Toilet Training: Addressing External Motivators

There are many challenges associated with a child in diapers.

Diapers are costly, odorous, need to be changed in special places that may not always be available, and at inconvenient times. Many parents — reasonably — experience sensory issues with dirty diapers. It’s also common for parents and children to enter repeated, daily power struggles around diaper changing. Parents may also experience external pressures from family members, friends, co-parents, or educators.

While there are some challenges a parent won’t face with a continent child, toilet training can be exceptionally difficult and comes with no guarantees of duration, difficulty, or success.

When the conditions are right (child shows readiness, the family is able to make time, etc.) toilet training may be the right way to address those challenges. Just as frequently, parents are better served by addressing the problem that is most pressing.

See below for a list of common challenges we hear about at the VCP. Click on the “carrot” for our suggestions of how to address each of them without toilet training.

Difficulty with the cost of diapers

Families should know that they are not alone in this. Nearly 50% of families nationwide struggle to pay for diapers at some point (NDBN, 2026).

Rules around Medicaid subsidized incontinence supplies have changed several times over the last years. However, providers should know that children of any age (not only those over three years old!) with Medicaid and a diagnosed disability that may affect continence acquisition can receive subsidized diapers. While providers historically complained that this program was difficult to access, many providers report that the system is far more straightforward now. Please check out our bulletin on Medicaid subsidized diapers for details.

While Vermont does not have an organized, statewide network of diaper banks, each region has multiple resources that can often supply diapers to families on a short-term or ongoing basis. We would suggest that primary care offices develop relationships with your regional designated mental health agency and regional parent-child center. Each region of the state will also have local non-profits, such as food banks or faith groups, that intermittently distribute diapers.

If your practice has access to gift cards, diapers are an excellent and caring use of those funds as well.

Their child refuses to change. They have frequent power struggles when it is time to change diapers or try the toilet

Continence readiness emerges in the same window that a child’s independence starts to blossom. This is not a mistake: children need a drive for mastery to make a big change like going from diapers to the toilet. However, parents need to be reminded that psychosocial readiness is as important as any other type.

In these situations, we strongly encourage families to let down the pressure on toilet training and diaper changes. For toilet training, this means decreasing or eliminating prompting altogether for a period of time. With diaper changes, this comes in the form of saying to a child “I notice you are pooping, and you are playing. Would you like to change your diaper when ____ or ____ (offering two natural transitions)?” Some children may need to experience the natural consequences of a wet or even soiled diaper for a period of time.

Diaper changing and toilet training can quickly become adversarial. Our overarching message is that parents and children all benefit when they enter the proccess as partners. Parents sometimes worry that pausing will “set them back”, but we find it is just the opposite: a natural break supports child and family well-being

The parent experiences emotional or sensory overwhelm with diaper changes

Changing diapers can be a truly awful experience, and parents benefit from us acknowledging this fact. Parents may be triggered by the sensory aspect of the diaper change, the conflict with their child, or the belief that their child “should” be toilet trained.

Encourage parents to develop distress tolerance, and to address their own needs first. This may mean a few deep breaths before asking their child to change, a perfumed scarf to block diaper smells, or a plan to take some time alone after the diaper change. Remind parents that the process of TT will involve much more confrontation and likely more mess and uncertainty. It is better to learn these coping skills before moving into TT.

Family and friends are pressuring them to start toilet training

Well-meaning adults are often misaligned in their beliefs about toilet training. We suggest that PCPs familiarize themselves with the VCP Continent & Confident program. Many parents have used this to justify the importance of following their child’s timeline. Coach parents to choose one or more inchstone that they can sharea with family as a constructive step they can take toward toileting.

The family has a “deadline”: a move, new baby, etc.

Often when parents think of toilet-training, they imagine the convenience of a toilet-trained child. However, toilet training itself requires, time, attention, and a plan, all things that are harder to come by during times of stress and change. Parents may also want to know that toileting skills often regress during times of change. Unless a child shows obvious readiness and interest, parents should be encouraged to delay TT.

The child is entering a program that does not accommodate children in diapers

This particular issue can be extremely difficult for parents. Parents should know that no entity that recives public funding can deny a child’s attendance or participation on the grounds of their continence status. This is true irrespective of the child’s disability status, as incontinence itself can be viewed as a developmental delay or disability in children over 48 months of age, per NASPGAN criteria.

When children attend programs without public funding that decline to change diapers or pullups, accommodations are still feasible. Many children can change their own brief, and the program can accommodate via a private bathroom with a trashcan. A child can also use a tissue or liner in their pullup which they can discard if it becomes soiled.