If your preschool-age child still struggles to use the toilet when it seems as though all his peers have been out of diapers for at least a year, you may consider getting him evaluated by a pediatrician. But if you're worried about your child having a problematic delay, keep in mind that some children are simply late bloomers.
Identification
Toilet training may be defined as delayed if a child is over 3 years old, has normal development otherwise and isn't toilet trained after at least three months of instruction, according to Barton D. Schmitt, M.D. In "Toilet Training Problems: Underachievers, Refusers and Stool Holders," published in a 2004 issue of "Contemporary Pediatrics," Schmitt says intervening in delayed toilet training cases as early as age 3 may help remedy situations in which parents are improperly carrying out toilet training. For example, parents who consistently force their child to sit on a toilet may inadvertently be causing toilet-training struggles.
Biological Causes
Sometimes delayed toilet training is caused by a health condition in the child. According to Schmitt, urinary tract infections, urethritis and urgency incontinence may be biological causes of daytime wetting. A child with chronic constipation or diarrhea may also be delayed in training. Children who are having trouble with toilet training because of a biological cause typically try to use the toilet by, for example, running to it or working hard to have a bowel movement, Schmitt says.
Behavioral Causes
Resistance or refusal to use the toilet is the most common cause of delayed toilet training, according to Schmitt. Resistant children typically know how to use a toilet but choose to soil or wet their clothing and refuse to sit on the toilet when prompted. Schmitt says this is commonly due to a power struggle between parents and strong-willed children.
Treatment
Treatment for delayed toilet training depends on the underlying cause. If the cause is biological, caregivers should start training again only after a doctor has prescribed the necessary medication, such as a laxative for constipation or an antibiotic for a urinary tract infection. If the cause a child's stubbornness, BabyCenter.com recommends that caregivers relinquish control and assign toilet responsibilities to the child, placing a potty chair where he can see it and leaving the child unclothed from the waist down to encourage use without parental involvement. The parenting website also recommends offering incentives such as small toys.
Regression
If your child had been using a toilet for months but has started to have accidents, she isn't delayed. Regression may simply be an indication of stress over changes in the home, such as a new baby, a parent having a new job or a move from the child's crib into a big bed, says "Parents" magazine. BabyCenter.com says that if caregivers let the child know they think she's old enough to use a toilet but lay off for awhile, she should soon be back to using a toilet again.
