big potty when you are away from home, have her practice with it at home first. You might also try the travel potty at grandma’s or a good friend’s house before you expect her to use it out.

To help her become comfortable at daycare, take her to use the potty there yourself just before drop-off and again at pick-up time. She may have success at relaxing if she is with you. Don’t push her to go, just allow her time to sit on the potty and relax with you there. I would also ask the teachers to take her in to the potty at another time or two during the day to either just go and be social with the others waiting turns, or, if she is willing, to sit on the potty for a few minutes to try. Just watching others can help in the process and all the better if she’ll sit.

Continue to read the children’s potty training storybooks, and continue to encourage the potty at home.

Sincerely, Dr. Rene

Ownership in Potty Training

Dear Dr. Rene,

My almost two-and-a-half-year-old decided she wanted underwear 11 days ago. So, we are 11 days into potty training. She goes to daycare, and is now fully potty trained at
daycare (at least barring any regression that could happen.) At home, I still
have to take her to the potty every hour, or she’ll have an accident. She rarely
initiates on her own, and often tells me she doesn’t want to go on the potty. We
had her choose her brand new potty seat, and we offer her “potty treats” after
she goes. We tell her she is a big girl, and we’re proud of her. Any other tips
to help my very head strong little girl with potty training at home? Or is this
just normal for a young girl, and I just need to be patient? (FYI – my older
daughter did the three day method when she was close to three years old, so this is all
new to me.)

Sincerely, June (mom of two)

First, I would ask for what they typically do and say at daycare. If this is going smoothly there, maybe replicate what they are doing. Also, take her to the potty there yourself at drop-off and pick-up. It may be helpful for you to be associated with that success. If available, maybe purchase a similar potty seat or ring for home.

At home, I would do all the small things to encourage interest including reading potty training picture books, watching the potty videos, letting her observe while others potty and playing potty with doll babies or a dollhouse set.

Bigger things to encourage her to more fully participate include offering her choices, descriptive praise and language of ownership. Choices include, “would you like to use the upstairs or the downstairs potty?” or, “do you want to sit on the little potty or the big potty?” Here is a link to a previous post on choices: https://parentingbydrrene.wordpress.com/2012/10/01/how-choices-work-in-positive-discipline/.

Descriptive praise is being behavior specific when you catch good behaviors. This sounds like, “you knew you had to go. You got to the potty quick!” or, “you were taking care of your body. You put all your poop in the potty!”  Here is a link to a youtube video on descriptive praise: http://www.youtube.com/watch?v=_LH6Y-qPnAo&feature=relmfu and the differences between descriptive and evaluative praise: http://www.youtube.com/watch?v=rn2Ddh16xIY.

The language of ownership is saying something along the line of, “do you know you are the only one in the whole world who really knows when you need to pee? I don’t really know that from out here. That’s your job.” or, “you are in charge of when you go potty. When you feel that pressure on your bottom that you need to poop, it’s your job to go potty.” The idea is to encourage them to take ownership without adding pressure. Use this langauge maybe every other day and not around the time of an accident, it shouldn’t sound like discipline.

Sincerely, Dr. Rene

Get Them Ready for Potty Training

There are several things you can do in the months leading up to potty training to encourage a child’s interest and increase their readiness.

  • Read About It – There are so many good children’s book on the market including Once Upon a Potty by Frankel, The Potty Book for Boys/Girls by Capucilli, What to Expect When You Use the Potty by Murkoff and Diapers Are Not Forever by Verdick among many others. The idea is to mix these in with your other read-alouds. There is a fuller list of potty related children’s books on my blog at https://parentingbydrrene.com/childrensbooks/#pottytraining.
  • Watch the Videos – There are also many helpful children’s videos including Potty Power, Once Upon a Potty, The Potty Movie and It’s Potty Time.
  • Play Potty – For introducing potty training through play you can purchase an inexpensive plastic baby doll, poke a small hole in the bottom and fill the body with water. Then you teach the doll baby to potty, and have your child teach the doll baby to potty. You can also buy just the bathroom set and doll from any dollhouse set, and let them play the potty process that way.
  • Let Them Observe – Young children learn best through observation and modeling. If you are at all comfortable, it can be helpful to take children in the bathroom with you and let them observe the process. It can be helpful for them to observe older siblings or others in the potty training process as well.
  • Talk them Through Your Process – If they are observing, it can be additionally helpful to talk them through your process of pulling down pants, sitting and waiting and wiping. I understand this is a lot of detail and can feel uncomfortable, but you are teaching them the language and the details of the process.
  • Change all Diapers in the Bathroom – This is helping them associate the sensation with being in a bathroom. If your bathroom is small, change on a mat just outside. Talk about how when people pee or poop, they need to be in a bathroom.

My full Potty Training audio class is available online at http://www.parentingbydrrene.com.

A Review of Our Potty Training Workshop

Our-Kids www.our-kids.com wrote a review of our Parenting Playgroups Potty Training workshop. Thought I would share here.


Thanks Our-Kids for the kind words!

Travel Potty Training Tips

Before you start potty training, it is beneficial to consider what you are going to do about the process when you are away from home. The first is to consider the potty itself. There are folding seats that fit on potties, folding stand-alone options, blow-up options and full-size floor potties available. Whatever you choose, it’s good to have your child use it a few times at home before taking it on the road.

In the weeks leading up to potty training, it can be helpful to start pointing out potties when you are out. Show them that there are potties at Target, or take a tour of bathrooms at Grandma’s house. This lets them know there are potties everywhere and people use them.

If you are planning a big trip in the next month, it may be best to wait until after to dive into potty training. The more consistent you can be the better, and it’s tough to expect a newly trained child to be successful at DisneyLand.

To be safe, carry a full change of clothes with you for a year after potty training. There will be accidents. We actually carried a change of clothes for each child in the car for several years. You never know when a big mud puddle will be the best playground entertainment.

Will Not Sit on Potty

Dear Dr. Rene,

My daughter will be four years old in January and will not pee or poop on the potty. She wears underwear all day long and very rarely has an accident. However, whenever she has to pee or poop, she asks for a pull-up. She puts on the pull-up herself, goes pee, takes the pull-up off, puts it in the trash and puts her underwear back on. If we are out, she only likes to change into a pull-up to go to the bathroom in the car. Sometimes I have to help her take her pants and shoes off, but she is self sufficient with the pull-ups. She is terribly afraid of the potty! We have two different potties, we’ve watched the movies and read the books, and she has a dollhouse with a potty to play. I don’t know how to physically make her pee where I want her to. A couple of times I have said that we have no more pull-ups for during the day, and both times she has held it all day until she is too uncomfortable to sit down – at which point I give her the pull-up. I don’t want to do this again unless I’m really going to stick to it. I just didn’t feel right having her in so much discomfort while trying to force her to pee on the potty. We also have a baby due in January, if that makes a difference.


Erkia, mother of one and one on the way

Dear Erika,

There are two answers here. First, the potty training answer. Second, the answer about managing fears and anxieties. I would start with the low key way of addressing the first while you learn about the second.

You are already on the path of the potty training answer. A more common related concern would be the child who will pee but not poop in the potty then has an accident or needs a pull-up to poop. The overarching suggestion there is to stay calm emotionally and allow the child to change into a pull-up as needed and then clean them as you would if they were not yet potty training. All of this while expressing, you know they are potty trained for pee (not in your case) and you know they will poop on the potty when they are ready.

There are several additional potty training things you can do to move forward. I would encourage her to be in a bathroom for the process. At home, move the stack of pull-ups to the bathroom and talk about how that is the room where people go when they need to potty. Carry a pull-up in your bag and guide her to a bathroom when you are out. With a silly tone you can remind her, “the car is not a bathroom, silly. When people go potty they go to a bathroom.” A next step, once she is comfortably going in the bathroom, would be to have her sit down when she is in the pull-up, either on the edge of the tub or on the can be closed potty. This is getting her into the sitting position which can feel different, but it’s necessary for eventually going on the potty.

Give her choices about which bathroom and if you help her or not. When she does at least make it in the bathroom, give her a bit of descriptive praise, “you knew you had to go, and you got yourself into the bathroom!” I would also give her language of ownership. This means saying every few days, and not on the heels of a pull-up, “you so know when you need to go potty. Your body knows soon enough that you can even get yourself changed to a pull-up. I know when you are ready, you will sit on the potty.” This is meant to be encouragement without pressure. Continue to mix in the story books and the video tapes. Continue to play with the dollhouse bathroom set.

If all that doesn’t lead to progress, you might take a consultation with the WASH Clinic at Children’s National Medical Center. They are specialists in potty training issues and may have additional answers to encouraging the process when there are specific concerns.

Your description of her being “terribly afraid” of going on the potty and her complicated answer to avoid it of changing, even in the car to go to the bathroom suggests while she is able, she has unknowingly convinced herself that is a scary thing. The more you just push or “force” her to go on the potty, likely the more she will push back. When there is an anxiety, the underlying idea is the thinking causes the feelings which cause the behavior. To help the child move beyond the avoidance behavior, the trick is to figure out and address the thinking to change the feelings to change the behavior. There is a good book titled Helping Your Anxious Child: A Step by Step Guide for Parents by Rapee, Wignall, Spence, Lyneham and Cobham. It is an activity book for parents and children to work through together to help children help themselves to calm the anxious feelings and outcome behaviors. I would start reading this book yourself, and, if they potty training suggestions don’t move the system forward, you can go back and start working through these activities together. This is a long term effort to your concern, but a healthy way to go. There are also area specialists who can work through this with you if you prefer a person to a book.

Sincerely, Dr. Rene

Potty Training Question

Parent Question: By this point, my child has the hang of peeing in the potty. She still sometimes goes in her pull-up, but more so on the toilet. We’re continuing to have two issues I’m hoping you can advise on:
1) Very rarely does she ask to go to the potty. She’s not good at vocalizing her need to go. Does this come with more practice and maturity, or is there something I can do to help get her to realize she needs to go and then tell us (before the fact)?
2) She has only pooped in the potty a few times since we started potty training in the beginning of September. Most of the time, she goes in her pull-up. Any advice?

Answer: For both issues, I would start with the language of ownership. For the first concern, something like, “do you know that feeling in your tummy/that pressure in your tummy when you need to pee? You are the only one in the whole wide world who knows when you feel that. It is your job to tell me when you need to pee.” or, “let me know when you need to pee. Remember I can’t do that for you.” For the second concern, “you are so potty trained for peepee! I know when you are ready, you will put your poop in the potty too.” I know this language can feel awkward, and it is supposed to be delivered in an upbeat (no discipline) way. Also, not around accidents or on the potty as it can feel like discipline. More a peptalk as you are tucking her in or while driving home from preschool, out of the blue.
Yes, the first concern should also settle with age and practice.
Have her at least be in the bathroom for the second concern. Say, “the place to be when you need to poop is in the bathroom. I know you’re not ready to sit on the potty for that, but everyone poops in the bathroom.” Don’t force this, just encourage. If she is willing to do that, you might have her sit (starting with pull-ups on and even dressed) on the potty.
I know this can be a long process.

Going Poop a Little at a Time

Hi Dr. Rene,
My son is three years and eight months old. He has been totally potty trained for pee for six months, but refuses to poop on the potty. He was constipated, but that resolved. He holds it in and poops a little at a time in his pull-ups. When he does, he immediately wants me to change him which ends up being five or six times a day. He has only gone poop in the potty three times. Each time, we had a parade in the living room to celebrate. I have tried just letting go, rewards, stickers and a coin jar. What else can I do?
Mother of two, ages three and 10 years old

Hi LeighAnne,
I would argue that you are still dealing with constipation or at least the withholding that can follow a bout of constipation. Children who have been constipated often hold their poop so they won’t  have the pain they felt from pooping again. Unfortunately, this just starts a negative cycle. The more they hold, the worse it can hurt and so on. The general idea is that this needs to move at their pace and without pressure.

There are many things you can do. Let’s start with the easy, general ones

  • Play the videos and read the books – There are so many good potty books and videos available. Mix them in with your other story or tv times.
  • When you do change him, let him watch you empty his poop into the potty. Help him make that connection “the potty is where poop belongs.”
  • Change all diapers in or just outside the bathroom. Again, sending the message about place and letting him know we have to stop and go to the potty each time.

Next let’s address the ones related to the constipation

  • Increase fluids, particularly water.
  • Increase exercise, particularly walking.
  • Check his diet. Think fiber, fruits and vegetables. Make fruit smoothies and add in a few prunes. Add raisens to all snacks.
  • Avoid white bread, rice, bananas and too much milk.
  • Talk to the pediatrician but you might try an over-the-counter remedy such as mineral oil.

Now for the specifics

  • Let him know it’s okay to poop in a pull-up, but encourage him to at least stand in the bathroom while he does this.
  • Once he is comfortable, encourage him to sit for poop. This can be with his pull-up on sitting on the floor or on the closed lid of the potty.
  • Once he is comfortable, you could have him try on the open potty and then on the open potty with no pull-up.

All of your language and efforts should be encouraging him to take ownership. Out of the moment and maybe once a day say things like, “you know you are the only one in the whole world who knows when you need to potty,” or, “you know that feeling in your tummy when you need to poop? I can’t feel that, just you!” The idea here is to make it their job, to encourage ownership without pressure.


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