Many people have sent me this article or want to know my thoughts regarding this. My first thoughts are "Nuh-uh. That's makes no sense." I realize that this man is a doctor, which for some people, makes him automatically right but I also know that he's really scaring a lot of people with a bad message. This is a very serious (and long) post and I ask you to read it carefully.
First: please read the whole article (linked above). And please read the comments. They will give an idea of what's wrong with his logic. Many of the people who commented are pediatricians and family physicians. Though I've read his book, what I'm going to do here is specifically break down this particular article, since these are his major talking points in most of his publicity.
I'd like you to bear in mind a few things. I think this doctor is doing tremendously good work with a small population of very troubled clients. He treats thousands a year, which sounds like a large number. I help potty train thousands a year. There are roughly 8 million children in the USA alone in the potty training age range. THERE'S NO WAY POSSIBLE any one person could know something sweepingly across the board. Given the range of factors that go into individual potty training: personality, parenting, genetics, what "type" of kid you have and when you choose to do it, it seems impossible to me that he can make such generalizations, but he does. So, without further ado:
WHAT HE STATES: Chronic holding is a damaging habit, and in my experience, children trained early -- especially before age 2 -- are more prone to developing this habit than kids trained around age 3, though kids trained later are certainly not immune from holding, and early trainers are not destined to become holders.
WHAT'S OFF: That 3 years is the norm for potty training. This is the first generation of parents who are considering 3 years the normal age for potty training. Though Dr. Hodges is not paid by a diaper company...this new normal age is due to the convenience of disposable diapers. For generations, children were potty trained in the 18-24 month age range. Though I appreciate his experience, if what he's saying is true there would be TONS more issues throughout the ages.
WHAT I FIND IN MY OWN WORK: Yes. Chronic holding IS a damaging habit. Chronic. Many children in the first few weeks of potty training have what I call "performance anxiety". This is not chronic holding.
WHAT HE SAYS: He cites studies. Very good. Did you read them? They state that the colon can be extremely distended and that constipation can be happening, even when there are no symptoms. That constipation can be causing pee accidents. That's very good information to know.
WHAT'S OFF: I feel he puts them out there as though they are conclusive findings to the correlation to potty training. They are not.
WHAT HE SAYS: Once kids learn to put off peeing and pooping, essentially the definition of toilet training, they tend to do so often and for as long as they can. Children -- and I mean all children -- don't like to interrupt their lives to use the bathroom. This is problematic, because each time you squeeze your sphincter to prevent the release of pee, you create resistance in your bladder.
What happens when muscles go up against resistance? Exactly what happens when you train your hamstrings at the gym: They get thicker and stronger.
WHAT'S OFF: I can't wrap my head around this one. Given what he's saying, you would think all the kids potty training are magically holding their pee for hours the day you start potty training. Is that YOUR experience? It's not mine. The kid who doesn't want to leave what he's doing will usually pee on the floor. WHAT'S REALLY OFF: His idea of muscle development. Yes...when you repeatedly lift heavy weights at the gym, you're muscles will thicken and get stronger. But holding and releasing is not lifting heavy weights. I do KEGELS. I even have the KEGLEciser ...a handy little barbell for the vaginal area. You practice Kegels so when you're my age, you don't do little pee-pees when you sneeze. Practicing holding and releasing doesn't thicken sphincter muscles. IT DEVELOPS THEM SO THEY WORK PROPERLY.
Other muscular analogies: we develop proper muscles through the use of a particular activity using that activity. We develop the muscles to walk, by walking. We don't keep a child in a seat until his muscles are formed. That would lead to atrophy of those muscles needed.
Good preschools, including Montessori, have children do specific tasks to build the muscles needed in writing, like using chopsticks and pulling tape off a roll. These help develop the muscles needed for the next task of writing. Kindergarten teachers can tell in an instant if a child doesn't have those muscles developed.
WHAT I'VE FOUND IN MY OWN WORK: I have found the complete opposite to what Dr. Hodges is saying. If the child's muscles fully form and then you potty train, that child is much prone to accidents. I see this in almost every child who BEGINS potty training over 3 and half. The potty training struggles are massive and there is much more chronic bed wetting. Again, I know many people say they potty trained effortlessly after 3 years old. I just haven't seen it in my work. I'm just allowing for all the different experiences here. In fact, my point here is that his experiences are not law.
Yes. I have clients whose children who hold a long time. BUT, far, far more children have accidents when learning to potty train. Most kids will scream out PEE in the middle of church and the market. He claims the child won't leave watching Rapunzel. How many of you just get pee on your couch? I just don't see this child; the one who can seriously hold his pee through a fun activity because he doesn't want to leave it.
But I also am curious: how long is too long? My best friend's husband pees once in the morning and once in the evening. Never had a problem. How do we know how long is long? Every child is different.
WHAT I'VE SUPER FOUND: I think of the release and holding as a switch. I definitely think some kids get their holding switch stuck on "on". I can tell this type of kid pretty quickly and we move in to fix it equally quickly. A KID PRONE TO HOLDING IS GOING TO BE PRONE TO HOLDING AT ANY AGE. So you can wait till he's 3 or 4, but he's still going to be prone to holding and you will need to deal with it. I fully agree with the doctor that this happens and usually needs an aggressive treatment. In my experience, this is not due to potty training. This is a "type" of child. And if you suspect you have this type of child, you should seek help.
WHAT HE SAYS: Perhaps you're thinking: My kid isn't constipated -- she poops every day. Well, many constipated kids poop regularly, even multiple times a day. Large poop masses in children typically go unnoticed because looser poop oozes by and finds a way out more easily than the hard stuff, giving the impression that the child has fully eliminated.
This is what happened with Zoe Rosso, the 3 ½-year-old who was suspended from a Virginia preschool for "excessive" potty accidents and who is now my patient.
As it turned out, Zoe had a poop mass the size of a Nerf basketball stuck in her rectum, though both her pediatrician and pediatric urology clinic missed it. Because Zoe's bowel habits were normal, they did not X-ray her.
WHAT'S OFF: Nothing! His now famous work with Zoe is amazing to me. When I first read about this, I was so relieved that someone was doing this work. I was stoked...I wrote down his name. Finally! It makes such good sense that you would xray a child's colon to check. And many people write into me with similar situations to Zoe's, so I was thrilled to this information and the doctor's name to pass on.
WHAT I'VE FOUND IN MY OWN WORK: I have always known that backed up poop can put pressure on the bladder and cause random accidents. But my work is mostly in the first few weeks of potty training and helping your child overcome any potential fear or problems they may have. However, over the course of many years and thousands of kids, I've had exactly 3 cases that would fit Zoe's situation. I actually sent those 3 clients to Dr. Hodges. None of them liked this potty training message and thought he was suspect. I'm actually MAD at this doctor. He's blocking his own good work with an inflammatory message. HERE'S MY SOLUTION: If you think you have a holder and you can't find out until you do: why not just recommend an xray? Or better yet, recommend an xray at wellness visits. I don't understand the huge leap of this problem to potty training. CORRELATION IS NOT CAUSATION.
WHAT HE SAYS: Perhaps you've read about studies demonstrating that late training causes more accidents. Maybe you want to post them in the comments section. Don't bother! I've read them all. Instead, call up the authors and ask if they used X-rays to make sure the children who trained late weren't also constipated (a common cause of the accidents and also of late training). Not to spoil the surprise, but they will tell you, "No, we didn't."
WHAT'S OFF: I think this was directed to me personally, since in the comments of another article of his, I did indeed link this, after which, comments were closed. "Incontinence is more associated with kids who potty train after 32 months". What the doctor says at this point in the article makes no sense: He says to wait until a child is 3, that will automatically take care of this. This study was with kids over the age of 32 months. There should be no reason to call the authors....also, PEDIATRIC UROLOGISTS to ask if they xrayed. Why would they? And if those kids ARE blocked up with poop, then my theory holds. If your kid is a holder, he's going to be a holder at 2, 3, 4 or 5 regardless of when you potty train.
WHAT I FIND IN MY OWN WORK: I absolutely find in MY work, more accidents and bed wetting happens when you potty train after 3. I'm not saying it's law and if you've had a different experience; that is awesome.
WHAT HE SAYS: Do you know how often I see children who are still in diapers and have recurrent UTIs? Never. That's right, never. Do you know how often I treat newly potty-trained children for recurrent UTIs? Every day.
WHAT'S OFF: I'm thrilled he doesn't see UTIs with kids in diapers, but his stance seems to be that it never happens. That's a bold face lie. Children prone to UTIs get them in diapers. And diapers may help a child who's a holder but it's a breeding ground for bacteria. There are many causes of UTIs, not just holding pee. Again, CHRONIC holders...yes. But how do you do you know if your child is a chronic holder or just good at holding? Consult with your pediatrician or a potty training expert.
WHAT I FIND: I have clients who have little camels. A child good at holding pee is not necessarily holding pee to the point of damage. I also know of children who can hold their pee for over a day. That is a problem. Yes. But holding pee for a few hours is not going to cause a UTI...unless your child is particularly prone to them. I have never seen a potty training kid get a UTI. Again...just in MY work.
I'm exhausting myself here so I'll hit just a couple more outstanding pieces of what doesn't make sense to me.
I believe in potty training when kids are ready -- when they show an interest and can tell you when they are peeing or pooping -- and I believe that few kids are genuinely ready before age three. I disagree on the age. The sweet spot is around 2. I'm not saying anyone is wrong for waiting until later. I'm not attacking anyone's choice of when they choose to potty train. I just find it miserable to potty train after 3 for behavior purposes. Once individuation hits...good luck getting your child to say yes to just about anything you ask of them.
Make sure your child's poops are mushy before you start training.
I mean mush, like mashed sweet potatoes or hummus. The sure way to sabotage the process is to try to toilet train a constipated kid. If your child's poops are formed, like logs or pebbles, or become formed during the toilet-training process, your child is constipated, and you should get her pooping chocolate pudding for several months before you attempt training. Extra-large poops also are a red flag. Pebbles are bad and I call them angry poops. But, I think I speak for most of my clientele who is largely very conscious of healthy eating...HUMMUS AND CHOCOLATE PUDDING POOPS? Seriously??? We left those behind with breast milk. WHO HAS A 2 OR 3 YEAR OLD with chocolate pudding poops? I have never seen this. I think there's a lot of room between hummus and constipated.
Okay. I'm tired of talking (and that never happens). I actually have a lot more to say and will most likely add a chapter to my book. This doctor makes my head spin. I can not state enough how great I think it is that he discovered something as simple as an xray can completely eliminate a potential serious problems with kids. In his book, he says a great deal about diet. But he doesn't in his publicity. In my opinion, he picked a really touchy subject to get just that: more publicity. If you are having big trouble with potty training...by all means...wait until your child is older. It makes no difference to me and I have no judgement. But for those of us who are doing it in what used to be the normal age range, I ask this doctor to stop making such broad sweeping SCARY remarks. It's polarizing in the opposite direction. He says late potty training leads to ridicule and yet he seems to be ridiculing any one who potty trains in a normal time frame. He completely negates infant potty training, even though countless have done this for years with no issue and he does so with a snide attitude.
There are many factors in why a child will hold his pee or poop. Besides being that kind of kid, you may be putting too much pressure on your child. It's possible to potty train without pressure. Your child may need a deeper squat. Or may have food allergies. I simply don't see how the whole shebang can be laid at potty training's feet.
And I ask YOU to do some research and follow soundbites into ideas. One of the most disturbing things about this whole article is that people are walking away with a soundbite and no thought. We can't do that...especially as parents. I encourage you to buy his book, if you suspect you have a holder. He's really doing good work with the population that needs it.