Ep. 68 – Dr. Katie Rinald – The Pee & Poop Episode! Toileting 101

Rachel Cram – Well, good afternoon, Katie.

Dr. Katie Rinald – Good afternoon. I’m so excited to talk to you today.

Rachel Cram – I am so excited to talk to you, too We’ve been prepping for this interview on toilet training for a little bit of time. It’s an important topic.

Dr. Katie Rinald – It is. I know. I think it’s something that probably a lot of your listeners are curious about or wondering about or even worried about. So I’m happy to be able to hopefully shed some light on it and make it less scary. Less intimidating, maybe.

Rachel Cram – Ok, well, we’ll make that our goal. Well, let’s start by finding out how you came into toilet training because I know you have your Ph.D. and you think, where does one go from a Ph.D. to toilet training? Like, I picture you as a little girl with those dolls that pee, you know? And then and then you just sort of played your way into this passion that’s become a profession. How did you get there?

Dr. Katie Rinald – You know what? Not far off Rachel.

I loved dolls. And I loved the dolls that pee. That was so cool. They still have them and sometimes recommend them to families as a little, “hey, let’s make this a less intimidating,” type thing. So

Rachel Cram – I know, they still have them. I was so into dolls and none of my three daughters have been into dolls. I don’t know why.

Dr. Katie Rinald – Oh, they are who they are, right?

Rachel Cram – It’s probably because I kept plugging out real live babies so they didn’t need the dolls.

Dr. Katie Rinald – That’ll do it. Yeah, that’ll do it.

Rachel Cram – But back to you. What led you to specialize in this aspect of human biology?

Dr. Katie Rinald – It was part of my job in university. I had many jobs, had to pay that tuition somehow. So one of my jobs was, I worked in early intervention for young kids with autism. I really enjoyed it. It ended up being my career path basically, but we worked on lots of different developmental goals and one of the areas was always toilet training. And when I had the opportunity to work on that I loved it. It’s one of those skills where if you teach it right and approach it right, they can catch on really quickly and be really successful.

And it matters so much to the family. And you see the sense of pride in the child. It’s just such a pivotal skill. And so I knew I loved that and I didn’t know if I could make it a career. It’s so niche. But when I was in graduate school, I worked with Dr. Pat Mirenda. So if you Google her, you know, toilet training will come up, like she’s really synonymous with that. And I approached her when I was doing my master’s and said, “I’d really like to study this for my thesis. I wonder if there’s some way I could do toilet training.”

And she was like, “Finally, someone who wants to do it.”

She loved it and was so fired up about this area of practice too, that she was just like, “Let’s do this Katie.”

And so she helped me to study it and become a researcher in toilet training too. And it kind of went from there. And since I did my master’s degree I just kept going and furthering my education and my expertise in toileting because it is something that so many families struggle with and need help with.

So I’ve been able to refine my practice and over time I’ve expanded beyond working with kids with disabilities. I also work with families who have typically developing kids who just for whatever reason, this is a stumbling block or something difficult for them. So I’m one of those lucky people where I kind of jump out of bed in the morning and go, “All right. Let’s do this.”

So, it’s been awesome. I’m so lucky, really.

Rachel Cram – When I think of kids and toilet training, it’s actually one of the first big milestones of independence. And that’s part of what makes it tricky for parents as well I think, because it’s one of those first steps in learning to let go of your kids.

Dr. Katie Rinald – It’s so true. I think it’s so emotional for parents.

It’s funny, like many experts you have on, I was really an expert on kids before I had my own and I would think, “Why would people be so intimidated about this?”

But then when you have your own kid, it is different. And with my own little guy approaching toilet training, I felt the same way. Even being an expert on it, “Okay, here we go. Are we really doing this? Okay, it’s time. Let’s try underwear.”

It’s just so intimidating. And I think it has to come back to Freud. Some of it.

Rachel Cram – I was just going to say, I was going to say, because I think even though none of us really study Freud anymore, there’s still wafts of him in the air. And that was kind of the basis of his whole study, wasn’t it? How toilet training affects who we emerged to be in our adulthood. And it could go so bad.

Dr. Katie Rinald – It can go so bad. I’m totally with you, because it’s funny parents will say to me, “I’m so scared to mess my kid up,” when we’re talking about toilet training as a topic. And I don’t hear that about other things really in such a pointed way. And I think that’s got to be Freud lingering like some, you know, Austrian guy over a hundred years ago. It’s like the parents of today are still going, “I don’t want to mess up my kid” because yeah, I can’t remember what he said could go wrong.

Rachel Cram – That’s where anal-retentive comes from, isn’t it? I’m thinking back to psych 100, I wasn’t if you were criticized or shamed for a toileting accident, then you could become anally retentive. And then if you were overly praised for toileting, you could become anally explosive.

Dr. Katie Rinald – Yeah, good memory. That’s exactly it. And I think there’s got to be some influence from that because parents just think, “I’m going to mess my kid up. This is going to change their whole personality if I don’t do this right.”

And, forget Freud. I think that it’s important to just approach it as an opportunity to connect, an opportunity to help your child with this big milestone, and don’t worry so much about what could go wrong, think about what could go right. Basically, I think coming into it cool and calm as you can is huge in making it successful and enjoyable for you and your kid.

Rachel Cram – Yeah. But and yet I noticed on your last Instagram post you did say, I’m going to pull it up here and read it. You said, “What not to do after a toileting accident,” which obviously means there is some wisdom to bring to the toileting process. And I’d love to hear that from you.

Dr. Katie Rinald – You’re right, Rachel. Thanks for pulling up my, “Oh, you did say on this date.” It’s like court.

No, you’re right. I do think a natural reaction as a parent is when your kid has an accident, especially after they’re pretty successful and they’ve had lots of success in the toilet. I always tell families I work with, “Every kid is going to have at least one accident where it’s like Murphy’s Law, the worst moment for them to have an accident.”

Usually it’s like the middle of Costco and you’ve got nothing with you. Or you’ve just set out on a road trip and now, the whole car seat’s wet. So there’s always going to be a bad moment. And I tell families, “Be ready, be ready for that moment and practice your reaction because shaming your kid about it, or reprimanding them, or even questioning them, it doesn’t help. It doesn’t help and it could hurt.”

So, okay, I guess I agree with Freud on that. That’s my one point I will take from him. He did say, “Don’t shame your kids or make it a point of huge emphasis if they’re not successful. So I’m with him on that.”

You don’t get anything out of it and I think it disrupts that connection factor, the good that can come of potty training, right? Being ready for accidents is a huge part of making it work for you.

Rachel Cram – Yeah. And it’s not necessarily going to go on to make them anal retentive or anally explosive. But in moments when the pee is all over the floor in Costco and you have people having to step around it, or you’re on the car trip and now the whole car smells of poop, your natural inclination is to say some things that later on you might regret. So I think it’s good to think out a positive and supportive response ahead of time.

Dr. Katie Rinald – Yeah, definitely.

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Rachel Cram – So as a parent, how do we know when it’s time to start talking about toilet training? Starting a toilet training process? It can be tempting to look around at what our friends are doing and the timelines that they’re using with their kids. Is that a good method of discernment? What would you recommend?

Dr. Katie Rinald – Oh yeah, it’s one of the most common things people ask me is just when do we do this? Tell me the age. Tell me their number of months, right? And it’s just not that precise. There are so many individual family and kid factors that go into it, right? There are relatively recent studies that say the sweet spot is something like 27 to 32 months. So if somebody needs a number, I’ll tell them that number.

Rachel Cram – That’s pretty specific.

Dr. Katie Rinald – Yeah. Pretty specific. But more precise, more accurate is to look at what’s happening in your family and with your kid at that time. So definitely looking at your neighbor is not it. It’s one of those things. Some kids get it early and some kids get it later and you got to go with the flow a little bit like so many things about parenting, right? But a biggie is, again, where is your family at? Like, if you’re about to have a new baby or just did, it might not be the moment. You might not have the focus, it might not be the time to change something huge for them, like expecting them to start with toilet training. So if things are pretty settled, that’s your moment, I would say, as settled as they can be, as a young family with young kids.

Rachel Cram – So you’re almost looking at your parenting readiness or your family readiness alongside or even more than the child readiness. Is that what you’re saying?

Dr. Katie Rinald – Definitely. I definitely think so. And being able to prioritize it above other goals or things that your child’s working on can be a good idea. But then in terms of variables within the kid, because I do work with a lot of families who have kids with developmental disabilities, and when you Google, “How do I know if my kid’s ready for potty training?” the things that come up are usually things like, number one is the kids uncomfortable in soiled diapers. And then other ones would be, they’re approaching the potty or the toilet. They’re asking to go. They’re saying they want to wear big kid underwear, which a lot of kids around this age range are going to do. But a lot of kids aren’t, especially kids with developmental disabilities. They’re just not there yet.

So often I tell families, “Don’t worry about those particular things. Your child doesn’t have to one day say, “I don’t want a diaper anymore,” and that’s how you know it’s time to start because while some kids do that, some kids don’t, and you don’t have to wait for it. There’s no research that says kids who shed the diaper on their own are most successful with potty training. It’s not a predictor of success really whatsoever.”

So it’s okay to encourage your child a little bit more. They might love their diaper still and you can still help them get ready, help them feel more ready and move towards potty training.”

So it’s one of those things where I can’t point to research that says, ‘Okay, if these five things are happening, start potty training’. It really is more, does your family feel ready? Can you focus on this and can you prioritize it for a little while? That’s more how I would generally look at it. Yeah.

Rachel Cram – That’s really interesting to hear because I think as a western culture right now our mindset is more towards ‘let your child tell you when they’re ready.’ And when you look beyond western culture, and I know I’m speaking broadly, but our youngest child is adopted from China so we’ve been there, and you don’t see any kids in diapers, period. They wear these little split pants, I think because if everybody in China was using disposable diapers, that would environmentally not be a good idea. That’s probably part of it. But you see kids as young as eighteen months toilet training because they’ve never worn a diaper. And obviously, at 18 months they haven’t told their parents that they’re ready. So I think when you look at this on a global scale, it is so different everywhere. So, that makes sense what you’re saying.

Dr. Katie Rinald – I do think you’re right, like in Western culture, we’re at this state now where it’s, ‘yeah, let your child not only tell you they’re ready, but basically be ready to kind of toilet train themself. And if you do wait till your child’s older the amount of instruction that’s needed is certainly less. But I’ve worked with lots of families from South America too, who’ve said, “Oh, 14 months, we’re working on it.”

A couple of different moms from Brazil in particular said, “When I was 18 months I was fully potty trained and my mother’s appalled that we haven’t worked on it.”

Of course grandmas have to get their opinion in there. But, it’s also something that changes in our society with time. There’s a study in 1957, a Stanford study that 92% of kids were toilet trained by 18 months, just American kids in general in 1957. So it used to be something that was prioritized earlier. And I totally think you’re onto something with the diapers idea, they’ve become more readily available and people aren’t washing cloth diapers and having the motivation to stop that process.

Rachel Cram – Well, and cloth diapers also came with a lot of diaper rash, too.

Dr. Katie Rinald – Yes, that’s the thing.

Rachel Cram – Yeah. My oldest child, he’s 30 now, but we were all gung ho on using cloth. And that was my really hard thing is the diaper rash that came with it. So that would be an impetus as well to get your child out of a diaper when they’re continually so sore.

Dr. Katie Rinald – Totally. And I think it’s interesting to look at history and look at other countries and go, kids actually can do this sooner. But there’s more legwork on the parents part or the greater communities part, because that’s another thing when you look at other cultures is there’s often more family support in the home or close by where, you know a grandparent is going to be really on it and really helpful or another relative, right?

So I do think we’ve seen this drift for kids to be toilet trained older and I don’t think it’s a bad thing or a good thing. It’s just a phenomenon that is occurring, right? And interesting to think about and point out but to know that kids maybe could do this earlier. But like I said, prioritizing it is important. And if it’s not a priority for you until your kid’s almost three or even after three, it’s okay. It’s not something that families need to feel like they need to do with their kids really young either. So yeah.

Rachel Cram – I think often what makes it become a priority is that they want their child to start preschool. And there are preschools, understandably, that would prefer kids to come toilet trained. I know at Wind and Tide, the preschool organization that I direct, we like it when kids come toilet trained because when you have 20 or 25 kids in a class and two or three teachers, if a lot of your day is taken up with changing kids, it’s hard to provide the rich environment of learning that you want for the rest of the kids. So I think sometimes that’s a pressure for parents, is they want their child to start school already toilet trained. Do you experience that?

Dr. Katie Rinald – Yes, definitely. I think a lot of preschools will require that just sort of as a blanket policy, like kids have to be toilet trained to attend. And it worries me. I just think preschool is magic for kids. When I think about my own little guy and what he gets out of preschool, it’s huge. It’s a whole world for him. And if he couldn’t go because we weren’t successful with potty training at home, I’d feel so bad right? And I work with a lot of families who feel that way and tell me.

“Oh, and he hasn’t been able to go to preschool because he wasn’t potty trained.”

I go, “Oh, no.”

And partly I worry about that on an instructional level because so many little kids are observational learners and when they get into preschool and if they’re not quite there with potty training, but they see their peers are using the toilet, it can kind of click for them and also motivating to be doing, oh, what my buddies are doing. But they have to get in the room where it happens to make it happen, right, to be part of it and to understand it.

So I appreciate the challenge of preschool teachers where the ratio and the facility might not be set up for potty training, but letting kids be working on it when they start preschool, at least trying like what you do at Wind and Tide I think is great. Telling families, get started and try and we’ll support you as best we can. I think that’s a realistic and it’s an inclusive perspective to let kids come to school wherever they are, whoever they are when they arrive and meet them where they are.

Rachel Cram – Yeah, absolutely. Well, all kids come with so many needs and as much as possible, we hope for schools that we’re realizing all kids are worthy of accommodations, whether it’s for their speech or for their mobility, or for their behaviors or for their toilet training, and that we all learn as we accommodate one another.

Dr. Katie Rinald – Yeah, precisely. This is just one accommodation that might be needed and I think that it’s huge to be able to have kids join the group, even if they’re not quite there with potty training.

Rachel Cram – Yeah, yeah I agree and how we accommodate all kids with their needs is a bigger and different and a complex conversation, so I don’t want to make it seem like it’s not, but it’s good that we touched on it here because starting school is a big pressure for parents when it comes to toilet training.

Definitely.

Musical Interlude #2

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Rachel Cram – Ok, so there’s not necessarily a designated time when we start toilet training, but the key is that parents are ready for the time and commitment needed for the process, and that family life is somewhat settled.

Ok, so Katie, when the moment comes to move away from diapers to using a toilet, what are child and parent sensitive methods that you suggest?

Dr. Katie Rinald – I bet this is the part that people are listening for. What do we do, right? Okay. But what do we do?

Rachel Cram – Get all that theory out of the way.

Dr. Katie Rinald – That’s all nice. Talk about Freud all you want, ladies, but come on. Yeah, the research says, and what I see in my practice, is most kids, and I’d ‘say most but not all,’ are going to do really well with an immersive method where you can really focus on your toileting for a week or so- ish, give or take.
So a couple components that are important and sort of non-negotiables of an immersive method are, I think I can pull it down to four big components.

Rachel Cram – Okay, I love a list. This is great. I’ll keep notes and I’ll be your powerpoint as you go along.

Dr. Katie Rinald – Thank you. Okay. So offering extra fluids is one. Another is doing lots of time on the potty, and I can talk about how to do that, what that would look like. Another is going right into underwear as soon as possible and for all waking hours if you can, which I know sounds scary. And then also having some sort of special prize or phenomenon or thing that happens after successes, especially early on. So those are the big four.

Rachel Cram – Okay. I love that. Can we take them one by one then?

Dr. Katie Rinald – Yes, let’s do it. I love that.

Rachel Cram – So offering extra fluids. How are you doing that? Are you talking intravenous here, or what’s the plan?

Dr. Katie Rinald – Yeah. Imagine. Yeah, then people would turn off the podcast immediately. No I think it’s yeah, we want hydrated kids. Hydrated kids pee more. We learn well with repetition, right? So for me, the biggest metaphor is like, I remember learning to parallel park and I had the meanest driving teacher in the young drivers of Canada.

My friends that were in it had these slacker kind of guys who, you know, you pick up their girlfriend as part of the driving lesson. And I got this meany guy and he made me parallel park like 100 times in a row one day. And I was sweating and tearing up.

But I got so good from his lessons at parallel, like I can still nail it. Like downtown Vancouver, cars whizzing by, I can parallel park so well because this guy got me to a fluent state with it by making me practice over and over.

So you don’t have to be mean like my driving teacher. But the more liquid kids drink, the more they pee. So the more practice they get the faster the learning should occur.

Rachel Cram – So you maybe want to be like pubs, like you want to have like salty crackers and peanuts out there, to get them drinking.

Dr. Katie Rinald – Yes, exactly like a pub. Exactly. Motivate the drinking however you can. Yep. Get your goldfish crackers or your pretzels or whatever they like. And it’s just a few days. You’re kind of pausing some of your other parenting ideals in service of this goal. We’re not going to do big bowls of pretzels and crackers all over the house and any juice you like along with your water, like all the dentists are cringing, I’m sure, but it’s temporary and it’s fun and kids tend to get, “Hey, this is different. This is a party. My parents aren’t going to be abandoning all rules forever. It’s something kind of different and special.”

Rachel Cram – So are you telling them, are you telling them, “Hey, we’re going to learn how to use the toilet now?

Dr. Katie Rinald – Ah, yeah, totally. Bring them into the whole plan.

Rachel Cram – You’re welcoming them to the party officially.

Dr. Katie Rinald – Yes, you’re welcome. I love that. Yes. You’re welcoming them to the party and having this sort of excited attitude like, “We’re going to do this together. It’s going to be really cool. You’re going to have drinks. Look we got special cups. We got those funny straws that are glasses that you wear and the liquid goes around the glasses,” like anything to make it kind of, “Oh, this is this is kind of weird. This is kind of fun.”

And toddlers love a party.

Rachel Cram – I want to be at this party you’re describing! I want the glasses!

Dr. Katie Rinald – I know, the glasses are fun. They’ll chug it, right? You’ll get lots of pees in that way. So it’s nothing excessive. It’s not like you need to force them to drink at all, but make it fun and offer lots because they’re going to pee more and they’re going to learn more quickly.

Rachel Cram – Okay. So we’re offering lots of fluid, is you’re number one. And then two, you’re offering lots of time on the potty. So, how do you get them there?

Dr. Katie Rinald – First of all, I mean, at this point, you’d want to have decided, are we going to use a smaller potty? Are we going to use the toilet, the real toilet? And you might hear some places, you know, on the Internet, Dr. Google, that it’s really critical to use the real toilet right away. I don’t really see that in practice. I find that if kids are able to learn on a potty, they’re going to generalize to a toilet most of the time without much issue, because, the toilet can be a bit of a roadblock because when we’re working with little kids, the toilets big, it’s designed for adults, right? And I think that a lot of kids are intimidated by it or even scared of sitting on it. And a potty can just be a more friendly approach for a little kid. Like, have you seen kids who are scared of falling in?

Rachel Cram – Oh totally. Yes. And there are all those little seats that you can put in the middle so that the hole is smaller because yes, that is a huge hole for a child. You could lose them right down there.

Dr. Katie Rinald – They really can fall in. What would Freud say about that, right? That’s traumatic I’m sure.

Rachel Cram – Who knows what would happen. You know what else I like about a potty too is that you can pop it in your car. So if you’re driving and they’re like, “I have to go,” you know you really only have about 30 seconds.

Dr. Katie Rinald – It’s so true.

Rachel Cram – So you can pull over and put it on the ground and have it there.

Dr. Katie Rinald – Yeah, as a mom of six, I bet you’ve done that a few times.

Rachel Cram – I have done that many times.

Dr. Katie Rinald – Yeah. Yeah. And I think there’s lots of reasons that with young kids I say, “Ah, just start with the potty and get to the toilet later.”

But in terms of time on the potty, a lot of folks will try to just have their kid run around kind of bottomless, half naked and see what happens, see if they sit on the potty when they need to pee, see if pee gets in there. And with some kid, you can do that because they already understand the process. They already understand what’s supposed to happen. So if they hang out bottomless, they will make it to the toilet or to the potty, but not everybody.

So if they’re not totally sure what they’re doing already, then you’re going to need to have them sit on the potty. So when I work with families of kids with developmental disabilities, it’s pretty much a non-negotiable. They’ve got to just sit at some point. So I’ve got no shame in giving them anything they like to do that will help them stay seated on the potty. So if that’s an iPad, that’s an iPad, baby. Anything it takes.

Or put the potty in the living room for a little while and have the TV on, have music playing, read them 30 books in a row, have some special toys. I like to do like a lap tray sometimes, like a TV tray that they could have activities on if they love Play-Doh or sand.

And I would suggest in combination with that extra fluid, so they already probably have to pee. You’d want them to sit for quite a while, like up to maybe 30 minutes at a time and just wait for the pee to just happen to come out. That’s how it usually happens with many kids I work with anyway the first few times. So they’re busy playing, you know, they’re playing Play-Doh on their lap tray or they’re watching Bluey or whatever, and they just happen to pee. And that’s kind of how the wheels start turning.

So I guess I want to encourage people, don’t be afraid to use things to have them sit, use things to keep them engaged because the natural state of a toddler is not sitting for 30 minutes. But again, put a pin in your other parenting ideals for a few days and it pays off usually.

Rachel Cram – I remember when I did this with my kids, a version of this, sometimes it was hard to know, like, “Did they go? Did they go? And you’re tipping their little bodies to the side to try and decide, is the water more yellow? I can’t tell. And something I read on, I think was on the Instagram feed. You talked about putting a foil sheet in so that you can hear it.

Dr. Katie Rinald – It’s such a good tip. Yeah. So you put a big hunk of aluminum foil or one of those disposable roasting pans you can get it at the dollar store or whatever, in the toilet and it makes such a distinct sound when they start to pee, like, you know, rain on a tin roof kind of sound when they start to pee. So then, you know, because you’re right, the first couple of times they sometimes don’t clue in that something’s happened. They’re so used to just letting pee go in their diaper they’re not going to tell you that they’ve peed, or they maybe don’t even notice. So that can help them notice and you notice, which is an important part of the whole thing too, is knowing it happened and being able to reinforce that which is jumping ahead in our powerpoint.

Rachel Cram – We’ll get to that. Now when they’ve peed, do you take them off the toilet at that point then.

Dr. Katie Rinald – Yeah. So you get them up right away, show them the pee and show them you’re excited. This is so cool. And if you’re using a potty, you could then dump the pee in the toilet with them. A lot of kids really like doing that and be part of that. And you get up and you take a break. So initially your kid is having so much liquid that your break should be pretty short, maybe about 10 minutes or so, and you’re back on the potty with the hopes that they’ll be again soon.

So, yeah, my usual pattern I recommend is sit about 30 minutes give or take, take a two minute stretch break close to the toilet and keep going back until they pee. So it’s a lot of time on the potty or toilet that I’m recommending, but it pays off. I swear it’s worth it.

Rachel Cram – What if the child does not want to stay on the toilet? What if they don’t want to sit there?

Dr. Katie Rinald – First I would look at what you’ve got for them to do while they’re sitting. So is it worth their while? Like, have you tried to do this without the use of the big guns, like the really special stuff and maybe it is time to pull out the iPad or whatever, but if they can’t sit long enough to actually pee, you could try the method where they’re hanging out kind of naked and you’re going to help them get to the potty. When they start to have an accident, you’re going to kind of lift them on to the potty. That’s okay to try it with kids who just do not like to sit.

And then, some kids are just not going to do it for a certain parent or person who’s helping them as well as they would for another one. And usually families will know this when I start working with them. Like the mom will go, “I think Dad should be here for this because he’s not going to listen to me.” Like and if you kind of know there’s a dynamic like that in your household, it might be better for one parent to be what we call ‘the initial change agent’. So the one who starts it off. And in some cases it’s even not a parent, it’s a trusted babysitter or an auntie, or someone. If you have one of those kids where you just have that sort of relationship where it’s really hard to introduce new things, it’s totally okay to get someone else in there to do the initial implementation. And a lot of families that I work with end up doing something like that. And that’s okay. I wish for parents to see potty training as something that is a bonding experience and something fun they can do with their kids. But some people, it’s just not that for them, it’s their dreaded parenting thing.

Like for me, the idea of my child losing teeth, I don’t know how I’ll handle it. It grosses me out. Wiggly teeth. Oh, I just can’t. When my nieces and nephews have had them I go, “oh,” it’s just yucky. So I know I will outsource all tooth fairy stuff to my husband. It’s already planned. No shame if that is something that really stresses you out and you can enlist some help, you can enlist some help. You’re free to do that.

Rachel Cram – Well, and if that it’s really stressing you out, well often we can think, “Well, our kids don’t know,” but they do pick up on it somehow. They get the vibes in the air.

Dr. Katie Rinald – 100%. The outcomes won’t be as good as you’d hoped if it’s really stressful for you, too.

Rachel Cram – That makes sense. All right, so in this method you’re suggesting having it be a week-long celebration. Number one is offering extra fluids. Number two is lots of time on the potty or toilet doing fun, exciting things that make your child want to be there. Number three, you talk about wearing underwear right away. Why do you suggest that? Because pull ups can seem like such a good solution because you can take them up and down like underpants, but then if they have an accident, it’s not all over your rug. So why are you saying underwear right away?

Dr. Katie Rinald – It’s appealing, isn’t it? The idea of not having pee or poop on your rug?

Rachel Cram – It is quite appealing, yeah.

Dr. Katie Rinald – It is appealing. It’s one of those things where now, as a parent, I go, “I get it.” I do get it. So the critical reason though is, in the research on potty training, where kids are most successful, they’re wearing underwear. So bottom line, it’s associated with success. But why that is I think is, diapers and pull ups are just a portable toilet. The kid is not going to be motivated to get themselves to the toilet if there’s no natural consequence for peeing or pooping in their pants. If they’re wearing underwear, they will start to feel the difference between being wet and dry really quickly.

Being potty trained is twofold. It’s like the child must learn that they need to pee and poop in the toilet, but also that they need to not pee or poop when they’re out of the toilet. So you can never get that second part, that, ‘Don’t pee or poop when you’re out of the toilet,’ fully mastered if they’re in a diaper or pull up because most kids will keep peeing in it if they’re in it. They might pee when you take them to the toilet, but they’re not going to make that leap to initiating if they’re in a pull up or diaper.

That said, I’m not militant about this point. Like if you’ve had a, a week at home of potty party time and they’re just not quite there and you’re a little bit worried and you’re thinking, “Oh, I just want to put a pull up on them for church or whatever.”

My best advice would be just let them go in underwear. If they have an accident. They do. It’s okay. But if for you as a parent, that’s very anxiety provoking, then it’s okay to do a little bit of pull-up here and there. But the best case scenario is to make that shift to underwear the whole time they’re awake as soon as you can and just be ready to roll with the accidents. Put some plastic covers all over your furniture, expect the accidents, know they’re going to happen and be ready for them. Because being in underwear is a really crucial part of the child totally mastering it and understanding it.

Rachel Cram – Yeah, I know one of the things that motivated my son, my oldest, because I remember his toilet training experience the most because it was fresh and new, was me getting him Power Ranger underpants. He didn’t get to watch Power Rangers, but he was aware of them and having underpants with those scenes on them made him want to wear them. And there’s so many great underpants out there for kids.

Dr. Katie Rinald – Oh, there are. I recently worked with a family where the kid loved planets, the names of planets in the solar system. And his mom custom made a bunch of underwear for him with each planet’s name ironed on. It was so cool. But it really helped it click for him like your son, where it’s like, well, I don’t want to get pee on the Power Rangers because I want to wear these all day, right? There’s a little extra motivation and that’s a cool way to build it in is look, not only do you get underwear, you get special underwear. That’s extra motivating. Yeah.

Rachel Cram – Okay, excellent. So, underwear is your third component in this ‘immersive toileting method’, which is kind of a fitting term, when you think about it. And the fourth is celebration after success. What does that look like?

Dr. Katie Rinald – Yeah, this is a big one and I’ll give some examples, but something that is really special to your kid is going to make this worth their while and help them to make the jump into really using the potty or really using the toilet. And one reason I guess I want to talk about this is I think that a lot of parents worry about over praising their kids. And I get the logic and part of it is you don’t want your kids to grow up to just be doing things to please you or other people or adults. You want that intrinsic motivation. And I think that it’s great to be thoughtful about the type of praise you give, and saying things like “you must be so proud of yourself” is better in the long term than saying, “I’m so proud of you,” and I like that. But I think it is important to just don’t worry so much about the type of praise when you’re doing potty training, just throw the praise at them. Butter them up in it, make them feel that they’re doing something really special because.

Rachel Cram – So it’s kind of like the iPad and the pretzels and the juice. It’s part of this special week that might not go on for all time. Like you might not be giving stickers for the rest of your life, but for this week, maybe stickers or something you can bring in, is that what you’re saying?

Dr. Katie Rinald – Exactly. Yes. It’s just whatever is going to motivate your kid and make them understand that this is special, do it, just do it. And so for some kids, it’s praise and that’s all they need. For some kids, it’s stuff. And that’s okay too.

When I work with kids with developmental disabilities sometimes the praise is cool, but for some of them it might be, Oh, it’s not the thing that really lights their fire. That might be like a really cool, squishy sensory toy you can present after successes. Or some families will make up a special dance that they’ll do. I’ve worked with a couple of kids too, who will you know face time their favorite Auntie as soon as they’ve had a success and she’s like on call the whole time. “Okay this is the day you got it. I know you’re at work. Pick up the facetime when we facetime.”

And the Auntie will go, “You did it. Oh cool! Wow!”

It’s just so cool to have that instant access. So it’s whatever for your kid makes them go, “Wow,” that’s what you need to give. And I’m talking very short term. This might even not even be through your whole party week. By the end of the week, if your kid’s having lots to drink and peeing a lot in the potty, they’re going to be so successful that it’s not that big of a deal anymore. It’s the first couple of times they’re successful that are really the time to party and to really help them understand this is something extra cool. So they’re motivated to continue doing it. But as it gets easier, they don’t need these huge amounts of reinforcement anymore. It’s your launch is the way to look at it. So that’s why I say, yeah, you’re not going to be giving this stuff forever, but make it special, make it exciting and make it a party. So yeah, make it, make it motivating.

Rachel Cram – I’m so with you on this Katie, I really am. However, with regard to motivating, I wonder if some people listening to this might feel like, “Hey, this goes against my way of parenting because it sounds like coercion. Giving rewards and prizes seems like manipulation. What would you say to that?

Dr. Katie Rinald – Oh, ok. I think what I’d like to say is, when you’re using things to motivate your child, it’s not about withholding them or dangling the carrot and forcing the issue. What you’re doing is celebrating what’s happened after it’s already happened. So you’re not going to say things to your child like “You have to pee and then you’re going to get this.”

What you want to have happen is they happened to pee and then something really cool appears. So it’s not a first/then type of teaching.

So that’s more how I would encourage people to think about it is, blow their mind a little bit, make it motivating, but don’t don’t dangle the carrot and pull it away. That’s not what it’s about. It’s about magic happening when they actually pee or poop.

Rachel Cram – Well, you were earlier saying how you don’t like wiggly teeth, but to pair it to that, when a child’s tooth comes out a tooth fairy comes. We don’t look at that as manipulation. We look at that as celebration because the reality is the tooth is going to come out and then we celebrate. It’s the same. Pee is going to come out. Poo is going to come out and then you celebrate. You don’t really have a choice in the matter. Teeth are going to fall out, bodily functions are going to happen and then you celebrate.

Dr. Katie Rinald – It’s nature. Exactly. It’s celebrating a bodily function. That’s exactly it.

Musical Interlude #3

Thanks for listening to family360 and our conversation with Dr. Katie Rinald – there is still more to come!

Over the next two summer months, a few of our releases will reach back to some of our early episodes with added updates from each of those fabulous guests. Our first is with Ranbir Puar. Ranbir shares the story of her birth in India as the 5th daughter to parents who longed for a son. Growing up unseen and unheard, she saw herself as a victim in her home, a narrative she redefined in order to grow and flourish in her adult life. Join us for her tender and insightful conversation.

And now back to the conclusion of our conversation with Katie and how to navigate nighttimes and regression….with toileting.

Rachel Cram – Okay, so what if you have all this in place, you’ve got the extra fluids, you’ve got the potty lined up or the special seat for the toilet. You’ve got the underpants, you have got the plan in place for the dance you’re going to do afterwards, or the auntie that you’re going to facetime. You got it all down and you go into it and they don’t pee. What happens if they don’t pee?

Dr. Katie Rinald – Good question. So for some kids this immersive approach is just overwhelming. It’s dysregulating, it’s too much. So in that case, I will often suggest – take it slow. So step back a little bit and maybe just work on potty training for something like a half hour a day.

So I would still recommend picking a time where you know they’re really likely to need to pee. So for a lot of kids that’s right when they wake up. You might be able to catch a morning pee that they would normally do lying in their diaper in bed. So in that moment, you might be able to go, let’s get up and do a quick potty sitting each morning at this time. And that can be a way to establish success. So if they’re able to sit on the potty for just maybe like a half hour a day and keep doing that as a regular routine, a lot of kids will eventually start peeing and then you’d still give them something really special.

And then once you see that they’re peeing regularly, when you do your half hour a day, then you’d know, okay, we can try adding a little more of the day. So we’ll maybe do this for more like 2 hours on the weekend and we’ll add underwear when we’re off the potty and that sort of thing.

So you don’t have to do this big, all or nothing immersive approach if for your child or for you, it could be too much. But it’s the parallel parking analogy, right? You won’t see that quick sort of light bulb going on in most kids. It’ll take a little bit longer. You’re looking at a couple weeks or a couple of months of doing a daily kind of potty sitting, and that’s totally fine. It might be what’s manageable for you and your kid, and progress can still happen but it’s more of a long game than a quick immersive approach like we’ve been talking about.

Rachel Cram – Throughout the day, you can often tell by your child’s body movements if they need to go to the washroom. Just the way that they’re standing. They go into sort of a crouch like, “Okay, I’m going to be having a bowel movement.”

I’m thinking those could be moments too where you say, ”Okay, let’s try sitting at the toilet.”

Dr. Katie Rinald – Definitely. Yeah, yeah. And that’s a good time to start talking to them about awareness of their body and knowing that they’re needing to go. So, yeah, a lot of kids have a telltale, especially poop sort of stance or they’re in that corner again behind the couch. I think we know what’s happening, right? The kids get in these routines of where and how they poop. It’s totally okay to go, “Oh, huh, I think you might need to poop. I can tell by the way you’re standing. Maybe we’ll try on the potty. Let’s do that.”

If you can shape that for your child and help them to start that thought process of, “You’re right, I do feel like I need to poop. Okay, let’s get to the potty,” then that’s a great way to approach it too. So it doesn’t have to be this all or nothing. It definitely can be something that’s woven into your day with your child.

Rachel Cram – Well and with woven into your day, it’s woven into our days. We’re using the washroom throughout the day.
What do you think about bringing your child into the bathroom with you so that they can see you going to the bathroom?

Dr. Katie Rinald – Yes, I think that’s a great idea. And for some kids, that really helps it click for them. Like we were talking about kids being observational learners, right? Even observing mom or dad using the bathroom can be really helpful. And it also, it just demystifies the whole thing. You don’t want to be making it so shameful or private. It’s something that I think in your house, it can be normal. We all do it. It’s something we all do.

Rachel Cram – I know there’s a wide range of how people can feel about this, but for me, what I feel like with my kids is I do want them to know these are regular body functionings, and there’s nothing nasty about it. There’s nothing shameful about it. I want them to come in and see, this is what Mommy’s doing and we all do this and no big deal.

It kind of expands also into how you talk about your body’s period. That everything on our body is totally beautiful and it’s got a function and there’s nothing embarrassing about it and we can talk about it. I mean, really, this probably extends on into sex education that this is a natural part of life and let’s just talk about it.

Dr. Katie Rinald – I was going to say, this is, I, as you know, I’m a fan of The Pod. I loved your episode with Saleema Noon. Everyone listen to that one after this one if you haven’t already it so good.

Rachel Cram – She had great information.

Dr. Katie Rinald – Yes, approaching body education for young kids. This can be part of it, too. Private parts are involved in peeing and pooping. So it’s another way to just demystify it. And yeah, it’s something we can talk about in our family and we can help you learn. So, yeah, I’m with you. I like that approach too.

Rachel Cram – It’s so interesting how all these parts of life come together isn’t it. And we want to be consistent in our messaging with our kids, so important conversations.

Dr. Katie Rinald – That’s very true.

Rachel Cram – Well we can’t end without talking about night time toileting, because daytime toileting comes first, and then I think in the excitement to perhaps save on the diaper bills and diapers into the landfills it can make us really want our kids to be dry right away during the night as well. But for some of my kids, that takes a lot longer. What’s your experience with night time toileting?

Dr. Katie Rinald – No. I’m with you on that. I think that sometimes parents want to do both or all of it – kick diapers all together all at once. But when we’re talking about little preschool age kids, usually their body’s not going to be ready to stay dry overnight when they’re that age. Some kids, yeah, but many not. Bedwetting, it’s usually not considered an issue medically until the kid’s about seven or eight. So when I work with families who say, “Oh, we really want to work on bedwetting,” and their kids under that age, I often say, “Well, maybe hold off,” because their body just might not be there yet.

Kids mature at different rates. And there’s a hormone that we need to produce that helps us inhibit our urine overnight. And some kids just, their body’s not making enough yet. And it will in a year or two or their bladders just not quite big enough or they’re really deep sleeper. And that’ll change over time. And until they’re about seven or eight, I usually say, “Let it go. Do your overnight heavy duty diapers and let time factor in, let nature take its course.”

And most kids are going to stop bedwetting by the time they’re age seven or eight. But it’s always something to bring up with your primary care provider if it’s a concern, because sometimes, and I don’t want to worry anybody, but sometimes bedwetting can be a red flag for other medical issues, like some kids who are diabetic. That’s one of the first ways that it’s identified, cause they’re peeing so much even when they’re asleep.

Or it can mean the child’s actually quite constipated if they’re bedwetting. So it’s always something to bring up and make sure your primary care provider is aware, but it’s not necessarily going to be a worry until they’re a bit older.

And then when they are older and, you know, they’re starting to go on sleepovers maybe or camp and you don’t want them to have to deal with that anymore when they’re getting around age eight or so, the most effective thing to do is actually to use a wetness alarm overnight. A bedwetting alarm. Have you seen those?

Rachel Cram – No I haven’t. No.

Dr. Katie Rinald – They’re designed to detect urine as soon as a drop hits it. So it’s a pad you can put down on the bed. So as soon as they start to pee, it’ll beep, beep, beep, and wake the child up. So usually in the course of a couple of weeks they’ll be able to wake up as they’re about to start to pee before it actually hits the alarm, because their body-brain connection has been made with the use of this tool.

So it’s going to be a couple weeks of disrupted sleep for everybody. These things are loud, but they’re effective. They’re really effective. That said, don’t push it. Like if your kid is not making enough of the hormone that they need or their bladder is not big enough, don’t do a bedwetting alarm when they’re four. It’s not going to work very well.

Rachel Cram – You’re saying wait till they’re at least eight before you start doing that.

Dr. Katie Rinald – Yes. And then this would be the appropriate sort of intervention to use. Yeah.

Rachel Cram – Well on that note, I found these bedsheets, plastic sheets that don’t feel like plastic sheets, like they’re not all squeaky. But I just put those on all my kid’s beds because also for the nights when they throw up. Like, it’s just so nice to have it be caught before it hits the mattress. And then you’re just taking off that sheet, throwing something else on. Quickly popping them back into bed again. And your whole night doesn’t have to be disrupted with now flipping over the mattress or taking the mattress out. So those are invaluable. I would have those on every child’s bed.

Dr. Katie Rinald – Yes, they are. And I learned recently from a family that I worked with such a good tip where they do a sandwich with the sheet so they’ll put a plastic protector on and then a sheet and then another plastic protector and then another sheet. So if you get a pee or barf incident in the middle of the night, you whip off the top layer,

Rachel Cram – But you’re still ready for shot number two.

Dr. Katie Rinald – You’re still ready. I hate that. I’m a bad middle-of-the-night parent, where I’m kind of trying to wrestle a sheet back on the bed in the middle of the night. That way you’re just removing something and you toss it and you’re back to bed. So I think that’s a really good tip.

Rachel Cram – Yeah, well, because you don’t want to be up so long that your child is now wide awake either. Or we’re wide awake. So, I think that’s a great idea.

Dr. Katie Rinald – Exactly. Both of you. It really helps. I think that’s a good trick.

Rachel Cram – And it’s so good to know these tricks. Ok, I have a question that bounces back into daytime toileting, but also applies to nighttimes as well.

It’s not uncommon for children to do really well using the toilet, and then regress. You’ve celebrated, you’ve got their fun underpants, it’s all going really well, and then it’s not. Why can that happen and what should we do?

Dr. Katie Rinald – Yeah. There are many reasons that regression can happen and first of all, I would say be ready for it and have your calm, cool reaction ready to go, so you’re not doing that. “What are you doing?”

That can have a really negative impact on how the child’s feeling about the whole thing and that can lead to more accidents if they get a really big reaction from their parent that’s negative. It can make the problem worse.

So I always say react as coolly and calmly as you can, I know that that’s easier said than done. And then just go back to implementing some of the things that were really helpful the first time around. That’s usually the most successful.

Oh, and you were asking about reasons and there are so many, I mean, starting a new school, or having a new sibling, moving, just changes. Changes are usually the things that result in an uptick in toileting accidents for kids. And it’s totally normal, totally expected. And usually the problem goes away pretty quickly for most kids. If it doesn’t, ask your primary care provider because it could indicate a medical issue if they’re really consistently having accidents again.

Rachel Cram – Ok. Well as we wrap up, my mind is going back to the beginning, when we were talking about Freud, dissing him for setting the premise that toilet training sets the stage for the rest of your life. But I’m going to ask you this; What do you think a good toilet training experience does offer a child as they continue on their growth journey? Why do we want to pay attention to this important stage of development?

Dr. Katie Rinald – Yeah. That’s such an interesting question. It really can be a bonding experience for the family. I think for a lot of parents, it can be this big milestone that they were maybe worried about but for the parent, they can see, “Hey, we were able to help our child be successful with this.” So I think it can be a bit of a relationship booster for families.

For the kid, I work with many families where once the kid’s in underwear, they kind of want to show the waistband to everybody they know as a little sense of pride. It’s a mark of, hey, I’m a big kid now. So I think it’s just something that can give kids confidence, a skill that they have. So, yeah, when it goes well, it can be huge. It’s a huge developmental milestone.

Rachel Cram – And it’s akin to learning how to ride your bike and making it across the monkey bars for the first time. And having a successful date. Driving a car. It’s the first of a long line of milestones.

Dr. Katie Rinald – Totally. Yeah, I definitely see it that way.

Rachel Cram – And one that we get to celebrate with our child.

Katie, thank you so much for this conversation. I have really enjoyed talking to you. You know, you can think a topic like toilet training is not a big sociological topic, but it kind of is.

Dr. Katie Rinald – I mean, we made it that way. Yeah, absolutely. No, I think it’s interesting to think about the background and where it comes from and what it means to families. I mean, it’s a huge area. So. Yeah. I was so happy to talk to you. This was so much fun.

Rachel Cram – It was so much fun. And we will put links to all of your work on your page on Family 360 so people can find you to get more information if they need it.

Dr. Katie Rinald – Awesome. That’s wonderful. Thanks, Rachel.

Rachel Cram – Thank you.

You’re a sociology major from way back, were you impressed we brought some social science into our conversation on toilet training? I bet you didn’t see that coming.
Well, first of all, I love being surprised by where these conversations roam, but no, I wasn’t surprised. Sociology is everywhere people are, even…on po toilets.
Potties. You were going to say “potties”, weren’t you. Not a word you’ve probably used many times in this recording studio. I wasn’t ready to roll off your tongue. Come on Roy, all the cool kids are saying it.
Well, I’m not a cool kid, so that might be the problem.
You are such a cool kid. You’ve probably owned over 50 eclectic guitars.
Regardless, I rest more comfortably in the nerd crowd.
Well, I think that is actually the cool crowd now, although honestly, I have no idea.
Which I think even the use of the word cool conveys.
True. Now I’m just thinking how to bring this back around to where we want to go.
Well, we want to move into celebrating our children whether they use the potty or the toilet, and taking the time to enjoy and even savor these unique passages in life.
To choose savor over stress.
Yes, choose savor over stress. And we’re ending with a poem we found on a site called ‘the life on purpose movement’ written by Dianne Loomans.
It’s called, If I Had My Child To Raise Over Again
And speaks to the celebration Katie was talking about.
Taking time to attend to…to be present…to celebrate big and small moments with our children.
I thought you were going to say, big and small movements…which would have been fitting.
We’re trying to move to a more serious ending.
I know. With a huge thank you to Katie, here is Dianne Loomans poem.

If I Had My Child To Raise Over Again
By Dianne Loomans

If I had my child to raise over again:

I’d build self esteem first and the house later
I’d finger paint more and point the finger less

I would do less correcting and more connecting
I’d take my eyes off my watch and watch with my eyes

I would care to know less, and know to care more

I’d take more hikes and fly more kites
I’d stop playing serious and seriously play

I would run through more fields and gaze at more stars
I’d do more hugging and less tugging

I’d see the oak tree in the acorn more often
I’d be firm less often and affirm much more

I’d model less about the love of power
And more about the power of love