The theory behind our approach to toilet training is that the normal human condition is to keep all body parts clean and dry. When a child is left in a wet diaper, even for a short period of time, he receives incorrect psychological information. Therefore, it is of utmost importance to change a child as soon as he has wet or soiled. Disposable diapers are designed to hold a great amount of fluid and because the synthetic fibers draw the liquid away from the skin, caregivers are inclined to leave a child in the damp, wet, heavy diaper for too long.

We assist the child in freedom of movement and refinement of physical control of his body with the exception of the parts of the body having to do with elimination. If the child is kept in disposable diapers for a long period of time, he can become detached from that part of his body. The disposable diaper becomes part of his body scheme. The child who is kept in disposable diapers will require a more conscious effort to toilet train than will the child who has worn cloth diapers or underwear from an early age.

Myelination, the process that coats nerves in a fatty substance to allow for proper information flow and to help speed the transmission of electrical signals has enabled the development of the control of the bowel and bladder muscles. At this point in development, we can observe that the child is able to stay dry for a longer period of time, has fairly regular bowel movements, wants to remove his diaper, and shows an interest in the bathroom. We call this a sensitive period for toileting. It occurs under the age of two and is observed earlier in a child who wears cloth diapers or is changed frequently.

This sensitive period is the natural time to change from diapers to cloth underwear. "Pull-ups" are disposable diapers; the only difference is the push/pull movement for pulling them on and taking them off vs. the Velcro tabs on other diapers. Those particular movements have no bearing on the child’s understanding the elimination process. However, they are helpful in the independence of undressing and dressing.

Observe your child. When both parents are in agreement to begin this process, discuss it with any caregiver so that everyone has an understanding of the situation. You will work as a team in assisting your child. The adults’ attitude must be positive. Negative comments are disrespectful. Clapping and cheering are unnecessary, as the child does not need an audience to perform a natural act. The child needs to understand he is doing this work for himself, not for the parent.

We will assume boys have watched their fathers use the toilet and girls have watched their mothers use the toilet. In the toddler community we have the boys stand in front of the toilet with the toilet seat up and the girls sit down.

When you are ready to begin show your child the underwear. Tell him simply that he no longer needs diapers (don’t tell him there are no more diapers if he will continue to wear a diaper at night). Once you are committed do not go back and forth between diapers and underwear. This gives the child a mixed message and tends to lengthen the process. Ideally, the child will wear underwear day and night. But each family needs to decide their level of commitment to this step toward independence.

Set up an elimination schedule based on your child’s habits. If you ask your child is he needs or wants to use the toilet, he will most likely say no. If you know it is time for your child to use the toilet, simply say, "It’s time to use the toilet" and take him. If there is no elimination in a short period of time, say, "We will use the toilet later." Then try again soon. In the beginning, invite your child to use the toilet when he gets up in the morning, when he is finished with a meal, before he goes anywhere in the car and after he arrives at his destination. Take your child before and after his nap, after playing outside and before bath and bedtime. Some children can go 8-12 hours between elimination and others go every 30 minutes. You will learn your child’s schedule very quickly.

Children who urinate frequently might not be emptying their bladder – they use the start/stop technique. When we realize this is happening we might say, "There is more urine to come out."

Limit the amount of liquid the child has at bedtime, to encourage nighttime success. A rubber sheet can be placed between the mattress and sheet to absorb urine in the bed.

When the child wets his pants the first thing to remember is to stay completely unemotional. Invite the child to participate as fully as possible in removing the soiled clothing, placing them in the proper place for laundering, and choosing dry clothes. This shows respect. Here it is clear why the "dress for independence" is so important. The child who can easily run into the prepared bathroom (step bench already in place in front of the toilet) and push down loose fitting pants and underwear will be more successful than the child who has to struggle with the shirt that is too long and the pants with fasteners that are too tight.

As when a child is learning anything new, there is a period of absorption of information before constructive use of that information can be made. The length of time varies from child to child. Please do not expect instant success when your child puts on underwear. Be calm and patient. Just as your child rolled over, crawled, sat up, walked, and learned to be successful with a spoon for feeding, he will master the use of the toilet.