By Steve Hodges, M.D.
So Kim Kardashian is bursting with pride that her 19-month-old daughter, North, appears to be a potty prodigy. North is “so smart,” Kardashian told People. “She is halfway potty trained, which is insane for her age.”
As a pediatric urologist, I can tell you Kardashian is right about one thing: It is insane for a 19-month-old to be potty training.
Well, if not insane, then at least totally ill advised.
Little North, her brilliance notwithstanding, will be at high risk for developing wetting problems down the road.
As our research at Wake Forest University suggests, children toilet trained before age 2 have triple the risk of later developing wetting problems, compared to kids trained between 2 and 3.
Of course, not every child trained as a toddler will later develop dysfunctional elimination, but in our study, published in Research and Reports in Urology, 60 percent of the children trained before age 2 did present with accidents well after mastering the toilet.
Parents who train their children early — to meet preschool deadlines, to save landfills from diapers, or because they think it’s awesome to have a potty-trained toddler — should know there can be serious repercussions.
Why Early Potty Training is Risky Business
It’s not that toddlers can’t be trained to use the toilet. For sure they can. Exhibit A: little North!
The problem is that toddlers don’t have the judgment to respond to their bodies’ urges in a timely manner. Compared to children who train later, they are far more likely to delay pooping and peeing.
These are risky habits. When a child chronically withholds poop, stool piles up and forms a large, hard mass. This mass can stretch the rectum — imagine a rat in a snake’s belly — from about 2 cm in diameter to 10 cm or more. I have plenty of patients harboring grapefruit-sized rectal lumps of poop.
There’s limited real estate in the pelvis, so the bladder gets crowded out by the poop mass. In addition, the nerves controlling the bladder, which run between the bladder and colon, become irritated. The upshot: unexpected bladder contractions – in other words, mad dashes to the toilet and accidents.
Poop accidents are a risk, too. An overstretched rectum loses tone and sensation, so poop may simply fall out — without the child even noticing.
Holding pee compounds the problems, thickening and further irritating the bladder. Eventually the bladder can get so irritable that it empties without any input from the child.
That’s when these potty prodigies show up at my clinic, with the sudden onset of pee and poop accidents, urinary tract infections (UTIs), or bedwetting.
“It doesn’t make sense,” a mom will tell me. “I didn’t push her – she basically trained herself.”
I believe these parents — and it doesn’t sound like Kim Kardashian is pushing North — but in my clinic the kids who develop the most serious problems are typically those who trained earliest and most easily.
In other words, they have been deciding for the longest amount time when they should pee or poop. It’s a disaster.
Early Potty Training Can Backfire
Parents of all stripes, celebrities and regular folks alike, take pride when their children toilet train early, in the same way they beam when their kids walk, talk, or read before their peers.
But you should not think of early toilet training with pride. You should think of it the same way you would if your 19-month-old made any other major life decision on her own: with trepidation.
I don’t want to be dogmatic about the appropriate age to start toilet training, but I’ve rarely met a child younger than 3 who truly has the judgment to make good toileting decisions.
My co-author, Suzanne Schlosberg, toilet trained her twins at 24 months. How’d that turn out? Check out her video, How I (Royally) Screwed Up By Potty Training My Twins Too Soon.
Based on my experience and our research findings, I encourage parents to delay potty training, to temper their expectations of toddlers, and to have more patience when children have accidents.
“Failed toilet training” is one of the leading triggers of child abuse, according to the Child Abuse Prevention Center. Every week brings news reports of toddlers beaten, scalded, or killed by adults frustrated over toilet training. Often the reason toilet training “failed” is that the children were trained at too young an age.
I also urge parents to stay away from potty bootcamps. Just this week a potty bootcamp owner in Hawaii went on trial for allegedly abusing a 17-month-old enrolled in her program.
I also hope our findings will encourage preschools to ease up on deadlines requiring children to be potty trained by age 3. These deadlines often prompt parents to train their toddlers extra early so that the children will be completely trained and accident-free by the time school starts.
What preschools fail to realize is that early training can backfire.
I understand that for multiple reasons, many parents will toilet train children under age 3, and I think the most important point to glean from our study is that constipation status — rather than age — is the critical factor that will influence whether a child develops wetting problems. In our study, virtually every child who had chronic accidents was stuffed with poop.
No matter what age you introduce your children to the toilet, make sure your child is ready — that is, interested and not constipated — and is leading the way.
Make sure your child pees every two to three hours, and remain vigilant about monitoring for signs of constipation, which are often subtle and not widely known. A child can poop daily and still be constipated. The top two signs are extra-large poops and hard poops, shaped like pellets or logs.
We offer additional toilet training guidance, especially for children prone to constipation, in book The Pre-M.O.P. Plan: How to Resolve Constipation in Babies and Toddlers and Overcome Potty Training Struggles.
Kim Kardashian says North is “halfway” potty trained. If that means she’s peeing on the potty but not pooping, North is very likely constipated, and her parents should dial back potty training.
I hope Kardashian and Kanye West can find something to feel proud about besides little North’s accomplishments on the potty.