Potty training, or toilet training, is a big milestone that many parents look forward to. But when it doesn’t go as planned, it can be frustrating. You might wonder if your child will ever be diaper-free — or worse, if something is wrong.
The truth is that every child learns to use the potty in their own time. Some catch on quickly, while others take longer. But in some cases, there may be a physical or developmental reason why potting training isn’t working.
We spoke with Philip Gleason, MD, a pediatric urologist with Banner Children’s, about what’s considered normal, when to worry and how to help your child succeed.
What’s considered a potty-training delay?
Children typically begin potty training between 18 months and 3 years old. Many are fully potty trained by age 4. But “fully trained” can mean different things.
“Daytime bladder control develops most naturally between ages 3 and 5,” Dr. Gleason said. “Nighttime dryness often takes even longer, sometimes up to age 6 or 8, and that’s still normal.”
So what counts as a delay? Here are a few signs your child may be behind:
- Still in diapers after age 3 or 4
- Strong fear of sitting on or using the toilet
- Frequent daytime accidents
- Little or no interest in potty training after months of trying
“If a child starts training before they’re developmentally ready, it can backfire,” Dr. Gleason said. “They may hold their pee or poop to avoid the toilet, which can lead to constipation and urinary issues down the line.”
What causes potty training delays?
Toilet training is more than just learning to use the toilet. It’s a process involving your child’s brain, body, personality and emotions. Delays can happen for many reasons.
Developmental readiness
“Potty training follows an orderly process,” Dr. Gleason said. “Kids first gain bowel control at night, then during the day. After that, they get bladder control during the day, then finally at night.”
Signs your child is ready to start potty training include:
- Staying dry for at least two hours
- Letting you know they’ve gone in their diaper
- Showing interest in the bathroom
- Pulling pants up and down with some help
If your child isn’t showing these signs, it’s OK to pause and try again later.
Emotional and behavioral factors
Fear and anxiety often play a role. Some kids are scared of flushing noises or afraid of falling into the toilet. Others may have had negative experiences, like being rushed or punished, that make them resist.
Major life changes, such as a move, starting daycare or having a new sibling, can also set back progress. And strong-willed children may resist because they don’t want to feel pushed.
“At times, toilet training just isn’t a priority for 4-year-olds,” Dr. Gleason said. “They’re busy exploring and playing. And yes, video games are often more exciting than going to the bathroom.”
He added that kids may even deny needing to go until they’re suddenly sprinting to the toilet (or having an accident) because they didn’t “feel it” in time.
Could there be a physical problem?
Sometimes, children who are emotionally ready to potty train still struggle due to underlying physical issues.
Constipation and bowel issues
Chronic constipation is one of the most common physical causes of potty-training problems.
“When the rectum is full of stool, it presses on the bladder and irritates the pelvic floor,” Dr. Gleason. “That pressure can mimic the sensation of needing to pee or lead to daytime accidents and even urinary tract infections (UTI).”
Signs of constipation include:
- Hard or painful poops
- Going fewer than three times a week
- Belly pain or bloating
- Poop streaks in underwear
Encouraging a diet with fruits, vegetables and fiber can help. Dr. Gleason also notes that over-the-counter (OTC) options like MiraLAX are sometimes used to keep stools soft and prevent buildup.
Urinary tract and bladder issues
Frequent daytime accidents, wetting shortly after using the bathroom or peeing with urgency may point to bladder dysfunction or an infection.
“Bladder control isn’t just about ‘holding it,’” Dr. Gleason said. “We actually learn to relax our bladder muscles and let the bladder empty completely. If children rush or tighten their pelvic muscles instead, they may not empty fully. This can lead to leaks, infections or confusion about needing to go again.”
Look for signs such as:
- Pain or burning while peeing
- Peeing very frequently but in small amounts
- Nighttime accidents after age 5
- Urinary urgency
- Wetting clothes shortly after using the toilet
Your child’s health care provider can help determine if treatment or a referral to a pediatric urologist is needed.
Other medical conditions
In rare cases, structural or neurological issues can delay potty training. These may include:
- Spina bifida occulta: A hidden spinal condition that can affect bladder control
- Tethered spinal cord: When the spinal cord is abnormally attached
- Other structural differences in the bladder, rectum or urinary tract
When to seek help
Potty training setbacks are common, but some situations call for a deeper look. Reach out to a provider if your child:
- Has frequent accidents past age 4
- Shows no progress after months of training
- Has repeated UTIs or signs of constipation
- Was previously trained but is having new accidents
- Appears fearful or distressed around toileting
Encouraging healthy habits
If you’re feeling frustrated, you’re not alone — and neither is your child.
“The goal isn’t perfection; it’s progress,” Dr. Gleason said. “Most kids do just fine with time, support and sometimes a little extra help.”
You can support your child by:
- Avoiding punishment or pressure
- Offering bathroom breaks every two to three hours, even if they say they don’t need to go
- Praising efforts, not just success
- Managing constipation through hydration, fiber and routine
Takeaway
Toilet training is a learning process and sometimes it takes longer than expected. Developmental readiness, emotional factors and medical issues can all play a role. If you’re concerned, trust your instincts.
If your child’s potty training delay has you worried or unsure, trust your instincts. Talk to their health care provider or a pediatric urologist. You can connect with a Banner Health provider today to get support, solutions and peace of mind.
