As a pediatric resident, I have families come into clinic on a daily basis with questions about parenting.  How do I discipline my child?  How do I get them to eat their vegetables?  How do I get them to stay in their own bed at night?   My question is: where does it say in the pediatric texts how to advise on parenting skills?  The truth: it often doesn’t!

As a doctor-in-training, the books tell us the what-you-need-to-do part of the equation, but leave the how-to-do-it part up for interpretation.  For example, the texts will tell you, a toddler needs to give up the bottle by 18 months, but it fails to say how you convince a child to do so.   It seems that effective pediatricians must have real-life inspiration to draw from.  Some ask their patients parents what has worked for them.  Others have their own child-rearing experience to draw from.  As for me, I rely on my sister.

My sister has two adorable boys – Finn and Oscar.  As the first grandchildren in our family, it hasn’t taken much effort on their part to stay in the spotlight.   As the eldest, Oscar was first to arrive on the scene, and he has certainly left an impression.  He is what you might kindly call “spirited” or “willful”.  But where euphemisms end comes the difficult truth: He has been one hard child to parent.

Oscar, like so many children, hasn’t followed the books.   He refuses to sit in a seat.  He laughs during a time-out.  He climbs high onto furniture and then throws himself off, laughing hysterically.   He pretends to kiss baby Finn and bites him instead.  He literally runs circles around us, as the rest of the family sits together having a family picnic.

As Oscar has hit every stage of development, I’ve found that my stock advice as a pediatrician has failed to hold up to the task.  Now, I don’t want to give the wrong impression: my sister has not asked for any advice in parenting from me, a non-parent.  I have merely heard her relay stories of failed efforts using tips I’m sure I’ve offered to many of my patients’ families.

Figuring out the right way to parent Oscar has been a challenge for my sister and her husband.  But the trials and tribulations of being a parent have won them the wisdom that comes with experience, and an arsenal of parenting expertise.  As Oscar enters his third year of life, he has mellowed a bit.  He is no longer waging a private war against his younger brother Finn, and his dare-devil acrobatics have ceased – at least for the time being.   He is learning to drink from a cup at mealtimes, and is finally enjoying his fruits and veggies.  As a mother to none, but an Auntie to two, I have had the benefit of learning from the tough experiences, without having to struggle through the lessons.  From my sister’s hard-won parenting battles, I now have a bit of real-life parenting to draw from, until I have the fortune of going through the lessons myself.

Related concepts:

Temper tantrums, Emotional storms

Introduction to tantrums:

When your child kicks and screams at not getting his way, the outburst often seems to come at the least opportune times: during grocery shopping, when you’re on the phone, when you’re trying to get out the door, trying to make dinner, or at a family gathering.

What are tantrums?

Temper tantrums are expressions of intense, immediate frustration. They occur most frequently at an age when children’s verbal skills are inadequate to express their roiling emotions.
Gradually, after a child has mastered walking, an irresistible urge to make his own choices begins to well up inside him. This is an exciting development, but to make an independent choice he must disagree with you in order for the choice to be his own. Now, when you ask him to do something, part of him wants to please you, but part of him wants to refuse.
Many people call this important phase of development the “Terrible Twos.” I prefer to call it “The First Adolescence.” This period begins long before age two and actually continues long afterwards, but in the majority of children, it is most intensely focused around the period from one-and-a-half to three years of age.
The hallmark of this stage is oppositional behavior. Our wonderful children instinctively want to do exactly the opposite of what we want. We have nice, reasonable expectations and they say “NO!” or they simply dissolve into tears. Suppose you have some place to get to in a hurry. Your son has been in a great mood all day until you say, “I need you to get into the car right now.” He will, of course, want to do anything but get into the car.
As if this weren’t enough, children in this phase of development have a great deal of difficulty making the choices they so desperately want to make. You ask your child what he would like for dinner and he says macaroni. You lovingly prepare it for him and then as soon as it’s made he says, “I don’t want that!” It is perfectly normal for him to reverse a decision as soon as he has made it, because at this stage, he even disagrees with himself.
This phase is difficult for parents but it’s also hard for children. When children take a stand that opposes their parents, they experience intense emotions. Although they are driven to become their own unique persons, they also long to please their parents. Even now, when I do something that my parents disagree with, I feel very conflicted. I am an adult, living in a different city, with well-thought-out choices, and it is still quite difficult. For a child who is tentatively learning to make choices, who is dependent on his parents for food, shelter, and emotional support, it’s even more intense. Dissolving into tears is an appropriate expression of the inner turmoil that is so real for children who are in the midst of this process.
This season of emotional outbursts in children is reminiscent of labor – a series of intense spasms that ushers in a whole new phase of life.

Who gets tantrums?

Children going through this volatile developmental stage are most likely to get frustrated and have a tantrum when the intensity of the immediate situation increases. The excess stimulation may be visual, auditory, tactile, or a combination. It often includes being confronted with a bewildering array of choices, or being unable to get the attention or the desired, chosen outcome.
Let’s look at the example of the grocery store. As an adult, you can choose whether or not you want to go to the grocery store, when to go, what products you are going to buy, and which products you will not purchase. When you are in the middle of shopping in the grocery store, your child will see things he wants. To make the supermarket situation worse, there are cleverly designed packages up and down the aisles that scream, “Buy me! Buy me! Buy me!” We are largely able to tune that out, although it affects us much more than we think. For a small child who is just learning to make choices, it’s like going to a deafening rock concert. They are visually overwhelmed by high-decibel choices. They are compelled to start wanting multiple attractive items. When they can’t have what they want, they dissolve into tears and worse — deafening screams. Of course everybody in the store turns and looks at your child and (shudder) at you!
Almost all healthy children will have a number of temper tantrums but will eventually discard them as they find better strategies.
Those with ongoing tantrums often have reason for ongoing frustration or they have discovered that tantrums work! If children get the desired attention or outcome from their tantrums, they can become a powerful habit. Often these tantrums only occur when the parents are present.

What are the symptoms of tantrums?

A child may be acting ‘out of sorts’ before the tantrum begins. Then he asks for something he can’t have, can’t make up his mind, or tries to do something, but fails. Crying, perhaps screaming, will result. Some kids flail the arms and kick the legs. Some throw themselves on the ground. Some cry hard enough to vomit (making their parents desperately want to give in). Others will hold their breath – even to the point of passing out.

Are tantrums contagious?

Tantrums are not contagious, although the behavior of those around a tantrum can play into it.

How long does tantrums last?

Most children outgrow frequent tantrums by the time their language is mostly understandable to strangers.

How are tantrums diagnosed?

Tantrums are not a diagnosis. They are a normal phase of development, though they may be more prolonged, more frequent, or more intense in some children.

How are tantrums treated?

Realize that tantrums are an expression of acute frustration. They deserve a medium amount of attention (children should not feel that they get more of your attention by throwing a fit). Parents may be tempted to be loud or angry, but tantrums are a time to be calm.
First, take a deep breath. I’ve been in a grocery store with my children having temper tantrums, as a pediatrician, with my patients in the checkout line. The first thing you feel is, “I just wish I could drop into the floor so nobody would see me.” Many people won’t understand. They will look at you and think your child is spoiled or that you are a bad parent. The truth of the matter is that you probably have a normal child and are a good parent.
People who don’t have kids may not understand, yet. That is their problem, though. Try to be patient with them.
When I see a parent whose child is having a tantrum in a store, I am reminded of labor. When I look at a mom in labor, I see something that is heroic, triumphant, and beautiful. Tears come to my eyes when I am privileged to be a part of a birth. So, the next time this painful situation happens to you, take a deep breath and remember: if Dr. Greene were here, he would see something heroic and beautiful.
Next, while you are taking a deep breath, consciously relax. Kids play off your emotions. It’s so hard to relax in this situation, but just let your muscles go. The more uptight you are, the more energy is available for their tantrums. Kids thrive on attention, even negative attention.
Where you go from here depends on your child. Some children will calm down if you pick them up and hold them. My first son was like that. His storm would dissolve if you just gave him a big hug and told him it would be all right. If you picked up my second son during a storm, he would hit you — there were different ways to get him to calm down. Each child is unique.
One thing that often works very well is to try to voice to the child what he is going through. “You must really want to get this, don’t you?” Then he may melt and say, “Uh huh.”
Handle tantrums with a light touch. Seasoning the interaction with understanding, humor, and distractions can save the day.
You will have to experiment with your child to see what it is that can help him understand that everything is okay, these bad feelings will pass, and that it’s all a normal part of growing up.
Whatever you do, if your child had a temper tantrum to try to get something, don’t give it to him, even if you would have ordinarily done so. Giving in to tantrums is what spoils a child. Giving in is the easiest, quickest solution in the short run, but it damages your child, prolongs this phase, and ultimately creates far more discomfort for you. Choosing your son’s long-term gain over such dramatic short-term relief is part of what makes properly handling temper tantrums so heroic.

How can tantrums be prevented?

Children are most susceptible to storms when they are tired, hungry, uncomfortable, bored, or over-stimulated.
Be creative at orchestrating life to minimize tantrum weather. You may want a toy basket that only comes out when you are on the phone or online. Dinner preparation is a great time for your child to watch an entertaining video.
When possible, plan shopping for times when your child is rested, fed, and healthy. Interact with your son throughout shopping and/or bring along stimulating toys or books.
Remember the situation from your child’s perspective. You are going along making choice, after choice, after choice, but when he tries to make a choice, he doesn’t get what he wants. You can see how frustrating this would be. It’s often helpful to let your child pick out one or two things when at the store. A good way to do this is when a child asks for something, instead of saying, “No,” (which will immediately make him or her say, “Yes!”) say, “Let’s write that down.” Then write it down. When your child asks for something else, write that down, too. Then when you are all done, read back a few of the things on the list that you think would be good choices, and let him pick one or two of the things on the list. If children can make some choices, they will learn more and feel better.
Another worthwhile technique is for you to make a list before you go to the store. That way it won’t look so arbitrary when you pick what you want off the shelf while your child doesn’t get his choice. As you shop, whenever you put something in your basket, check it off your list. Even if it is not on your list, check it off. The list is to teach that each item has a purpose, not that you had thought of it previously.
His task during this time is to gain skill at making appropriate choices. To help him accomplish this, offer your son limited choices at every opportunity. He will be demonstratively frustrated when he is given direct commands with no options. He will decompensate if he has too many alternatives. Two or three options generally work best.
Make sure the choices you offer fall within an appropriate agenda. Your son still needs the security of knowing that he’s not calling all the shots. When it’s time to eat, say something like, “Would you rather have a slice of apple or a banana?” He feels both the reassuring limits that you set and the freedom to exercise his power within those limits. If there are two things he needs to do, let him decide which to do first, when appropriate.

Related A-to-Z Information:

Attention Deficit Hyperactivity Disorder (ADHD), Breath Holding, Head Banging, Nightmares, Separation Anxiety

Dr. Greene’s Answer:

You are not alone! Most parents who have had a two-year-old have experienced the same situation and the same feelings. Temper tantrums are very common at this age, and when viewed in context, they can be an extremely constructive part of the development of a healthy child.

Newborns and infants are quite happy as long as their basic physical needs are met. Children in the developmental stage known as the “Terrible Twos,” or “First Adolescence,” become aware of the choices available to them and as a result become angry or frustrated when they are powerless over those choices. The result is often “Temper Tantrums” or what I like to call “Emotional Storms.”

Let’s look at the example you mentioned of the grocery store — as an adult, you can choose whether or not you want to go to the grocery store, when to go, what products you are going to buy, and which products you will not purchase. When you are in the middle of shopping in the grocery store, your child will see things he wants. To make the supermarket situation worse, there are cleverly-designed packages up and down the aisles that scream, “Buy me! Buy me! Buy me!” To a large extent we are able to tune that out (although it affects us much more than we think). For a small child who is just learning to make choices, it’s like going to a deafening rock concert. Visually they are overwhelmed by high-decibel choices. They are compelled to start wanting multiple attractive items. When they can’t have what they want, they dissolve into tears and worse — deafening screams. Of course, everybody in the store turns and looks at your child, and (shudder) at you!

Surveys have shown that there are two common reactions of parents in this situation. The first is to spank or discipline the child in some way. Our role during this phase is to teach our children to make choices, to teach them to grow up as independent, highly functioning people. If you discipline a child for a temper tantrum in a store, you are teaching a powerful unconscious lesson: down the road, when he or she is in second adolescence, and is confused, hurting, scared, and doesn’t know what choices to make — don’t talk to Mom or Dad, because they will not understand and it will hurt.

The second major way that people deal with temper tantrums in stores is to give the children whatever they had the temper tantrums to get. Basically, this teaches kids that if they cry hard enough, or act out sufficiently, they will get whatever they want. We don’t want to teach our children that either.

So, what does one do about temper tantrums? Try to avoid emotional storms whenever possible. Children are most susceptible to storms when they are tired, hungry, uncomfortable or bored. When possible, plan shopping for times when your child is rested, fed, and healthy. Interact with your son throughout shopping and/or bring along stimulating toys or books.

Remember the situation from your child’s perspective: you are going along making choice, after choice, after choice, but when he tries to make a choice, he doesn’t get what he wants. You can see how frustrating this would be. It’s often helpful to let your child pick out one or two things when at the store. A good way to do this is when a child asks for something, instead of saying, “No,” (which will immediately make him or her say, “Yes!”) say, “Let’s write that down.” Then write it down. When your child asks for something else, write that down, too. Then when you are all done, read back a few of the things on the list that you think would be good choices, and let him pick one or two of the things on the list. If children can make some choices, they will both learn more and feel better. Another thing that is really worthwhile is for you to make a list before you go to the store. That way it won’t look so arbitrary when you pick what you want off the shelf, and your child doesn’t get his choice. As you shop, whenever you put something in your basket, check it off your list (even if it is not on your list, check it off. The list is to teach that each item has a purpose, not that you had thought of it previously).

These strategies can greatly reduce the number of emotional storms, but their appearance is inevitable. What then?

First, take a deep breath. I’ve been in a grocery store with my children having temper tantrums, as a pediatrician, with my patients in the checkout line. The first thing you feel is, “I just wish I could drop into the floor someplace so nobody would see me.” A lot of people won’t understand. They will look at you and think your child is spoiled, or you are a bad parent. The truth of the matter is you probably have a normal child and are a good parent.

It is not a defect in parenting that your child is acting this way. People who don’t have kids may not understand, yet. That is their problem, though. Try to be patient with them.

When I see a parent whose child is having a tantrum in a store, I am reminded of labor. When I look at a mom in labor, I see something that is heroic, and triumphant, and beautiful. Tears come to my eyes when I am privileged to be a part of a birth. So, the next time this painful situation happens to you, take a deep breath and remember, if Dr. Greene were here, he would see something heroic and beautiful.

Next, while you are taking a deep breath, consciously relax. Kids really play off your emotions. It’s so hard to relax in this situation, but just let your muscles go. The more uptight you are, the more energy is available for their tantrums. Kids thrive on attention, even negative attention.

Where you go from here depends on your child. Some children will calm down if you pick them up and hold them. My first son was like that. His storm would dissolve if you just gave him a big hug and told him it would be all right. If you picked up my second son during a storm, he would hit you — there are different ways to get him to calm down. Each child is unique. One thing that often works very well is to try to voice to the child what he is going through. “You must really want to get this, don’t you?” Then he may melt and say, “Uh huh.” You will have to experiment with your son to see what it is that can help him understand that everything is okay, these bad feelings will pass, and that it’s all a normal part of growing up.

Whatever you do, if your child had a temper tantrum to try to get something, don’t give it to him, even if you would have ordinarily done so. Giving in to tantrums is what spoils a child. Giving in is the easiest, quickest solution in the short run, but it damages your child, prolongs this phase, and ultimately creates far more discomfort for you. Choosing your son’s long-term gain over such dramatic short-term relief is part of what makes properly handling temper tantrums so heroic.

Instead you might say, “Sorry, I would love to give you what you want, but because you had a temper tantrum, I can’t right now. Next time, let’s do that.” Stand by your child during this difficult time for both of you. When you feel yourself getting tense, again say to yourself: temper tantrums are a beautiful, albeit painful, part of growing up, so take a deep breath, relax, and remember, “Dr. Greene thinks you are beautiful, courageous, and worthy of high praise!”

Dr. Greene’s Answer:

Children of perfect parents (if there were such a thing!) would still need to go through the developmental phase your son is going through. Ideal children do NOT always agree with their parents. Ideal parenting does not prevent the “Terrible Twos” — it helps children navigate them.

Although children are each born with a unique personality, their early experiences are profoundly influenced by their physical states and by their environments (primarily their parents). Thus, early on, your son’s desires tended to be either responses to physical needs (he was hungry and wanted to eat, he was sleepy and wanted to sleep, or he had a soiled diaper and wanted you to change it) or reflections of your desires. He wanted things that made you happy, that engaged your attention. When you smiled, he smiled. When you became tense, he became emotionally agitated. Through that first year a wonderful dance between parent and child developed as your son mirrored your moods. Because his moods were usually in synch with yours, he seemed like a “good boy.”

Gradually, though, sometime after he had mastered walking, an irresistible urge to make his own choices began to well up inside him. This is an exciting development, but the difficulty with his making an independent choice is that he must disagree with you in order for the choice to be his own. Now, when you ask him to do something, he refuses.

It is unpleasant to have anyone passionately disagree with you. When this opposition comes from your own little delight, the situation is decidedly disagreeable. Many people call this important phase of development the “Terrible Twos.” I prefer to call it “The First Adolescence.” This period begins long before age two and actually continues long afterwards, but in the majority of children, it is most intensely focused around the period from one-and-a-half to three years of age.

The hallmark of this stage is oppositional behavior. Our wonderful children instinctively want to do exactly the opposite of what we want. We have nice, reasonable expectations and they say, “NO!” or they simply dissolve into tears. Suppose you have some place to get to in a hurry. Your son has been in a great mood all day. . . until you say, “I need you to get into the car right now.” He will, of course, want to do anything except get into the car.

As if this weren’t enough, children in this phase of development have a great deal of difficulty making the choices they so desperately want to make. You ask your child what he would like for dinner, and he says macaroni. You lovingly prepare it for him, and then as soon as it’s made he says, “I don’t want that!” It is perfectly normal for him to reverse a decision as soon as he has made it, because at this stage, he even disagrees with himself.

His task is to gain skill at making appropriate choices. To help him accomplish this, offer your son limited choices at every opportunity. He will be demonstratively frustrated when he is given direct commands with no options. He will decompensate if he has too many alternatives. Two or three options generally works best.

Make sure the choices you offer fall within an appropriate agenda. Your son still needs the security of knowing that he’s not calling all the shots. When it’s time to eat, say something like, “Would you rather have a slice of apple or a banana?” He feels both the reassuring limits that you set and the freedom to exercise his power within those limits. If there are two things he needs to do, let him decide which to do first, when appropriate.

This phase is difficult for parents; it is also hard for children. When children take a stand that opposes their parents, they experience intense emotions. Although they are driven to become their own unique persons, they also long to please their parents. Even now, when I do something that my parents disagree with, I feel very conflicted. I am an adult, living in a different city, with well-thought-out choices — and it is still quite difficult. For a child who is tentatively learning to make choices, who is dependent on his parents for food, shelter, and emotional support, it’s even more intense. Dissolving into tears is an appropriate expression of the inner turmoil that is so real for children who are in the midst of this process.

I like to think of the process as similar to childbirth. Labor is a very intense experience. Pain, after pain, after pain eventually produces something beautiful– a child is born. The episodes of oppositional behavior in “First Adolescence” are psychological labor pains — one difficult situation, then another, and another, and as a result your son’s own persona is being born psychologically. This is a beautiful (but difficult) time with a truly worthwhile result.

As an oak tree is already present in an acorn, this aspect of your son’s unfolding development was already present when he was conceived. Although you will have a large impact on its course, it’s not caused by something you are doing wrong, and it won’t last forever.

Dr. Greene’s Answer:

What a sinking feeling to see, or hear about, your toddler biting another child. It may be comforting to know that most parents will go through this at one time or another as their children explore the wide variety of ways to interact with others in their search to find the best ways to relate.

Your son is at an age where the urge for exploration and experimentation propels him forward throughout the day. He is also continually seeking to attract attention, especially from adults. It wasn’t always this way. Your son began his life in the solitary confines of the womb — a protected place where he alone was the center of attention and where all his needs were met. After his birth, his primary relations were with adults who likewise treated him with love and understanding. In encounters with other children, he had very little control. It wasn’t until he began to toddle that a whole new world of decisions opened up — to approach or run away, and how to respond if he and another child both want to play with the same toy or be with the same person. A whole set of previously unknown situations presented themselves to your son. Somewhere in this time period most children experiment with biting to see how exerting this power will affect their interactions with other kids — whether it will get them the things or the attention they want (children want attention even more than toys and playthings).

What your son is going through is quite normal. It is particularly normal for bigger kids to bite smaller kids in order to assert their power. The biting behavior can be reinforced by paying lots of attention to it, even if it is negative attention. To help him grow quickly through the biting stage, when you observe biting, say, “No!” firmly, so he can tell you are not pleased, then repeat and name the behavior, “No biting!”. Then scoop him up from the situation and set a timer for about two minutes (the rule of thumb is one minute for every year he is old) and pay no attention to him for the next two minutes, even if he acts sorry or angry. Instead, lavish attention on the bitten child. When the two minutes are up, go right on with your son as if nothing has happened.

You will have to repeat this scenario a number of times, but it will teach him that biting is not the way to get the things he wants. Consistency is important, so if you are going to leave him with other adults in charge, ask them to take the same approach.

It is a fine idea to use distraction as well. When you see a situation arising where you think your son might bite, you might want to distract one or another of the parties involved and delay these learning experiments until he is a little older and can learn more quickly. Some people advocate spanking as a solution for biting, but if the goal is to teach him peaceful resolution of conflicts, that is probably not the quickest way to get there.

When a toddler or preschooler is still using a bottle to go to sleep, there are two patterns that must be overcome. First, she has chosen the bottle as her special comfort object to help her with the transition from a wakeful state to a sleep state. Secondly, this choice has become a deeply ingrained habit. Weaning her from the bottle will require either finding an effective substitute, or using tremendous force to break the patterns.

Here are some gentle suggestions:

• Set a date in the near future, perhaps her birthday, and offer her an exciting opportunity. To celebrate this milestone, she can collect all her bottles, take them to a local store, and trade them in for something that would be thrilling to her (perhaps a small bicycle — something that will make her feel more grown up). If she excitedly looks forward to the date, she may be able to sacrifice the bottle in order to enter a new phase. Only communicate in a way that builds her security and self-esteem: You are excited about who she is; you will be excited about who she becomes.
• If you are not able to enlist her resources directly, weaning the bedtime bottle can be accomplished by substitution. Replace the bottle with a more age-appropriate transition/comfort object. Make the alternative as attractive as possible, while making the bottle less attractive.
• This new transition to sleep might include a consistent bedtime ritual, when you spend about 20 minutes together doing the same nighttime activities in the same order.
• Give her something wonderful to hold as she sleeps. A large stuffed animal (about the same size she is), or a really great doll that she falls in love with, would be a good choice. Put away other stuffed animals or dolls for a while; she will form a more special bond when she only has one or two.
• You may also want to make a tape or CD recording of your voice singing to her or telling her stories. Listening to you repeat the same stories or songs night after night will comfort your child as she drifts off to sleep.
• To make the bottle less attractive, try adding a drop of ‘bitter apple’ on the nipple or actually in the bottle (available in pet stores to teach pets not to chew). A small amount will give the bottle a mildly bitter or musty taste, making it a less important part of the sleep transition. Many children will stop asking for the bottle within one to two weeks.
• Offer milk (or something else to drink) in a cup at the beginning of the bedtime ritual — before reading a story, taking a bath, or brushing her teeth. Reduce the amount she gets in her bottle by 0.5 to 1.0 ounces a day until it is empty, and then take the bottle away.
• Respond to requests for the bottle with hugs.

Most children are ready to tackle the challenge of potty use somewhere between age 2 and shortly after their third birthday, with boys generally at the latter end of this range. Letting you know when their diapers are dirty is an early sign of readiness. When they start to let you know just before they need to go, it is time to begin. Here are some suggestions for easing the transition from diaper to potty:

Try reading aloud (together) one of the outstanding books that describe potty use as a part of growing up. My favorite is Toilet Learning by Alison Mack. Illustrations of fire fighters, doctors, baby sitters, and parents all going to the bathroom will delight and educate your child. Watching the same-sex parent or older sibling in the bathroom reinforces this process.

Buying fun new underwear for them can act as further encouragement.

If your child seems to be afraid of the toilet itself, then gradually acclimatize him or her to the potty. Have them sit on one of the little potties fully clothed for a few minutes each day while you read or tell them a story. When that becomes old hat, take the diaper off so they can sit on it just like Dad and Mom.

Begin putting the contents of their dirty diapers in the potty so they can see what happens. Then give them the opportunity to run around bare-bottomed so they can try to go on the potty if they want.

If your child is afraid of failure, it is paramount that when he or she does make a mistake, your response is not an exasperated or a punishing one. Instead, say something like, “Oops, there it went. Someday soon they’re all going to land in the potty. We’ll try again.” Let them know that accidents are okay and that he or she will ultimately succeed.

When they do get something in the potty, leave it there for them to admire. Congratulate them warmly, but don’t get too excited or they will feel more pressure.

If children begin holding their stool in, the stool can become hard. It will be important to soften the stool using either a high-fiber diet or a gentle medicine from your doctor.

During the toilet training process, it can be comfortable and convenient for children to wear pull-ups, but for some, this can slow the process by minimizing comfort as a motivating force.

It is common for children who are potty trained to still wet the bed at night. By age 5 or 6 years, most children no longer wet the bed at night.

Physical readiness for potty training often occurs around the time that children develop strong oppositional behavior – you say, “yes,” they say, “no!” You say, “red,” they say, “blue!” This underlying negativity is the final powerful force affecting potty training. Thankfully, this begins to fade at about age three. Still, if you tell them, “This is what you’ve got to do,” their natural, healthy response is “no,” because they are in the process of developing their unique, independent personality. Potty training is not an area to enter into any kind of battle. You will always lose; everyone involved will lose. Instead, minimize the issue and make it quite clear that this is for them – in their timing – and not for you. Help teach them how to do it, but don’t push and don’t punish.