Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary research in child development can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Wednesday, July 31, 2013

Potty training advice: take time to tell the story

Yesterday I had the pleasure of doing 22 radio interviews in 4 hours as part of a PR tour for a new potty training book Potty Palooza: A step-by-step guide to using the potty.  I did not write the book, which is a fun but quite quirky board book designed to introduce children to the process. Rather, after writing a blog last year entitled The Poop Wars, I was approached by the publisher to write the short   parent guide that comes as an insert in the back of the book.

As I explained to my interviewers, it is not a "how to" guide but rather a set of "guiding principles." For just as in the case of sleep , the path to successful  toilet training is to know the family story. This became very clear in one interview about halfway through the morning.

The five guiding principles, that I repeated in some form in response to the radio hosts' questions are: trust yourself and your child, look for signs of readiness, relax, have fun, and pay attention when your child resists.

This particular interviewer was the mom of a three-year-old. As it was a public radio interview, rules of confidentiality that I follow strictly in my practice do not apply. The bulk of the ten minute conversation was taken up by her telling me about her frustration with her son saying "no" to repeated requests to poop on the potty. As she was not in fact a patient, and the purpose of the conversation was to talk about the book, I repeated the "advice" from the parent guide. I explained that each child-parent pair is unique, and it is important  to tailor the process not only to each individual child, but also to the family circumstances under which toilet training is occurring.

With about two minutes to go, she mentioned that she was pregnant with twins. After giving me about 30 seconds to address the possible relevance of this fact, she switched to the topic of her husband, who rather than helping model for their son, locks the door to the bathroom to protect his private time. The other radio host, a man, wisely interjected with, "when the twins come there will be no private time." Now we were getting somewhere. Seconds later came, "Thank you for joining us on our program."

The whole process felt emblematic of the trouble with our culture of advice and quick fixes. If there is an exclusive focus on "what to do" about "problem behavior" there is no time to reflect on the nuances and complexities of relationships. These relationships, and the family stories they are part of, are inevitably inextricably linked to the "problem." In telling the full story, "what do do" usually becomes clear.

For the mom of this three-year-old, that might mean backing off on the toilet training until after the babies are born. It might mean that some more explaining about where babies come from is indicated (a three-year-old might very well confuse the babies in the tummy with poop and hold on to the poop in an effort to be like mom.) There might be some work that needs to be done in the marriage in terms of shared responsibility for parenting.

Of course I am part of our culture, and I'm the one who wrote the 1,000 word guide to toilet training. And I do think that some "advice" can be helpful.  But above all, parents know their child best, and should trust their judgment. When things get derailed, and families are stuck, taking the time to tell the story and make sense of the problem can be very useful.





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