Sunday, January 19, 2014

How To Win a Vaccination Debate

 It can blindside you like a hit-and-run. One minute you are happily cruising along with good intentions, inquiring of friends or strangers online about the risks of vaccinating your family.  Then– BAM! Someone compares you to Hitler!   Next thing you know, people are accusing one another of being negligent, misinformed, or even cruel or stupid.  You, my friend, have just found yourself in the middle of a good old fashioned vaccination war. How do you get out? How do you win? 
At its core, this debate isn’t about right versus wrong. It is about one truth conflicting with another amidst a sea of myths. It rages on because vaccination is a decision that pits the rights of the individual against the rights of the collective population. And it is one that causes an immediate incendiary reaction that is sure to hurt feelings and ruin friendships.
Should you list vaccinations on your taboo list right under religion, politics, and hemorrhoids? Maybe, if this isn’t a fight you care to lose friends over. But it is still an important issue that seeks a resolution. And it needs to be talked about now more than ever, since populations are on the rise, epidemics carry more risk, and drug producers are just as vulnerable to corruption and scandal as any other corporation. If we ignore the issue, it will take a pandemic to get populations vaccinated, or it will take a major malpractice to get people to evaluate the risks. If we keep talking, it will keep pharmaceutical companies accountable for their products.

So let’s have this conversation. Here’s what to do.

1. Take a moment for some critical awareness
How long do you think people have been arguing over vaccinations? Ten years? Twenty? Ever since Jenny McCarthy hit the media? Nope. Try 293 years. That’s not an exaggeration.  When the smallpox inoculation was first introduced in 1721, people opposed it on grounds of religious freedom. They haven’t stopped since. Are you going to end it today? Not likely. 

2. Decide what your goal is in arguing
If you can’t end this debate, what can you do? At best, you might be able to get some people thinking. They might not change their stance. But if you play your cards right, you might at least make their decision more informed. That’s as close to “winning” as you are going to get. If you are anti-vaccination do you really want the other person to change their stance? If you choose not to vaccinate your child on the grounds of herd immunity protecting him, it stands to reason that every time you persuade someone not to vaccinate, you are putting your own family at a greater risk.

3. Listen and keep an open mind
When people encounter someone whose biases don’t affirm their own, they make an assumption that the other person is ignorant, uneducated, or malicious. This isn’t usually the case. Pro-vaccinators assume that anti-vaccinators are falling prey to scare mongering and hearsay instead of “real” sources of information. Anti-vaccinators assume that pro-vaccinators have blindly followed the advice of authorities and haven’t considered cases which demonstrate real health threats.  The truth is that members of both sides are aware that all vaccines have associated dangers, and each side chooses to interpret the risks differently.  If you find your opponent has done some investigating, you can show your appreciation that they have taken the time to do so. Acknowledging their research on the topic will earn your opponent’s respect, and they just might open up to you. This will also get you down off your high horse (everyone has one). People don’t listen if they feel you are talking down to them.

4. Ask questions instead of stating facts
When you state facts that run counter to what someone believes, she will reject them, ignore them, or reinterpret them to fit her own point of view. If you are anti-vaccine and you say “some vaccines have been linked to narcolepsy,” the pro-vaccinator will be dismissive: “Nah, that’s fear mongering.”  People generally prefer to be asked questions instead of being preached to. It puts them in the position of being the preacher, but it also causes them to think, and to possibly to face their own flawed logic.  Some examples: "Do you consider Pharmaceutical companies to be infallible?"Do you know the component of the adjuvant?"  "Has anyone researched the long term effects of this?" "What is the source of the thing you just quoted?" "Do you have a plan in case of an outbreak?"  "How do you plan to increase your immunity without vaccination?"  "What if you choose to travel to an area prone to epidemics?" 
     Just be sure your questions are valid, and avoid snarky or rhetorical questions like: "What kind of parent do you think you are?

5. Focus on being kind, not being right
While it is tough to say if anyone has ever won a vaccination debate, there are some obvious losers. If you get to the point of belittling, name calling, or judging others, you have lost.  You cannot shame a person into changing their behaviour or ideologies. If you say to an anti-vaccinator “you’re going to make your kids sick, you negligent twit!” or the more passive aggressive, "I choose to vaccinate because [unlike you] I love my children," that person will set out to prove just how healthy and loved her kids can be.  If you are anti-vaccine and you say, “look at the side effects, you ignoramus!” that person will get the shots anyway just to prove she’s going to be just fine. Putting a person on the defensive is a sure-fire way to deepen her resolve. Instead, show some compassion. It shouldn’t be so hard to find grounds for empathy. After all, we all have the common goal of doing what we feel is best for our families.

6. Understand the big picture and you will see how you are both right
It’s all about statistics. Pharmaceutical companies face an ethical dilemma every time they come up with a new vaccine. None of their products are risk free. There will always be some negative correlations and some uncertainty.  
     Imagine, if you will, an aggressive virus (or a zombie apocalypse, whatever you want) which kills, say, 50% of the people that it infects, and there is a risk of it infecting the whole population of the world in a short period of time. The best the drug company can do is to invent a product which can protect 99.9999% of the population but it will cause death to the remainder. This might seem like an easy decision. One out of a million people hardly compares to half the world dying.  If there are eight billion people in the world, and if the whole world gets vaccinated, 8000 people will die. Big deal, right? Better than 4 billion. But then think of what will happen down the road. Most of the world will be vaccinated and feel safe from the virus, but there will be news reports of up to 8000 people dying from this vaccine– moms, dads, children, friends of friends all over the world. Faces of the deceased will be plastered on magazines and viral internet articles. Suddenly one in a million seems like a much more probable occurrence. Everyone will know of someone who died from a vaccine. And now that the virus is mostly contained, the risks from the vaccine are higher than from the virus. Any single individual would technically have better odds avoiding it. But if everyone in the whole population becomes this one individual, the virus will return.  This creates a paradox in which the best thing you could advise the population to do would be to avoid the vaccine but have everyone else get it. This is nonsensical, of course. You can’t have everyone get vaccinated and not get vaccinated.  In this respect, the governing agencies and pharmaceutical companies are not being malicious; they are protecting the good of the greater whole, but not your own individual safety.  This is a hypothetical example, but each individual immunization comes with its own numbers. Your risks differ from one needle to the next, and each individual case merits its own discussion and research. Personally, I have looked into the numbers and decided for myself that the vast majority of common vaccinations are worth the risks. 

7. Be aware of your own discomfort, it’s telling you something
Cognitive dissonance refers to that uneasy feeling you get when someone provides a fact that doesn’t confirm your beliefs. If someone tells you that her child got sick from the very same shot you just had administered to your child, you may feel strongly doubtful. Your mental processes reject this information because it doesn’t align with what you believe. So you might accuse the other person lying or exaggerating, and the mudslinging begins.  But as Aldous Huxley said, “Facts do not cease to exist because they are ignored.”  Instead of denying the fact, give it the benefit of a doubt. It doesn’t mean you have to change your stance. “Well that is unfortunate,” you might say, “but it doesn’t mean that it’s probably going to happen to everyone.” If you are anti-vaccine and you find out that there are cases of measles going around in your child’s school, it won’t do you any good to claim that it’s just hives. Instead you might just take your unvaccinated children out of school until the virus gets eradicated and hope for the best. Or you might decide that now is the time to reassess your stance, since the probability of measles now exceeds the probability of risk factors.

8. Don’t bring anecdotal evidence into the argument
This is the “I knew a guy who got sick right after the flu shot three years in a row!” type of fallacy. If any one person never got immunized and never got sick, that information means nothing. If some kid got the H1N1 shot and still had the virus, it is of no consequence.  One person who got the MMR and also has autism? Coincidence.  Someone who used elephant repellant and didn’t get any trouble from elephants? Well, you get the picture. A lot of poor decision making is a result of narrowly focused personal experiments with a sample group of one. And that one guinea pig is self selected, with hindsight, by a biased individual looking to draw the bull’s-eye around the arrow.  
"I caused this calamity!"
“But three times in a row,” you say, “That can’t be a coincidence, right?”  Yes, it can be. Imagine a hundred thousand caged monkeys in a lab. They can’t see each other. The monkeys are sleeping, eating, flinging poo, or rattling the bars of their cages. At random intervals, a machine sprays the monkeys with cold water. Five thousand of the monkeys happen to be rattling the bars of the cage when it happens the first time, and of those, maybe a thousand are rattling the cage the second time it happens, and of those, fifty are rattling the cage the third time it occurs.  The machine gets turned off. What happens to those fifty monkeys? They conclude that rattling the cage caused the water to be sprayed. From their perspective, they rattled the bars three times, and after each time, the cold spray came on. They never rattle anything ever again. They get released into the wild, form a colony, and those fifty monkeys go around warning all the other monkeys not to rattle things because it makes it rain.  Every time it rains they will look around to see who rattled something. And superstition is born.
People get sick all the time. Especially in flu season, which also happens to be cold season and non-categorized virus season.  The chance that any one individual becomes sick after getting a flu shot is moderate to high. The chance of it happening to any one individual a second time is a little lower. But the chances of you knowing someone who got sick after getting the shot more than once is extremely likely, especially so if your selected individual is like the monkey, warning everyone about his perceived connection. 
If you are going to debate the likelihood of a specific side effect, you don’t need to use a single case as an example.  There are plenty of published reports on the total number of people experiencing side effects, and this will give you a better grasp of true causation.

9. Try to interpret scary-sounding facts logically
Even if all your information is correct, it might not be as meaningful as you think. Almost all people consider severity over probability when they would be better served doing the opposite.  You might read an article online which tells you that hundreds of people who receive the flu shot have contracted Guillian-Barre Sydrome (GBS), a terrifying autoimmune response which causes sudden paralysis. It can mean years of learning to walk again or being confined to a wheelchair, even death in extreme cases. This is a true fact, and a scary sounding one. But it isn’t one you should be concerned with.  One in a million people get GBS from the flu shot, but five times that many people get GBS from getting influenza. And hundreds of people die from influenza as well, many more than from GBS.  But in a population of billions of humans, all those GBS numbers mean almost squat to you. The important thing is that probability of getting GBS is very low. The probability of getting the flu, over an extended period of time, is tremendously high, almost guaranteed. But when the choice is framed in this manner, every time people will commit the fallacy of saying “I’d rather get the flu than paralysis!”  But this is like saying “I don’t jog. I’d rather stay inside and get fat than go outside and get hit by lightning.”
Another thing which clouds your decision making process is social proof. If everyone else is doing something, it seems like it must be right. Solomon Asch did an experiment in the 1950’s in which subjects were asked to answer questions in the presence of other people. Unbeknownst to them, the other people were actors. When the actors answered obvious questions incorrectly, so did the subjects.  You might have a hundred people on your facebook feed urging you to get a vaccine for a new virus in another continent which only has a few documented cases so far. If you are cautious about vaccines, you are aware that new vaccines carry a higher uncertainty. Not a higher calculated risk, but an unknown, uncalculated risk because there may not have been time to evaluate long term effects. So you might choose to wait for a period of time.   This won’t make you very popular but your decision making process is more rational than getting injected with something of unknown advantages because of something you saw on the internet. Pay no attention to popular opinion when making a decision about your family's health.

10. Know When to Quit
There sometimes comes a point when a conversation has gone past the point of being useful. If your opponent has already formed a strong opinion based on years of holding to a certain belief, you might not be able to change it, especially if you are a stranger on the internet. If people are judging you or calling you names, you have found some friends more toxic than adjuvants. They have lost the argument. Turn off your computer and go outside. Breathe in some fresh air, enjoy some sunshine and exercise.  If the prize for winning a vaccination debate is good health, go claim it.

Title image composite contains two photos courtesy of  Stuart Miles and piyaphantawong,
Chimpanzee image courtesy of  africa,

Monday, January 6, 2014

How I potty trained my 23-month-old in 3 days

See also: Readiness, DIY Potty Charts, 50 Ways to Prepare your Child for Potty, Old Men on Potties
The quick method of potty training is also called the 3 day method, boot camp, or cold turkey.  I prefer to call it the “Diligent Method” because the number of days it takes will vary, and boot camp and cold turkey suggest something grueling.  It's not that bad. This method gets results relatively quickly, but it requires a concentrated effort. Parents need to be committed to the technique and learn to be super vigilant. It’s not for everyone. This method might not be for you if you can’t get a few days of one-on-one time with your child, if you live in a rental unit with white carpets and a steep damage deposit, or if your family is undergoing some major transitions, or if your child has a condition which makes him unable to cope with sudden changes to routine.

The first time I tried to potty train my daughter she was 21 months old. It was an instant success, and then an utter failure. I had checked a potty training video out of the library, which she would watch and faithfully complete the task every day. Then after a week the library phoned. They wanted their video back.  I returned the video and my daughter promptly returned to peeing on the floor.  What went wrong? She was ready, she had used the potty for 7 days. Clearly, I had no idea what I was doing.

I had heard of the 3-day method so I looked it up online. I discovered some introductory articles and videos from women who had done all the research and compiled all the best information, and then cleverly put it behind a paywall. While I admire their entrepreneurial spirit, I don’t like paying for things. But I do like doing research, so I went off to the library and came up with a plan of my own. It worked so well that I tried it on other children in my care and had great success. Here are the lessons I learned and what I did.

1. You need to have a clear plan. This includes reward systems, training methods, backup plans, and personal knowledge. Before my failed attempt I thought that if I just showed my daughter some videos she would figure it out or we could wing it. But that didn’t work. If you don’t know what to expect, neither will your child. Even if the diligent method isn’t right for you, it would be beneficial to read some potty training books before you begin and you will be equipped to tackle any problems which arise immediately. In my case I personally enjoy reading about science so I chose books by renowned developmental psychologists and applied what is known about human behaviour to my potty training methods. Check out "7 Old Men on Potties" for a summary.

2. Understand what readiness means. Yes, your child will show some signs of being ready to potty train. But the right time won’t always be obvious.  And waiting for readiness doesn’t mean you should wait for your child to train herself.  I’m not a fan of enabling the diaper habit for longer than necessary and you can read more about why here. In my case, I felt that 20-24 months of age was the ideal window for my daughter because there were no major events, vacations or interruptions and I had some time off work. I also didn’t want to wait too long because I thought that once the “terrible twos” began, she wouldn’t be as obedient and willing to listen. And BOY, was I right. I’m convinced that if I had waited another three months I wouldn’t have been able to train her so easily amidst her tantrums and intervals of shouting “NO!”

3. Ready your child. Despite what you’ve probably heard, there are plenty of things you can do to help your child become ready. In our case, my daughter responded very well to potty training books, especially “Once Upon a Potty.”  She also loved stuffed toys so when I played with her, I showed her how her stuffies could use a toy potty.  We chose big girl underwear together, we decorated her potty, and we made potties out of play dough.  These are things that interested my daughter specifically, but all children are different. For some individualized suggestions check out this list of 50 ways to prepare your child for pottytraining.

4. Set a date for going diaper-free and begin the countdown. If you have a general idea of when your child’s best window will be for potty training, have a look at your calendar and mark off at least three days when you will be able to have solid one-on-one time with your child without distractions.

5. Make preparations. Arrange for a helper or a babysitter if you have other children who require a lot of attention. Clean the house, buy groceries, and do any chores beforehand that will consume your attention. Freeze meals or pre-package something to put in a slow cooker so you don't have to cook. Tell your child that Potty Day is coming, and explain that it will be a celebration of “no more diapers!” Put a super treat in a treat bag and pin it to the wall in the bathroom out of your child's reach. Print this out, then turn off your phone and computer.

6. Go shopping. You will need:
• 15-20 pairs of underwear, slightly large. Not training pants, not Pull-ups.
• Juice, popsicles, freezies, chocolate milk, or any other liquid your child will consume lots of
• Snacks which are rich in fibre: Cereal or cereal bars, broccoli, prunes, beans, etc.
• Treats. I used small Easter eggs, you can also use jelly beans, M&M’s, grapes or berries
• Super treats: Small toys or candies that your child has a special interest in
• A very small gift bag with a photo of your child on it (optional)
• A mattress cover, absorbent blankets and several plastic tablecloths
• Waterproof drop cloths if you have carpet (These are available wherever paint is sold. Be careful!  Never leave your child unattended in a room with loose plastic, as it can be a suffocation hazard. For bedrooms just use blankets or towels)
• A potty chair for each floor in your home, preferably light in colour
• Stickers or a self-inking stamp
• A potty chart (I like to customize them. Click here for a DIY tutorial)
• Potty day decorations (Optional)
• Fold-up travel potty seat


Potty Day

Make sure your child gets a good night’s sleep the night before Potty Day.  If desired, inflate some balloons and draw potties or underwear on them. The point is to show him today is special and that the game is changing. Cover the carpets if applicable, and maybe even draw some happy faces on the drop cloths to make it fun. Place the super treat in the gift bag and pin it up on the wall out of reach. (I prefer to make the bag look enticing and leave its contents a surprise, but you don't have to.)

Shortly after your child wakes up, announce that it is time to ditch the diapers. Let your child do the honors if he wants to. In our case case, my child wore both disposable diapers and expensive cloth diapers and I didn’t want to throw them in the garbage. So Instead, I put a clean bag in the garbage can, carried the bag to the curb while she watched, and then retrieved it later when she wasn’t looking.

Once all the diapers have gone “bye-bye,” put big kid underwear on your child. Pants are not necessary. Explain to him that when he feels like pee is going to come out, he will go to the potty and then get a sticker on his chart. Don’t ask your child to sit down on the potty right away, just explain what will happen when it comes time to pee.
Begin the day’s activities by giving him a drink. If you provide a special drink like juice or chocolate milk, he will be inclined to drink more than usual. This is what you want. More pee means more accidents, and more accidents mean more opportunities. Blue doesn’t consume drinks very quickly so in our case we made Popsicles. 

Now go about your business as usual. Watch a movie, play with toys, or read a book. Keep putting liquids into your child. Once in a while, say “Tell me when it’s time to go pee!” but don’t be forceful. 
Passing the time until "pee time"

WATCH your child. And I mean really watch. Be super-duper vigilant. Don’t take your eyes off him. He will eventually begin to have an accident. He will pee on the floor, on your lap, or on his chair. This is good. The second the pee starts to drip down his leg, don’t panic, but scoop him up and walk to the bathroom. Place him on the potty.  Do this calmly and reassure him that all is well. Then check the potty. If even a milliliter of urine is in that potty, even if it dripped off the soaked underwear, make a huge deal. Praise your child up and down and let him know that what he did was really special. Put a sticker on the chart, and slip him a candy.  If he goes poop, give him two candies or something big. HEAP on the praise and make sure to be specific about what your child did right. Don’t just say, “good boy.” Be specific and say, “that’s where the pee goes; right in the potty! You did a great job getting some pee in the potty!” 
If your child doesn’t manage to get a drop of pee in the potty, don’t say anything negative. Keep the conversation light and humorous. Say, “Oopsy. You peed on the floor! It’s supposed to go in the potty, silly. Maybe next time.”

Let your child get up. Do not make him sit for any length of time unless you think he is actively having a bowel movement and he wants to be there. Wash up and carry on.

Continue this all day throughout the next few days. When a row of the chart gets full, administer the super treat. Remember, do not tell your child when it is time to try the potty. Your aim will be to have your child recognize the feeling he gets when pee is imminent. If you use reminders, a timer, or any external source, all your child will learn is to respond to an unnatural cue, and he will have accidents as soon as you stop reminding him. In Blue’s case, I had accidentally taught her to respond to a video instead of her body’s natural cue, which is why she regressed when I returned the video.

At first it will seem like this method is a flop. But remember, there is a science to it. Like any scientific endeavor it will take repeated attempts and repeated failures before you achieve success. Then it takes a number of successes before they become ingrained. So continue on as best you can and don’t get discouraged. My daughter had many accidents and didn’t appear to be getting it at all until the fourth day.
Nap time
Generally naps go better than parents expect them to. You may wish to postpone nap time until just after your child has peed. Some people say to use diapers for nap and bedtime, but I personally prefer not to, at least until the training has taken hold.  After all, you have already told your child that he no longer needs diapers and you don’t want to send a mixed message. I prefer to protect the bed, not the bum.  You can use layers to make it easier. I used a waterproof sheet, and absorbent sheet, then a regular fitted sheet. I alternated the three for three or four layers so that when an accident occurred, all I needed to do was pull off one layer and replace my daughter’s underwear. Sometimes she didn’t even wake up.
You don’t need to spend a lot of money on bedding. I went to a goodwill store and bought extra sheets and absorbent blankets, and I used plastic table clothes from the dollar store, and a plastic mattress pad on the very bottom.

Night training
Do the same thing as nap time with the layers on the bed. If your child has a big kid bed, you might want to put a potty chair in the room and tell him to get out of bed if he needs to go. For a child still in a crib, tell him to call for mom and dad if he needs to go pee. Some people suggest cutting off liquids two hours before bedtime, which makes sense. For some children, having extra liquids does the job just as well. If your child is capable of getting out of bed and going to the potty, having liquids will cause him to get up for a potty break earlier in the night, and not at 3 or 4 am when he is in a deeper sleep and more likely to sleep through it. You might need to experiment to see which works for your child.

The Scoop on Poop
Bowel movements are often harder to manage than pee, partly because they happen less often and also because your child will be able to hold them in if he gets scared. It is common for young children to hold poops for three or four days at a time when first learning the potty. If this happens, keep your child well hydrated and give him fibre rich foods so that he isn’t constipated.

If your child begins to soil himself, one trick you can use is the “fake out.” Rush him to the potty and begin to remove his underwear, and with your best sleight-of-hand, try to get the poop into the potty without him seeing you do it. Then ask him to try to poop. He will either think he made it in time, or he will think he fooled you. It doesn’t matter, either way, it will give you an opportunity to demonstrate what happens when he goes poop.  Heap on the praise, and if desired, give a big reward. 

Blue did quite well with both #1 and #2 at first, but a couple weeks later began to hold her bowel movements because she was nervous.  The way I solved it was I didn’t make a big deal out of it or try to force her, I just upped the ante on the reward system and appealed to her natural curiosity. On the wall across from her potty, just out of reach, I hung a small gift bag with a picture of her face on it. Inside the bag I put a toy rabbit, with its ears poking out the top. I didn’t say anything about it but it drove her crazy wondering why her face was on a bag that clearly contained something good. When she asked about it I just casually said, “Oh, that’s your bag. You’ll get that at bag time, but that is not until after poop time. And poop time isn’t right now.”

You can just imagine her reaction to my sly little bit of reverse psychology. “It is if I say it is!” she must have thought, because she went, on the potty, right then and there. I had four rabbits so I put another one in the bag.  The great thing about toddlers is that they can’t count or keep track of their things. When all four rabbits were gone, I put the first one back in the bag and started over. I rewarded her with the same four rabbits for a month.

 About Rewards

There is a reason I like using small candies for potty rewards which I discussed in previous posts, and that is because potty use is a mindless habit that lends itself well to operant conditioning. Your child responds appropriately to the pee cue, and they are rewarded with a small amount of sugar, which in turn causes an immediate spike of dopamine in the brain. This causes the habit centre of the brain (basal ganglia) to connect potty usage with pleasure.  You don’t have to explain, “you get this treat because you used the potty.” I used this method with a child who didn’t speak English and he got the picture right away. After repeating the process several times, your child will catch on without having to think about it. If you make it into a big thing your child might try to start negotiations.

The reason I do both a candy and a sticker is because you are appealing to two parts of the brain. The candy enforces the habit, but the sticker appeals to the visual cortex. Many children are visual learners and the chart will help them see their progress. If, however, your child doesn’t seem to be interested in the chart, you can skip it.  You can either have your child fill a whole chart and have the satisfaction of completing it, or you can have small goals, such as 5 successful potty visits for one big treat. The chart should clearly indicate how many successful potty visits your child needs to aim for at a time.

There is a difference between bribes and rewards. A bribe comes in the form of “If you do this, you’ll get that,” and the prize will become the cue instead of the “urge”. When you use bribes, you might end up with a child who refuses to go until he sees the jellybean in your hand. In the case I just mentioned, it was important to note that my daughter was already doing the “gotta go” dance when I placed the incentive bag in sight, so she already had the cue. Also, I didn’t tell her that she had to go poop to get the prize.  The way I phrased it was that I expected there to be a time for poop, and following that, a time for a treat bag. The “bag time” became a natural consequence of using the toilet, and it also gave her the illusion that she could manipulate the schedule. Toddlers love to manipulate. 

Night Treats
Dental Hygiene is important, but so is consistency. So what do you do if your child uses the potty after he already brushed his teeth?  That’s your choice. I gave the treat anyway the first few days of potty training, figuring that a couple days of treats weren’t going to do major damage. Then after the potty routine was more set in I had a “tomorrow” bag. I let my daughter choose between having one piece of cheese for a treat now, or putting an Easter egg in the bag for tomorrow. If she chose the cheese, it wasn’t a sugary treat so I didn’t have to worry about her teeth.

Removing the Rewards
Once your child is sufficiently trained and can go at least a week or more without an accident, you can start to remove the rewards. One thing you can do is just let the jellybeans run out as your child uses them up. Upon giving out the last one, say, “You did it! You earned every single jelly bean, and now you are a big kid who can use the potty!”  If he really puts up a fuss, just say, “I see you like having treats, so I’ll write ‘treats’ on the grocery list and we can buy some next time we’re at the store. He’ll probably forget, and if he doesn’t, just replace the treats with something healthier like small crackers and then transition to no rewards.

Leaving the House

Eventually, you will have to leave the house with your child. Don’t be nervous. Most children do better outside the house because their bladders become shy in a public place. Just bring a couple extra changes of clothes for both of you. Carry some paper towel just in case.  If you have a choice as to where you are going, look for a family bathroom or a bathroom that does not have loud hand blowers or toilets that flush with a jet engine force. Those can terrify your child and set him back. If your child is still having frequent accidents you will have to take him to the public bathroom once in a while instead of waiting for him to tell you it’s time, because if you are in a restaurant or a store it will not be as easy to dash to the bathroom and make it in time.



• If your child just has accident after accident, don’t sweat it. The first two or three days it may appear that you are just not getting through. If you are doing everything right, you are likely to still feel like the method is failing. DON’T GIVE UP.  Blue had 20 accidents her first day. She had 15 the second day, and about 10 the third day. I put her to bed the third day thinking that it was going to be a long road.  But she woke up on day 4 asking for the potty and didn’t have one accident that day.
I’m not saying it will take three days for everyone. I have heard of people using a similar method for a full two weeks before the accidents stopped altogether.

• If your results are not consistent, make sure you are being as vigilant as you can possibly be. Try to catch your child immediately as soon as the pee begins to drip onto the floor. Your success lies in that last little bit going into the potty.
• If your child gets very angry or upset and fights you, it might be time to abort the mission. Bring the diapers back and try again in a week or more.

• Clever children will learn to manipulate the system. If he pees just a little and then jumps up for the reward, have him sit and complete the pee before giving it to him. Don’t give him more than one reward in a short time span, except at the very beginning when he is first catching on.

• Sometimes children like the chart but they don’t like relinquishing the sticker. That happened with the little boy I trained, so I would just put the sticker on his shirt and make a mark on the chart. Starting a debate about the reward system is counterproductive, so follow your child’s lead.

• Often children will be trained for one parent or caregiver but have accidents for another. If you have chosen to use this method, print out this page and give it to your child’s alternative care provider. If possible, provide the exact same bag for treats, the same potty and a copy of the same chart. The more consistency you have between environments, the easier the transition will be.

• Children who are over 3 might not be as easy to train. That’s understandable. Old habits die hard. Just keep with it and stay positive and it will happen eventually. Don’t enable your older child by putting a diaper back on him just because he asks.

• Keep in mind that the length of time is not guaranteed. When I say this took me 3 days, I am referring to the time it took between ditching the diapers and the time I could safely say that my daughter had caught on. The readying that happened before this day took a few weeks or months. And this is not to say that accidents didn't occur from time to time afterwords. At the time of writing this she is 2 and a half, and she has an accident maybe once or twice a month, usually at night.

Q. What if my child doesn't tell me when it is time to go?
A. The important thing is that you try to sit him on the toilet when you know he is feeling the urge, whether or not he expresses it. At first, your child may not verbally tell you when it it time. But a child who is not emptying his or her bladder automatically will usually "tell" you in one way or another with body language, if you pay very close attention.   If you consistently make a trip to the bathroom every time your child eliminates, even if you miss the entire "opportunity," your child will get the hang of the routine and may turn toward the bathroom out of habit when it is time to go.