Toilet Training in Less Than a Day (1976)
Nathan Azrin and Richard Foxx – 30 Q&As – Unbekoming Book Summary
Well, I never used disposable diapers because of 1 the expense and 2 tossing into trash seemed detrimental. I made cloth ones and used and washed them as my mother and grandmother had. I had read a small book, Toilet Training in Less Than a Day written by some folks who developed a system that worked with severely disabled adults and had them potty trained in a week or less. They said once a child understands the difference between Yes and No, they can be trained easily. I used the method with my daughter at 1 and she was fully trained within 7hrs and never had an 'accident' after. My son, who was autistic, was closer to 2 yrs and it took 3 days to fully train him. Still not too bad, though. I've since used the method to train nieces and nephews who never lived with me and generally done and trained in 2 days. I've also made cloth diapers for many, but young folks today don't want to use them and think they are gross to touch or wash. The brainwashing by disposable diaper companies has been complete. Arghhh - DNPmom
In the early 1950s, American children were typically potty trained by eighteen months, using cloth diapers and time-honored methods that emphasized early independence. By 2001, however, this milestone had shifted dramatically: the average age of potty training rose to thirty-five months for girls and thirty-nine months for boys. This delay stemmed not from a natural evolution of parenting but from industrial social engineering, fueled by the advent of disposable diapers. Aggressive marketing by diaper companies convinced parents that extended diaper use was both convenient and developmentally appropriate, a shift that can be described as "complete brainwashing." The fallout was significant—rising rates of preschool incontinence, chronic constipation in children aged two to ten, and even six-year-olds still in diapers. This historical regression highlights how profit-driven industries reshaped toilet training, prioritizing convenience over children’s autonomy and well-being.
Against this tide of delayed development, the Azrin-Foxx method, developed by Nathan Azrin and Richard Foxx, stands out as a revolutionary, science-based solution. Unlike traditional approaches that drag on for months, this method teaches children toilet independence in an average of four hours through a structured blend of imitation, practice, manual guidance, and positive reinforcement. Its effectiveness is remarkable: studies show a 100% success rate for children over twenty months, with accidents dropping by 90% on the first day and 99% within a week. The method’s adaptability shines in cases like DNPmom’s who trained her daughter in seven hours and her autistic son in three days, proving its value for children with special needs. By reframing toilet training as an educational process rather than a prolonged struggle, the Azrin-Foxx method restores a developmental timeline that empowers children and defies industry-driven norms.
The benefits of the Azrin-Foxx method reach far beyond the immediate goal of dryness. By guiding children through the entire toileting process—recognizing the urge, reaching the potty, managing clothing, and cleaning up—it cultivates independence, confidence, and a stronger parent-child bond. Parents often notice unexpected gains: improved personality, self-reliance in dressing and feeding, and, in about one-third of cases, an end to bedwetting without further effort. This approach challenges the disposable diaper industry’s grip on parenting, offering a path to save families years of frustration and expense. If widely embraced, it could shift societal norms, positioning toilet training as a pivotal early milestone where children learn not just to stay dry but to take pride in their growing capabilities.
With thanks to Nathan Azrin and Richard Foxx.
Toilet Training in Less Than a Day: Azrin, Nathan, Foxx, Richard M.
Related Posts
Deep Dive Conversation Library (Bonus for Paid Subscribers Only)
This deep dive is based on the book:
Discussion No.73:
23 insights and reflections from “Toilet Training in Less Than a Day”
Thank you for your support.
Analogy
Think of traditional toilet training as teaching someone to swim by putting them in the water for a few minutes each day, showing them one movement at a time, pulling them out when they struggle, and repeating this process for months. They might eventually learn to swim, but it's slow, frustrating, and creates dependency on the instructor.
The Azrin-Foxx method is like an intensive swim clinic where all the elements are taught simultaneously in one focused session. First, the student watches a demonstration of proper swimming, then practices each component with guidance until they can do it themselves. The instructor provides immediate feedback, adjusts techniques as needed, creates plenty of opportunities to practice, and gradually removes support until the student swims independently.
In both cases, the same skills are being taught, but the intensive approach creates independent swimmers in hours rather than months, with less frustration and more confidence. Just as a well-taught swimmer doesn't need someone standing by the pool reminding them how to swim, a properly toilet-trained child becomes truly independent, managing the entire process themselves with pride and confidence.
12-point summary
Revolutionary rapid method: The Azrin-Foxx method teaches complete toilet independence in an average of four hours, compared to traditional methods that often take months or years. This scientific approach combines multiple learning techniques simultaneously: learning by imitation, practice, manual guidance, positive reinforcement, and teaching of cleanliness attitudes.
Readiness is essential: Before attempting training, parents should verify three types of readiness: bladder control (child urinates large amounts at once and stays dry for hours), physical development (adequate coordination and walking ability), and instructional readiness (ability to follow simple directions). Most children are ready around 20 months of age.
Preparation matters: Essential supplies include a potty chair with easily removable pot, a doll that wets, 8+ pairs of loose-fitting training pants, favorite drinks and snacks for rewards, and a distraction-free environment (typically the kitchen). Prior to training day, parents should create a "Friends-Who-Care" list of important people to the child and teach basic dressing skills.
Learning through demonstration: Training begins with the "Doll-That-Wets" procedure, where the child helps teach the doll to use the potty, witnessing the entire toileting sequence and appropriate responses to both success (praise and rewards) and accidents (practice trials and changing). This demonstrates expectations before the child needs to perform them.
Structured learning sequence: The method uses prompted potty trials where the child practices walking to the potty, lowering pants, sitting, and eventually emptying the pot. Instructions progress from direct commands to general reminders until the child initiates toileting independently, with parents providing less guidance as skills improve.
Consistent motivation system: The method employs five types of approval: verbal praise, snack treats, drinks, social motivation through the "Friends-Who-Care" procedure, and physical affection. All rewards must be enthusiastically delivered with clear explanation of why they're being given, creating strong motivation to stay dry.
Effective accident response: When accidents occur, parents implement four steps: verbal disapproval (without anger), Positive Practice (ten rapid trials of going to the potty from different locations), Wet-Pants Awareness (feeling wet pants and hearing disapproval), and Cleanliness Responsibility (changing clothes and cleaning up independently).
Independence focus: Unlike traditional methods that create dependency, this approach teaches children to handle the entire toileting process themselves: recognizing the need, walking to the potty without reminders, managing clothing, emptying the pot, and maintaining cleanliness—creating true toilet education rather than mere training.
Impressive success rate: Studies showed 100% success with children at least 20 months old who were responsive to instructions (except when fathers actively opposed training). Accidents decreased by 90% on the first day after training, 95% by day three, and 99% by the end of one week, with benefits maintained for years.
Post-training maintenance: After training, parents continue pants inspections before meals, snacks, naps and bedtime (about 6-7 daily), gradually reducing frequency while maintaining the expectation of dryness. Accidents are addressed with simplified versions of training procedures and the potty chair remains accessible for trips and outdoor activities.
Unexpected benefits: Beyond toilet independence, many parents reported their children showed improved personality, greater independence in other activities (dressing, feeding), better responsiveness to instructions, and enhanced parent-child relationships. Approximately one-third of children also stopped bedwetting without additional training.
Adaptable for special needs: Modified versions of the method can be effective for children with mild or moderate mental retardation, though training should begin later (around 30 months) and may require adaptations such as increased manual guidance, simplified instructions, and elimination of components requiring higher cognitive functioning.
30 Questions and Answers
Question 1: What is the Azrin-Foxx method of toilet training and how does it differ from traditional methods?
The Azrin-Foxx method is a rapid toilet training approach that teaches a child to toilet independently in less than a day (typically 3-4 hours for the average child). This method incorporates multiple teaching techniques simultaneously: learning without distraction, increased opportunities for urination through extra fluids, practice in walking to the potty chair, practice in dressing skills, relaxation training, learning by imitation (using a doll that wets), learning by teaching, manual guidance, positive motivation, and teaching the general attitude of personal cleanliness.
Traditional toilet training methods typically involve the mother seating her child on a potty chair at predictable times when he usually urinates, often strapping him in place until urination occurs. The child might wait an hour or more during which the mother attempts to remain present but is often called away by other duties. This old method creates many problems: it requires considerable time over months or years, causes fear of the potty chair in some children, leads to parent-child conflicts through punishment, and creates dependency since the child waits for the mother to remind and assist rather than independently toileting.
Question 2: What are the three readiness tests that determine if a child is ready for toilet training?
The first test evaluates Bladder Control through three indicators: 1) The child urinates a good amount at one time rather than dribbling throughout the day, 2) The child stays dry for several hours at a time, and 3) The child shows awareness of urination through facial expressions or special postures. If the child demonstrates all three, bladder control is established, though the training may still work if only the first two are present.
The second test assesses Physical Readiness by evaluating if the child has enough finger and hand coordination to pick up objects easily and can walk from room to room without assistance. The third test determines Instructional Readiness by asking the child to perform ten simple actions such as showing body parts (nose, eyes, mouth, hair), following instructions (sit down, stand up, walk to a specific place), imitating tasks (like patty-cake), bringing objects, and placing objects in specific locations. If the child can carry out eight of these ten instructions, they are considered intellectually ready for training.
Question 3: How does the "Doll-That-Wets" procedure work as part of the training process?
The Doll-That-Wets procedure utilizes a hollow doll that wets to teach the child by imitation and by having the child teach the doll. First, the parent dresses the doll in training pants and fills it with water. The parent then tells the child that the doll needs to "pee-pee" and instructs the child to help the doll approach the potty chair, lower her pants, sit on the potty, and remain quietly seated. The parent causes the doll to wet by squeezing it or using its mechanism, and encourages the child to praise the doll enthusiastically and offer it a snack treat.
The procedure continues with having the child help the doll empty the potty into the toilet, flush, return the pot to the chair, and check if the pants are dry. Later, the parent creates a scenario where the doll "accidentally" wets her pants by spilling water on them. The child is instructed to express disapproval to the doll, have the doll practice going to the potty quickly (doing practice trials), check the doll's wet pants, and change the doll into dry pants. This entire sequence demonstrates all aspects of the training process before the child needs to perform them, making learning easier.
Question 4: What is the "Friends-Who-Care" procedure and how does it motivate a child during training?
The Friends-Who-Care procedure creates social motivation by helping the child understand that all important people in their life care about their cleanliness. Before training begins, the parent creates a list of all the people and fictional characters the child admires, such as Daddy, siblings, grandparents, the mailman, baby-sitter, Santa Claus, and favorite television characters like Captain Kangaroo or Sesame Street characters.
During training, when giving approval for the child's correct toileting actions, the parent continually includes comments about how these important people would also be pleased with the child's achievement. For example, "Tommy is sitting on the potty; Grandmother will be so happy," or "Eddie [his brother] will say, 'Tommy is a big boy.'" The parent also describes similarities between the child's approved actions and those of these important people: "Good boy, Tommy. You flushed the toilet. Just like Daddy." This procedure helps form the child's attitude toward cleanliness more rapidly by conveying that all their heroes and loved ones share the same concern about staying clean and dry.
Question 5: What supplies and teaching aids are needed for implementing this toilet training method?
The required supplies include a well-designed potty chair with a pot that can be easily removed from the top (not the back) of the chair. A urine-signaling chair is ideal but not essential. A doll that wets is needed to demonstrate urination, and this doll should wear training pants. Several pairs of cloth training pants for the child are required, and these should be several sizes larger than normal to make them easy to pull down and up, with leg openings and waistbands loose enough for the child to manage independently.
Additionally, the method requires a variety of drinks (such as soft drinks, punches, fruit juices) to increase the child's desire to urinate, and small snack treats (sugar-coated cereal, potato chips, candy, corn chips, fruit slices) to use as rewards. Other necessary items include facial or toilet tissue for wiping, cleaning cloths for accidents, and an apron with pockets for the parent to carry treats. The parent should also create a Friends-Who-Care list of people and characters the child admires, and have reminder sheets to track pants inspections and prompted toiletings.
Question 6: How does the method use extra drinks during training and why is this important?
The method instructs parents to give the child as much of different beverages as they want throughout the training to create a strong and continuing desire to urinate. The parent should start offering drinks even before training begins, such as at breakfast, and continue throughout the session, encouraging the child to drink at least eight ounces (one cup) every hour. Different types of the child's favorite drinks should be offered to prevent the child from tiring of one flavor.
This high fluid intake serves two critical purposes: First, it creates many urination opportunities during the brief training period, providing more chances to teach the child to urinate correctly in the potty. The more urination episodes, the more learning trials. Second, the drinks themselves become motivators when used as part of the approval system—given only as rewards for having dry pants or for toileting correctly. If a child is reluctant to drink, the parent can stimulate thirst with salty snacks, model drinking themselves, prime the child by placing the cup against their lips, or offer a wider variety of favored beverages.
Question 7: What is the purpose of dry-pants inspections and how are they conducted?
Dry-pants inspections serve to teach the child awareness of personal cleanliness and create motivation to remain clean and dry. The parent conducts these inspections every few minutes during training, calling the child's attention to the condition of their pants by asking, "Are your pants dry?" The child must feel the crotch area of their pants and indicate by word ("dry") or gesture (a head nod) whether they are dry.
When the pants are dry, the parent shows delight and rewards the child with a drink or small treat and praise: "Mickey, you're a big boy. You have dry pants. Big boys get candy." Initially, the parent should manually guide the child's hand to ensure they're touching the correct part of their pants. These inspections take less than a minute each and should occur about every three to five minutes when the child isn't receiving other instruction. After training is complete, scheduled inspections continue but become less frequent—before meals, snacks, nap times, and bedtime—with praise still given for dry pants but treats discontinued.
Question 8: How should a parent handle accidents during the training process?
When a child wets their pants during training, the parent should implement four specific procedures. First, show immediate verbal disapproval by saying "No!" loudly enough to potentially interrupt the urination, followed by statements like "You wet your pants" or "Wetting is bad" in a disappointed but not angry tone. Second, implement Positive Practice by having the child rapidly perform ten practice trials of walking to the potty, lowering pants, sitting briefly (no urination intended), raising pants, and returning to various locations.
Third, conduct Wet-Pants Awareness by having the child feel their wet pants during ten pants inspections, each time telling them how unhappy you and others are about wet pants. Finally, implement Cleanliness Responsibility by having the child change into dry pants themselves, carry the wet pants to the hamper, and clean any wet spots on the floor. Throughout this process, the parent should maintain a calm, instructive attitude rather than an angry one, explaining that these corrective steps are necessary because "I want you to pee-pee in the potty and have dry pants because I love you."
Question 9: What is "Positive Practice" and how is it used after an accident?
Positive Practice is a corrective procedure used after a child has an accident, designed to teach them to rapidly toilet themselves so they'll know how to quickly reach the potty chair when they feel the urge to urinate in the future. After expressing disapproval for the accident, the parent guides the child back to where the wetting occurred and instructs them to "Practice going to potty. Practice quickly."
The child must walk rapidly to the potty chair, quickly lower their pants, sit on the potty for just one second (not long enough for urination), quickly stand and raise their pants, and then walk quickly to another location. This sequence is repeated for ten total trials, starting from different rooms or locations in the house. About two of these trials should begin from the location where the accident happened, with the other eight from remote locations, teaching the child to go to the potty from anywhere in the house. The parent should maintain a brisk pace throughout, providing instructions and manual guidance as needed, repeatedly emphasizing the connection between the practice and the accident: "You wet your pants. You must practice going to the potty fast."
Question 10: How does manual guidance work in the training procedure?
Manual guidance involves the parent gently but firmly guiding the child's hands, legs, or body through proper motions whenever they don't carry out instructions—either from lack of understanding or reluctance. The guidance should be as light as possible while still maintaining sufficient firmness to direct movement. As the parent feels the child beginning to complete the action themselves, they should immediately lighten their grasp to a mere touch and eventually remove their hand entirely, keeping it nearby to resume guidance if needed.
This technique should be implemented within one or two seconds after giving an instruction if the child doesn't begin to follow it. Parents guide different body parts depending on the action: shoulders for walking to the potty, sitting down, or carrying the pot; hands or fingers for pants raising, wiping, removing and reinserting the pot, emptying and flushing; and legs when helping with pants after an accident. Manual guidance prevents parents from doing tasks for the child and helps teach independence by showing exactly how to perform each action. It's needed more at the start of training and with children who have previously experienced unsuccessful training attempts.
Question 11: What is the recommended training environment and why?
The kitchen is recommended as the ideal training environment for several practical reasons. Kitchen floors are typically designed to withstand spills or wettings, making cleanup of accidents easier. The necessary drinks can be kept cold in the refrigerator, and ice is readily available. Various snack items are usually stored in the kitchen, providing convenient access to rewards. The kitchen generally offers sufficient space for the potty chair and movement without feeling confined.
If the kitchen is extremely small and confining, the parent should select another room with an uncarpeted floor that won't stain easily from accidents. The chosen environment should be free from distractions—radios and television sets should be turned off, toys and games should be removed from the training area, and interruptions from phone calls or visitors should be minimized. The goal is to create a distraction-free space where both parent and child can concentrate fully on the training process without interruption.
Question 12: What is the typical timeline for toilet training using this method?
The Azrin-Foxx method produces remarkably rapid results compared to traditional approaches. According to the book, the average child requires less than four hours to be trained to toilet completely independently without assistance or reminders. Some children were trained in as little as thirty minutes, while the longest time required by any child was two days (fourteen training hours). The effectiveness of the method is attributed to its comprehensive approach that combines multiple learning techniques simultaneously.
Age and gender factors slightly influence the training timeline. Girls trained slightly faster (by one-half hour) than boys. Children over the age of 26 months tended to train faster, in about two and one-half hours, than children younger than 26 months, who averaged about five hours. After training, accidents were reduced by 90 percent on the first day, 95 percent by the third day, and 99 percent by the end of one week. Follow-up reports showed that all children maintained the benefits of the training, some for as long as two years (the maximum follow-up period).
Question 13: How does the method approach verbal instructions and attention-getting?
The method employs several specific techniques for giving effective verbal instructions to the child. Before starting an instruction after a silent period, the parent should say the child's name so they know they're being addressed. Instead of standing at a distance, the parent should stand within easy arm's reach before speaking to facilitate manual guidance if needed. Pointing or gestures should accompany instructions when possible, indicating the doll, pants, potty, toilet flush handle, or other relevant objects.
Instructions should be brief to enhance understanding, using consistent wording each time. Initially, instructions should be very specific and detailed, becoming more general as the child learns. The parent should ensure attention by calling the child by name, orienting their face toward the parent if necessary, and always requiring a response (verbal, gestural, or action) to confirm understanding. Questions should be asked after each instruction, and the child's tone should convey warmth and optimism that the child will comply, never impatience or irritability. This attention-getting approach ensures instructions are understood and followed effectively.
Question 14: What is verbal rehearsal and why is it important to the training process?
Verbal rehearsal is a procedure where the parent tells the child what the correct toileting actions are, what benefits come from correct toileting, and what disadvantages result from accidents. The parent asks simple questions like "Mommy will be happy when you pee-pee in the potty. Will you pee-pee in the potty?" (Child nods.) "Will you pee-pee in your pants?" (Child shakes head.) "Where will you pee-pee? Show me." (Child points to potty.) This technique teaches understanding of what is expected and why.
This rehearsal is crucial because it allows the child to understand the future advantages of personal cleanliness without having to experience them all directly. The parent can incorporate the Friends-Who-Care list during rehearsal, describing how important people approve of toileting correctly. The rehearsal should be used continuously throughout training, especially during free moments when the child isn't actively practicing toileting. It should address any aspects causing particular difficulty, such as reluctance to wear training pants instead of diapers. Even when the child demonstrates understanding, the parent should continue rehearsing, covering different advantages, situations, and people involved in toileting.
Question 15: How should pants raising and lowering be taught as part of the process?
Pants raising and lowering is a critical skill for independent toileting that requires specific teaching techniques. During training, the child should wear loosely fitting training pants (several sizes larger than normal) without trousers or a dress. If the child wears a shirt, it should be rolled up and pinned to prevent interference with grasping the pants. When teaching lowering, the parent should ensure leg openings and waistband are sufficiently loose and have the child bend their knees to make reaching easier without bending too far over.
For raising pants, the parent should teach the child to bend their knees slightly and place one hand behind their back with palm facing backward while grasping the front of the waistband with the other hand. This hand position allows the waistband to be lifted easily over the buttocks as the child straightens up. The parent should provide clear verbal instructions, manually guide the child's hands when necessary, and give enthusiastic approval as the child masters each step. As training progresses, the child will require less assistance with these skills, eventually managing pants independently.
Question 16: What are prompted potty trials and how are they conducted?
Prompted potty trials are structured practice sessions where the parent teaches the child to perform each necessary toileting action. The parent instructs the child to walk to the potty chair, lower their pants, sit on the chair for several minutes, stand up, and raise their pants. These trials are given frequently at first, about fifteen minutes apart, and decreased in frequency as the child masters the skills. Initially, the child sits on the potty for about ten minutes to ensure an opportunity for urination, but after two or three successful urinations, this is reduced to five minutes.
To eliminate the need for reminders, the parent begins with direct instructions ("Billy, go to the potty"), then progresses to questions ("Billy, do you want to potty?"), then general statements about the potty ("Billy, show me where you pee-pee"), and finally just comments about dry pants. The parent should watch for signs the child needs to urinate (holding genitals, crossing legs, facial changes) and prompt them at those moments. Ensuring the child is relaxed while sitting is important for successful urination—praise should be given for sitting quietly, but conversation should be minimized to avoid distraction from the task.
Question 17: How does a parent know when training is complete?
Training is considered complete when the child walks to the potty chair for the first time without any reminder and completes the entire toileting experience without instructions or guidance. The parent should continue observing a few more independent toiletings to confirm success, but should gradually fade out approval for toileting, reserving praise only for having dry pants during inspections. This shift helps motivate the child to remain dry rather than seeking continued approval for the act of toileting itself.
Other indicators of completed training include the child's ability to perform all toileting steps independently: walking to the potty from any location in the home, lowering and raising pants without assistance, sitting on the potty until urination is complete, removing the pot, emptying it into the toilet, flushing, returning the pot to the chair, and properly reinserting it. The parent can begin introducing toys and games after several successful independent toiletings, allowing the child to learn to interrupt play activities to toilet themselves—an important skill for maintaining dryness in everyday situations.
Question 18: What are the recommended after-training procedures?
After training, parents should continue pants inspections for several days, particularly during the first day or two when the child may be testing the new expectations. These inspections should occur before each meal, before between-meal snacks, before nap times, and before bedtime—about six or seven inspections daily. If possible, other family members should conduct some inspections to reinforce the social importance of staying dry. The parent continues to ask if the pants are dry and requires the child to check, but no longer offers snack treats—only praise for dryness.
Parents should handle accidents with a simplified version of the training procedure: reprimand the child (without anger), require the ten Positive Practice trials, and have the child change into dry pants independently. The wet-pants awareness procedure is omitted since the child now understands the difference between wet and dry. Pants inspections can be discontinued after a week without accidents, but parents should still occasionally comment positively on the child's dry state. The child should continue wearing loose training pants with no return to diapers during the day, though diapers may continue at night for younger children.
Question 19: How should a parent handle tantrums or resistance during training?
When a child shows resistance or has a tantrum during training, the parent should not allow this behavior to interrupt the instruction. The parent should follow the required sequence of instructing the child and using manual guidance when necessary, then showing approval for correct actions when resistance subsides. By maintaining consistency and not allowing tantrums to postpone the required actions, the child quickly learns that resistance is ineffective and that cooperation brings praise and positive attention.
The method emphasizes that most children find training to be a pleasant experience filled with continuous adult praise and warmth. Tantrums typically occur at the very start of training and are more common in children with a history of tantrum behavior or previous unsuccessful toilet training attempts. Even for children prone to tantrums, parents should not experience more than two or three testing incidents, as children learn that the parent is teaching one small skill at a time with detailed instructions, demonstrations, and praise—not requiring more than they can easily accomplish with guidance.
Question 20: What are the benefits observed after successful training?
After successful training with the new method, numerous benefits occur for both parent and child with no harmful effects observed. Typically, children are delighted with their newly acquired skill and show increased independence. Many mothers reported that this independence generalized to other activities such as the child feeding and dressing themselves. Children's personalities often improved as they gained a feeling of greater independence and awareness of personal appearance. Their relationship with parents frequently changed from avoidance to pride, and they became more responsive to parental instructions in general.
An unexpected benefit was that one-third of children also stopped wetting their beds following daytime training. For parents, the benefits were equally substantial: more time for personal interests and other duties, less impatience with and shame about their child, and a view of their child as a source of pride and pleasure rather than interruptions and drudgery. The parent-child conflicts caused by lack of training or the old method of training were resolved by the new approach, which created a positive, affirming experience for both parent and child.
Question 21: How does the method address bowel movements?
No separate training is needed for bowel movements because defecation typically doesn't occur without urination, so the training for urination naturally generalizes to defecation. An interesting challenge that sometimes arises is that training for correct urination is often completed so rapidly that the child may not have defecated even once during the training period and therefore couldn't receive approval for doing so correctly. In these cases, bowel training continues after urination training is complete.
If a child has a bowel accident after training, it should be treated exactly like a wetting accident: the parent gives verbal disapproval, requires ten Positive Practice trials, and has the child change their soiled clothing independently. Since bowel control normally develops at an earlier age than urinary control and is generally easier for most children to learn, once a child has mastered urination in the potty, they typically have little difficulty with bowel movements. During training, toilet tissue or facial tissue should be kept beside the potty chair, and the child should be taught to wipe themselves after a bowel movement.
Question 22: How does the method approach nighttime training?
The method addresses nighttime training differently based on the child's age. For children younger than about 2½ years of age, the book recommends continuing to dress the child in diapers at bedtime. For children older than 2½ years, the child should wear training pants to bed instead. To protect the mattress, parents should place a plastic or rubber sheet under the top bed sheet.
The nighttime approach is less intensive than the daytime method, as the book acknowledges that the child can't control urination while asleep. Instead, it relies on a transfer effect, noting that "Some children will begin staying dry at night simply as a result of the daytime training." This suggests that for many children, the increased awareness and bladder control developed during daytime training naturally extends to nighttime dryness without additional specific training. For children who continue to wet at night, the authors mention their development of a separate "Dry Bed" method for eliminating bedwetting in a companion publication, but don't include those details in this book.
Question 23: What types of approval and rewards are recommended during training?
The method recommends five major types of approval: 1) verbal praise, 2) snack treats, 3) drinks, 4) the Friends-Who-Care procedure, and 5) nonverbal praise such as hugging, stroking, smiling, and clapping. These rewards must be very desirable to the child and should be given with obvious enthusiasm and excitement. The parent should "overreact" with loud praise, broad smiles, close hugs, hand clapping, and multiple expressions of delight to effectively motivate the child.
Approval should always be accompanied by an explanation of why it's being given, connecting the reward directly to the child's action: "Billy peed in the potty, I'm so happy." Initially, approval should be continuous to establish a positive atmosphere, given at the start of each action and continuing throughout. As the child masters skills, approval should be delayed until the completion of actions, then until several actions are completed, and eventually only for the final step of replacing the emptied potty in the chair. Ultimately, approval for toileting itself is eliminated, with praise reserved only for having dry pants during inspections.
Question 24: What modifications are needed for children with mild or moderate mental retardation?
For children with mild or moderate mental retardation, several modifications to the standard method are needed. First, training should start at a later age—around 30 months at minimum, with more severely retarded children possibly waiting until 5 years of age. The Doll-That-Wets procedure might need to be eliminated if the child pays no attention to the doll, throws it, or cannot understand the meaning of the doll's actions, particularly for children with IQs below 20.
The Friends-Who-Care procedure may be ineffective if the child hasn't formed attachments to specific people or cannot identify named individuals. In these cases, the parent should rely entirely on their own approval. For retarded children, manual guidance will be needed more extensively, gestures should always accompany speech, and instructions must remain very simple. Longer periods of sitting on the potty are required, and if the child is in an institution, special procedures are needed to ensure consistent implementation by staff members. The authors refer readers to their more specialized book, "Toilet Training the Retarded," for detailed guidance on severely retarded individuals.
Question 25: What is "Cleanliness Responsibility" and how is it taught?
Cleanliness Responsibility is the fourth procedure implemented after a pants-wetting accident, designed to educate the child to assume responsibility for remedying their untidiness. After verbal disapproval, Positive Practice trials, and Wet-Pants Awareness, the parent requires the child to change into clean, dry pants independently rather than changing them. The parent may provide minimal manual guidance for leg placement but should ensure the child does most of the work themselves.
The child must remove the wet pants, carry them to the soiled-clothes hamper and place them there, obtain dry pants from an accessible location, and put them on. If urine has caused noticeable wetness on the floor, the child must get a sponge or cloth and wipe up the wetness immediately to prevent staining. This procedure teaches the child why parents are concerned about pants wetting and trains them to correct any accidents in the future. It educates the child that cleanliness is their personal responsibility, not something others should handle for them, which is an important component of the overall toilet education.
Question 26: How should outdoor accidents or accidents during trips be handled?
Outdoor accidents are more common than indoor ones because children may be preoccupied with outdoor activities, the house doors may be difficult for them to open, and they may be wearing heavy outdoor clothing that's hard to remove. To reduce these accidents, parents should ask if the child needs to use the potty before leaving the house, ensure easy entrance into the house, and dress the child only in outdoor clothing they can remove independently.
When outdoor accidents do occur, parents should follow the same procedures as for indoor accidents: reprimand the child (without anger), conduct Positive Practice trials, and have the child change their pants. The Positive Practice trials should start from the outdoor location where the accident happened, which helps identify what aspect of the novel outdoor situation may have caused the problem. For longer trips away from home, parents should take the potty chair with them or teach the child to ask for assistance in using an adult-sized toilet. For short trips under an hour, simply ask the child to use the potty before leaving.
Question 27: What pre-training experiences can help prepare a child for toilet training?
Several pre-training experiences can prepare a child for successful toilet training at an earlier age. First, parents should have the child assist in dressing and undressing, especially in lowering and raising pants. Even if the child cannot complete the entire process unassisted, they should be encouraged to perform parts of it, such as pulling pants up to the waist after the parent has guided their feet through the leg openings.
Second, the child should be allowed to watch family members toilet themselves, with parents pointing out the steps: "Look, I'm going to the toilet; see, now I'm pulling my pants down." The child can even assist by flushing the toilet afterward. Third, parents should teach toilet-related vocabulary words such as "potty chair," "pants," "wet," "dry," "sit down," "stand up," and preferred terms for urination and defecation. Finally, the child should learn to cooperate in following instructions generally, with parents ensuring that directions are followed, praising attempts, and not allowing tantrums to discourage completion of instructed actions.
Question 28: How should a parent manage distractions and interruptions during training?
To create an effective training environment, the parent must eliminate all distractions and avoid interruptions. Radios and television sets should be turned off, and all toys and games should be removed from the training area. If the telephone rings, the parent should ignore it or briefly explain to the caller that they'll call back later. Meals should be planned for quick preparation, or better yet, prepared before training begins. If visitors arrive, the parent should politely explain they're preoccupied and return immediately to the child.
Siblings and other adults should be out of the house during training, perhaps by arranging care elsewhere on a weekend. If another adult must be present, they should actively assist rather than merely observe, focusing their communication on the child rather than conversing with each other about unrelated topics. The child may introduce distracting topics, such as noticing the weather or asking about television, but the parent should redirect the conversation back to toilet training. This complete focus conveys the importance of the training and prevents the child's attention from wavering.
Question 29: What should be done if a child is not completely trained in one day?
If training isn't completed within one day, the parent should leave the child in training pants at the end of that first day rather than returning to diapers. Throughout the remainder of the day and evening, the parent should periodically remind the child to keep dry by using the potty and not to wet their pants. If accidents occur, the parent should follow the standard accident procedure with reprimand, practice trials, and self-changing.
The next day, training should resume at the same point where it ended the previous day. For example, if the child was responding to general suggestions about going to the potty at the end of day one, the parent shouldn't revert to giving direct instructions on day two. The book emphasizes that most children learn the method in less than a day (averaging 3-4 hours), but acknowledges that a small proportion may require more time. The key is maintaining consistency in expectations and procedures across days rather than starting over or abandoning the training.
Question 30: What is the documented success rate and effectiveness of this method?
The Azrin-Foxx method demonstrated remarkable success in formal studies conducted by the authors. In their evaluation involving approximately 200 children (with one-sixth participating in a formal study), all children who were at least 20 months old, somewhat responsive to instructions, and whose parents desired the training were successfully trained without exception. The only exceptions were two children whose fathers actively opposed the training, suggesting parental alignment is important for success.
The effectiveness extended beyond initial training, with follow-up reports showing maintained benefits for as long as two years (the maximum follow-up period). Accidents were reduced by 90 percent on the first day after training, 95 percent by the third day, and 99 percent by the end of one week. The rare subsequent accidents were usually attributable to understandable complications such as illness or overly tight clothing. The method was effective for both genders and across age ranges, though slightly faster results were observed with girls and with children over 26 months of age. The completeness of training was also notable—children learned not just to urinate in the potty when placed there, but to independently execute the entire toileting sequence without reminders or assistance.
I appreciate you being here.
If you've found the content interesting, useful and maybe even helpful, please consider supporting it through a small paid subscription. While everything here is free, your paid subscription is important as it helps in covering some of the operational costs and supports the continuation of this independent research and journalism work. It also helps keep it free for those that cannot afford to pay.
Please make full use of the Free Libraries.
Unbekoming Interview Library: Great interviews across a spectrum of important topics.
Unbekoming Book Summary Library: Concise summaries of important books.
Stories
I'm always in search of good stories, people with valuable expertise and helpful books. Please don't hesitate to get in touch at unbekoming@outlook.com
For COVID vaccine injury
Consider the FLCCC Post-Vaccine Treatment as a resource.
Baseline Human Health
Watch and share this profound 21-minute video to understand and appreciate what health looks like without vaccination.
Some time ago I read adult diapers outsold infant diapers in Japan & probably that trajectory will apply around the world soon. May need to develop a technique for the adult diaper folks?
I used this book and method with my daughter back in 1979. Worked perfectly. She never had a mishap with the bathroom. She was 18 months.