$Unique_ID{PAR00228} $Pretitle{} $Title{2 1/2 Years to 5 Years: Daily Care Basics} $Subtitle{} $Author{ Editors of Consumer Guide Mendelson, Robert A Mendelson, Lottie M Meyerhoff, Michael K Ames, Louise Bates} $Subject{2 1/2 Years to 5 Years Daily Care toilet training potty chair problems flush flushing separation sibling arrival medical regression wetting accidents washing teeth brushing hygienic uncircumcised bathe tub baths sponge bath shower showering bathing shampoo shampooing Dry scalp wash washing naps sleep HYGIENE preschooler preschoolers} $Log{ Preschoolers are usually adept at getting the sleep their bodies need*0055701.tif} The New Parents' Question & Answer Book 2 1/2 Years to 5 Years: Daily Care Basics How can I tell if my preschooler is ready to start toilet training? It is very important to understand that children are ready to begin toilet training at different times. Some begin to show signs of readiness as early as 20 months, while others are not ready until three years of age or later. Until certain specific signs of readiness (see accompanying list at bottom) are apparent, attempts to toilet train your child will be both frustrating and futile. This normal physiologic maturation process should not become a battleground. If training is attempted too early, it often results in an inappropriate focus on the issue and actually may delay the time when the child uses the toilet independently. Once your child demonstrates these signs of readiness, you can begin the process; remember, however, not to rush it. What do I need to do to get ready as well? Your preliminary tasks fall into two categories--behavioral and mechanical. With regard to the former, it is helpful to allow your preschooler to accompany you when you use the toilet so he will have an appropriate model. Also, start using specific terms for the body parts and functions involved regularly, so your preschooler will know exactly what you are talking about. Finally, talk to your preschooler about the advantages of being toilet trained in a positive, upbeat manner every now and then. With regard to the mechanics of toilet training, you probably will want to purchase a potty chair or adapter seat. A potty chair allows your preschooler to be largely independent, since he will not need you to lift him onto the seat. The fact that it is easily portable can mean a lot in terms of convenience. Make sure that the potty chair is simple to use and clean and that it is stable and has nonskid features to keep it from slipping on a tile floor. An adapter seat, on the other hand, has the advantage of direct flushing, but it may create inconvenience for other family members who will have to remove and replace it. If you purchase one, make sure it fits your toilet securely. You may want to consider purchasing a sturdy footstool as well so that your preschooler can climb up more easily. If your preschooler is older and larger, you may want to train him directly on the regular toilet; but for most, this is problematic. How should I begin the process of toilet training my preschooler? The first thing to do is to inform your preschooler of what will be happening. Then, give him several opportunities to practice the various steps involved--removing his clothing, sitting on the potty chair, etc. Once your preschooler is aware of the process, pick a time of day when he usually eliminates, and take him to the toilet. Tell him in a pleasant and reassuring tone using words he can understand and say ("pee" and "BM," for example) that from now on, his waste products will begin going into the toilet instead of into his diapers. Then place him or help him onto the potty chair, and ask him to try eliminating. Never strap him in or in any way make the process seem like punishment, and be sure to stay with him at all times. While he is trying, talk to him, read to him, or in other ways keep him entertained and comfortable. Don't force him to sit on the potty if he is unwilling; keep the time to a minimum (less than five minutes). Praise every bit of progress lavishly--even if it's something as simple as sitting quietly on the potty chair for more than a few seconds. And be patient. Toilet training rarely is accomplished completely in one session; and if things aren't going well, just forgetting about it for the moment and attempting it again later often is the best solution to whatever problems are arising. What kinds of problems can I typically expect when toilet training my preschooler? Quite commonly, preschoolers resist the first attempts at toilet training. If they are pushed, the bathroom becomes a battleground, and the whole experience becomes extraordinarily unpleasant for everyone involved. Therefore, if your preschooler demonstrates that he is not inclined to approach this process with a positive attitude, the easiest thing to do is just wait a couple of weeks and try again. Some preschoolers manage to do very well up to the point where flushing comes in--they may get very upset that something that was a part of them is considered "dirty" and must be gotten rid of. If this occurs with your preschooler, it helps to explain that this is "extra" that he doesn't need. He may feel better if you wait until he leaves the bathroom before you flush, or he may prefer to flush and wave "bye-bye." Once he is toilet trained, what do I do when my toddler has an accident? Most accidents of this kind are truly accidents--that is, it is likely that your preschooler will feel worse about them than you will. It therefore is a good idea to just clean up in a matter-of-fact manner, console him as necessary, and encourage him to use the toilet "just to see if there's anything left." Never shame or scold him. If your preschooler has a "deliberate accident" in order to punish you or express his anger over something, be careful not to overreact and give him what he was looking for. Clean up calmly; you may want to take your time so that your preschooler remains uncomfortably wet for a while. It is suggested that you also have him help in or take responsibility for cleaning up so he can realize that accidents are not in his best interest. If accidents start occurring frequently, a medical problem may be involved (see "Safety and Health: 2 1/2 Years to 5 Years" for more on frequent fecal soiling). On the other hand, your preschooler may be genuinely "regressing" in response to a separation, the arrival of a sibling, or some other emotional disturbance. If you suspect it is a medical problem, consult your pediatrician. If it is a case of regression, again, don't scold or shame, but have your preschooler help in the clean up, and possibly suspend some of his "big boy" privileges for a while as well. Do what you can to help him work through whatever the real problem is, and let him know that you will be happy to start all over again with him as soon as he is ready. Although he does fine when he's in the house, my four year old has frequent wetting accidents when he's outside playing. How can I get him to be more careful? What you are describing is a very common occurrence in children of this age, and although it can be disappointing to you, it will pass in time. To help the situation, you'll need to use positive measures. Start by asking him to take time to go potty before he goes out to play. When he doesn't have accidents, tell him what a big, responsible boy he's getting to be. When an accident does happen, don't get overly upset, but do make him responsible for changing his clothes, cleaning himself up, and putting the soiled garments in the laundry. Peer pressure does wonders in this regard, and usually the embarrassment will motivate him to become more careful. If the problem continues or increases, consult your pediatrician. It may be advisable to have your preschooler screened to make certain everything is normal with his urinary tract. My preschooler is capable of washing himself and brushing his teeth, but can I trust him to do these jobs properly? By the end of this period, most preschoolers have mastered most such hygienic activities. However, it is probably not a good idea to let your preschooler carry them out unsupervised too often. While he will understand and appreciate the importance of keeping himself clean, you simply can't count on your preschooler keeping this concern in the forefront of his mind and at the top of his priority list all the time. Quite often, he may become fascinated by a particular act or a particular feeling, and as a result, he will wash or brush the same area over and over again and neglect everything else almost completely. Also, he may be in a hurry to hear a special bedtime story, go on a special trip, etc., and as a result, he may "go through the motions" in a big hurry without really doing a very good job. Your trust in him in this regard will gradually become total, but even by five years of age, it is unrealistic to expect that it can be complete. My three and a half year old has been potty trained for a year. Besides using too much toilet paper, he doesn't get himself clean, but he refuses to let me help. Should I insist? You don't want to discourage him from doing it all by himself. You can offer to help wipe. If he refuses, you might try giving him a sponge bath on days when he's not going to have a full bath to make sure he isn't irritating his bottom by not wiping it clean. To help with the toilet paper, you could put the roll out of his reach and leave him a few sections (be careful not to inconvenience other family members by putting it too far out of their reach). Explain how much he should use and how too much can clog the plumbing. Emphasize that big boys don't want to clog the plumbing. My uncircumcised son is now three years old. On two occasions, I've had trouble pulling back the foreskin to clean beneath it. What should I do? Never force the foreskin back if it is not totally separated from the glans. Natural separation will occur over time. Although in many boys the foreskin may separate completely by age five, in some boys separation is not complete until puberty. If the foreskin has separated from the glans, gently retract it at bath time, and clean whatever portion of the glans is exposed. Do not force it back. Retracting the foreskin should never cause pain; if it does, you are forcing it. As early as possible, teach your son to gently retract the foreskin when he urinates and during baths and showers. How often does my preschooler need to bathe? The recommendation is two to three times a week. More frequent bathing can cause dry skin. To keep your preschooler's hands, arms, and face clean between tub baths, you can give him a sponge bath. His bottom may also need a frequent sponge bath, since at this age he may not be adept at wiping himself. Tub baths don't have to be long; a short "in-wash-out" for youngsters is fine. Avoid using bubble bath since it can be drying and irritating to his bottom. If your preschooler prefers to take a shower, that's fine, too. When he gets out of the tub or shower, you can lightly spread a little lotion over his skin before you towel him off to help prevent dryness. Avoid lotions with perfumes, however, as they can cause irritation. My preschooler suddenly stopped enjoying bath time. What can I do? Most preschoolers love to take baths and splash around in the water. If your child resists bathing, find out why. It could be that you scrub too hard when you wash him; in that case, ease up. It may be that he doesn't want you to wash him at all and would prefer to do it himself; if so, let him wash himself, and then just lend a hand for the hard-to-reach places. Sometimes the temperature of the bathwater is the problem; let him choose whether the temperature should be warmer or cooler. Shampoo in the eyes or tangled hair is uncomfortable and often the reason a child wants to skip the bathing process (see the next question for tips on making shampooing easier). Do whatever you can to make bathing or showering a more pleasant and comfortable experience for him. How often should I shampoo my preschooler's hair? Unless your child rolls in dirt every day, daily shampooing is not necessary and not recommended; once or twice a week--or whenever it looks and smells grimy--should do it. Dry scalp and dry or damaged hair can result from too much shampooing. On in-between days, you can rinse his hair without washing it if necessary. Even if you wash his hair only once or twice a week, use a mild shampoo, and only shampoo once. Many shampoo instructions say to shampoo twice, but this is unnecessary, especially for children. Be sure to rinse his hair and scalp thoroughly. Use clean water for rinsing, since using bathwater won't get his hair clean enough. If you don't have a shower or if you prefer to bathe your child, there are shower attachments available (the shower head is attached to a rubber hose that fits over the tub faucet) that are ideal for rinsing your preschooler's hair and body. Make certain that the water temperature is comfortable for your child, and avoid rinsing shampoo or water into his eyes. If his hair is very tangled after shampooing, you can use a creme rinse to make combing easier. How many naps should my preschooler be taking each day? Should I insist that he take them? Each child is an individual with individual needs. Some children require more sleep than others. In addition, children go through periods when they need increased rest due to growth spurts, increased physical activity, or increased environmental stimulation (such as going on a vacation). Many four year olds still require an afternoon nap, while others have given naps up completely. Preschoolers usually sleep or rest between eight and 11 hours a day. If your child is fatigued in the afternoon, he should be given a chance to take a nap. If he doesn't want a nap, a quiet period with quiet play may suffice. If napping becomes lengthy and pushes back bedtime at night, you'll want to cut down the nap time and probably eliminate it. Still, on occasion, a child will need a nap, and if it's accepted gracefully, fine. If not, try to opt for an earlier bedtime that night. Although parenting should be flexible, children do better with a fairly structured routine. If bedtime is about eight-thirty or nine each night, you should avoid pushing it back an hour or more for special occasions. If you prefer to sleep later in the morning, you can try to manipulate his bedtime, but it may not always work. Like adults, some preschoolers are early to bed and early to rise, some are late to bed and early to rise, and others are late to bed and late to rise. All in all, they're usually adept at getting the necessary amount of sleep that their bodies require. If your child often seems overly tired and cranky, you'll want to try to encourage more rest. Help him avoid activity and excitement just before bedtime. If he doesn't seem to catch up on his sleep, you may want to consult your pediatrician. SIGNS OF READINESS TO TOILET TRAIN When these signs of readiness appear, you can begin toilet training. Keep in mind that trying to toilet train your child before he demonstrates the necessary signs may very well delay the process. Your preschooler is probably ready to begin toilet training if he: - Has a dry diaper for increasingly long time periods, which indicates that his bladder is able to store increasing amounts of urine. - Has bowel movements on a fairly regular schedule. - Shows a desire and ability to follow instructions. - Is anxious to be changed from a wet or dirty diaper. - Tries to copy bathroom activities of other family members. - Demonstrates to you in a recognizable way (by facial expression; by squatting or running to a particular place, such as his changing table; by actually telling you so; etc.) that urination or a bowel movement is about to occur. - Has the motor skills to remove and at least partially replace the clothing that must be removed to use the toilet. - Has the ability to get to the toilet or potty when he needs to "go" MAKING HYGIENE FUN Helping your child to develop good hygiene habits now will help ensure that he'll continue them later on. For your preschooler, hygiene is fun when: - The time allotted is always an important part of the everyday schedule. - He is praised by you for having clean teeth, hair, hands, and nails. - He gets to choose his own new products for hygiene, such as a toothbrush, comb, nail brush, soap dispenser, and cup--all in his favorite colors. - He has a mirror at his height to watch himself get his face and teeth clean and comb his hair. - He has a nonskid stool or set of little steps so that he can reach the sink with ease. - He and his parents can be hygiene pals--washing hands together, brushing teeth together, and combing hair together.