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Grandchild, Age Three, Still Isn't Potty-Trained

QUESTION: My three-year-old granddaughter wets her pants when she visits with us quite often. She seems to forget to use the toilet regularly, or is uninterested in doing so. She seems to be having trouble keeping dry periodically, at home too, even though she has been using the toilet since she was 18 months old. She will be attending a nursery school that requires her to be potty-trained. Can you give us any suggestions to help motivate her?

ANSWER: I assume, first, that a pediatrician has ruled out any physical problems that could cause difficulty with using the toilet or indicate lack of readiness. Also, talk with your granddaughter's parents to determine whether recent potty accidents may be the result of some particular stress or traumatic event. If this is not the case, it may be time for an extra incentive and learning program for your grandchild.

Clear and consistent expectations. Begin by communicating your expectations that your grandchild use the toilet. Do so with more conviction than before, and in a way that piques her interest. Explain to your grandchild that it is one of the rules of your house that everyone must use the potty, and so you are going to help her learn how to do this more consistently.

Body education. Get creative! Tell her that her body is equipped with sphincter muscles that help her control when the pee is held and when it comes out, and stimulate her curiosity about how her body works. Draw her a picture of the bladder, or use a small balloon filled partway with water, using your fingers to demonstrate how we can use our sphincter muscles to "hold on" and "let go" of urine at will. Show her how difficult it can be to hold pee when the fluid brims to the top, but how much easier it is when we empty our bladders when they are less than half-full, such as every two to three hours.

Ask, too, whether she can tell when her bladder is "this" full or "that" full, engaging her in considering the physical cues that tell her it is time to use the potty. Make it clear that you believe in her body's ability to learn this process because she is now three and her body is ready to use these muscles. Instill a sense of pride in her body and in learning to recognize her own body signals.

Positive reward. You may also need to motivate her with a reward program that will better inspire her performance. Talk with her parents about a plan you can all agree to reinforce, both at home and at your house. Consider a reward that will work for your grandchild. Many parents resort to candy reinforcement for toilet training. There is no need to create an ongoing pattern of using food for reward, but at this age, many children do respond to candy, when other nonfood rewards, such as stickers, have failed. Lollipops, held on a stick, hold great appeal to children of this age. Perhaps it has something to do with the still-virulent "sucking" reflex that brings such pleasure. Whatever you settle on, make sure it is acceptable to her parents, and be sure also to reward her with your verbal appreciation of how well she is picking up on her body's signals!

Your granddaughter can learn to take pride in learning the cues her body gives her that signal to her that it is time for a trip to the bathroom. Help her to develop a sense of pride in her accomplishment. Remember that a crucial part of toilet mastery is the development of a sense of pride (not shame!) during this process. So, above all, be patient and positive in your approach!

Gayle Peterson, MSSW, LCSW, PhD is a family therapist specializing in prenatal and family development. She trains professionals in her prenatal counseling model and is the author of An Easier Childbirth, Birthing Normally and her latest book, Making Healthy Families. Her articles on family relationships appear in professional journals and she is an oft-quoted expert in popular magazines such as Woman's Day, Mothering and Parenting. . She also serves on the advisory board for Fit Pregnancy Magazine.

Dr. Gayle Peterson has written family columns for ParentsPlace.com, igrandparents.com, the Bay Area's Parents Press newspaper and the Sierra Foothill's Family Post. She has also hosted a live radio show, "Ask Dr. Gayle" on www.ivillage.com, answering questions on family relationships and parenting. Dr. Peterson has appeared on numerous radio and television interviews including Canadian broadcast as a family and communications expert in the twelve part documentary "Baby's Best Chance". She is former clinical director of the Holistic Health Program at John F. Kennedy University in Northern California and adjunct faculty at the California Institute for Integral Studies in San Francisco. A national public speaker on women's issues and family development, Gayle Peterson practices psychotherapy in Oakland, California and Nevada City, California. She also offers an online certification training program in Prenatal Counseling and Birth Hypnosis. Gayle and is a wife, mother of two adult children and a proud grandmother of three lively boys and one sparkling granddaughter.

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