Computers, Doctors, and Toilet Training

Alan R. Greene, MD, FAAP

Introduction

As a pediatrician and as a parent, I am privileged to watch children's development as it unfolds. As an Internet physician, I am privileged to watch our rapidly evolving medium. From my vantage point, I'm struck by the similarities between physicians' adoption of the Internet and toddlers' adoption of the toilet.

Some are simply afraid to learn a new procedure; others are reluctant to part with their beloved offline solutions (diapers). And some simply refuse to change their "workflow" (which for toddlers is all-important play).

I advise my young patients to "dress for success," by initially wearing clothes with few buttons, zippers, or snaps, during their important potty-training period. Similarly, doctors need to be properly equipped in order to easily incorporate all that the Internet has to offer.

For children to successfully master toilet training, there are 2 core concepts that must be assimilated. Children need to learn both how to use the potty and to use the potty consistently. This includes overcoming any reasons for resistance and assuming responsibility for their own toileting. In the same vein, doctors must learn how to use the Internet and to use it consistently.

When it comes to potty training, experts tout many different methods. Most techniques work for some children, or they would not have become popular. By understanding the underlying forces that surround toilet learning, parents can identify which of the many suggestions out there are most likely to work for their child.

The first force is the intrinsic powerful urge in children to grow and develop. The quest for mastery unfolds naturally. Initially, most children need a little help recognizing the toileting urge. Often, others see them shifting from foot to foot before they do. When parents notice this or other such behavior, they can point it out and suggest that this might be a good time for the potty.

George Lundberg, MD, has seen this type of urge in physicians for years: "Every decade since the 1960s, I have written and stated that doctors would be using computers big-time, and every decade I was wrong -- until the 1990s."[1] We physicians are beginning to recognize what Dr. Lundberg had already observed.

Closely coupled with the urge to grow is the toddlers' strong desire to imitate those they care about and admire. Parents can capitalize on this with the outstanding literature and multimedia tools that describe potty use as a part of growing up. Illustrations of firefighters, doctors, baby-sitters, medical journal editors, and parents all going to the bathroom will delight and educate. Watching a parent or older sibling real-time in the bathroom reinforces this process. Buying children fun new underwear can further encourage them. Doctors can be encouraged in similar, but more expensive, ways.

If these were the only forces affecting potty training -- and Internet use, there would be no problem. Fear, however, often plays a major role: fear of failure, fear of how this is going to change their role in society, fear of disappointing others, or fear of the toilet (or Internet) itself can derail the process. Potty training tends to come at a stage when children's fears are most intense; adopting the Internet comes at a stage of great uncertainty for the medical profession.

If children seem to be afraid of the actual toilet, it's best to gradually acclimatize them to the potty. Have them sit on one of the little potties fully clothed for a few minutes each day while someone reads to them or tells them a story. Dumping the contents of their dirty diapers into the potty can help them see what happens. When that becomes old hat, take the diapers off briefly so they can sit on the potty just like Dad and Mom. Eventually this will become old hat, too. Then give them the opportunity to run around bare-bottomed for a while so they can try to go on the potty themselves when the need arises.

The desire for approval is another strong motivating force that impacts potty training. 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.

Readiness for potty training often occurs around the time that children develop strong, independent, oppositional behavior. You say, "yes," they say, "no!" You say, "PC," they say, "Mac!" This underlying mood is another powerful force affecting potty training. If parents say, "This is what you've got to do," children's natural, healthy response is "no," because they are in the process of developing unique, independent personalities. Potty training is not an area to push or to enter into any kind of battle. You will always lose; everyone involved will lose.

Pushiness creates and complicates toileting problems. Instead, minimize the issue and make it quite clear that this achievement 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. Pushing physicians to adopt the Internet is equally perilous.

When accidents do happen, and they will, encourage them -- "Someday soon it's all going to land in the potty. We'll try again." Accidents are part of the learning process.

Often toilet training seems to be going well, and then the process stalls. When progress comes to a halt, take time to consider the constellation of forces that work together to motivate a child to complete toilet training, and those that oppose completion. Altering the balance of forces will generally get the process rolling again.

Although this time can be a frustrating and messy one, it's also a time of exciting change.

As Dr. Lundberg said in his address at eHealthcare World 2000,[2] "Doctors are very smart; they will use whatever works to help them get their job done better and doesn't waste their time."[][1]]

Once mastered, using the toilet offers considerable freedom and efficiency advantages over the alternatives. Children, too, are smart. Ultimately, they will choose the toilet and succeed.

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