Potty Learning Isn’t Just Physical: Why Emotions, Autonomy, and Play Matter
Potty learning can feel like one of the biggest milestones in early childhood — and one of the most stressful. Many parents worry about when to start potty training, how to know if their child is ready, and what to do when challenges like potty refusal or accidents happen.
While potty learning is often treated as a simple developmental step, the reality is more complex. For many children, learning to use the bathroom involves emotional readiness, body awareness, and a growing sense of independence.
To help families better understand the process, we spoke with Dr. Savannah Carlson, a pediatric pelvic floor physical therapist and the founder of Rhea Physical Therapy in St. Louis, Missouri. Savannah specializes in helping children with bowel and bladder challenges, including constipation, accidents, and difficulty with potty learning.
Her biggest message for parents? Potty learning is about far more than just getting pee or poop in the potty.
“It’s not just a physical accomplishment,” Dr. Savannah explains. “Potty learning involves cognitive skills, emotional readiness, and a child’s sense of safety and autonomy.”
Understanding these pieces can make the process less stressful for families.
Potty Learning is a Whole-Body Developmental Skill
Many people think potty training is simply about learning to use the toilet. But developmentally, several important skills are happening at once.
First, children must learn interoception—the ability to notice signals from their body.
“They have to recognize a situation like pressure in the belly or bladder. Then, they have to decide to act on that signal.”
That means potty learning involves a multi-step cognitive process:
Noticing the body signal.
Understanding the body signal means they need to pee or poop.
Choosing to respond by going to the bathroom.
These are brand-new cognitive skills for toddlers.
Emotional regulation also plays an important role. Children must learn that it’s okay to pause a preferred activity, like playing a game or watching a show, to take care of their body.
“For some kids, there’s a real fear of missing out,” Dr. Carlson says. “They worry that if they leave to use the potty, they’ll miss something important.”
Feeling secure that they can leave an activity and return safely is an important emotional step in potty learning. This is one reason play therapists often see potty struggles connected to bigger themes like control, anxiety, or transitions.
Why Autonomy Matters During Potty Learning
Potty training often happens at the same stage where children are seeking more independence.
Because of this, the process can sometimes feel like adults are taking control of their body and time.
“If a child doesn’t yet recognize their body signals, it may feel like a parent is interrupting them for no reason,” Savannah explains.
When that happens, resistance can appear quickly. Children may feel that adults are imposing a responsibility they don’t yet understand — especially during a time when they are learning to make their own choices.
Supporting autonomy—rather than forcing compliance—can help reduce power struggles during this stage. This can make potty learning feel safer and more collaborative.
Parents can encourage independence by:
Letting children choose their potty seat or step stool
Allowing them to pick out special soap or towels
Offering choices such as “Do you want to try the potty now or in two minutes?”
These small decisions help children feel more in control of the process. When autonomy and safety are present, children are more likely to engage in learning new skills.Learn how to support your child’s autonomy in a safe, age-appropriate way with our therapeutic parent coaching, personalized to you and your child.
A Common Parent Reaction That Can Add Pressure
Many parents celebrate when their child successfully uses the potty — which is important. But focusing only on the final result can sometimes add pressure.
“In our culture, we often praise the final result — the pee or poop in the potty. But we don’t always acknowledge the steps that lead up to that moment,” says Dr. Carlson.
For example, a child may first:
Notice the body sensation
Stop what they are doing
Walk to the bathroom
Sit on the potty
Give their body time to try
Those actions represent major developmental progress. When praise focuses only on the outcome, children may feel rushed or pressured to produce results. That can create stress around bowel or bladder movements.
Instead, Dr. Savannah encourages parents to celebrate the effort and the process.
“You can say things like, ‘That was awesome how you paused your game to go try the potty,’” she suggests.
Focusing on the process helps children build confidence and reduces anxiety around bathroom routines.
Why Play is One of the Best Potty Learning Tools
Children naturally explore the world through play. Because of this, play can be one of the most effective ways to make potty learning feel safer and more familiar.
For many kids, the bathroom can feel intimidating or even scary.
“The toilet is loud, things disappear with a flush, and kids don’t always understand where everything goes,” Dr. Carlson says. Play helps reduce that fear.
Some playful strategies she recommends include:
Bringing a stuffed animal “helper” or “companion” into the bathroom
Keeping special books or toys that are only used during potty time
Singing songs while sitting on the potty
Blowing bubbles (which also encourages helpful breathing patterns)
“Play allows children to practice a very adult skill in a developmentally appropriate way,” Dr. Savannah says. “A child’s occupation is play.”
This is also why play therapists sometimes support families during potty challenges. Through play therapy in St. Louis, children can safely explore fears, body awareness, and emotional regulation.
Signs Your Child is Ready for Potty Learning
Parents often feel pressure to start potty training early. In reality, readiness varies widely between children.
Children typically begin noticing bladder and bowel sensations sometime between ages one and two. However, most children are developmentally ready to begin potty learning between ages two and three.
Signs of readiness may include:
Curiosity about the bathroom
Telling you when they are wet or soiled
Staying dry for longer periods
Wanting to imitate adults or siblings
Following simple instructions
Even when these signs appear, potty learning still takes time.
“We don’t expect children to be fully potty trained during the day until around age five,” Dr. Carlson explains.
That means occasional accidents at three or four are still developmentally typical.
Common Potty Training Challenges
Two of the most common issues Dr. Carlson sees are potty refusal and constipation.
Potty refusal often happens when children feel fear, pressure, or a loss of control. They may refuse to sit on the toilet or only go in a diaper or pull-up.
Leading with curiosity can help uncover the underlying reason. Parents might ask:
“What did it feel like when we tried the potty?”
“Is there something about the potty that feels scary?”
Another frequent issue is constipation. Sometimes a child experiences a painful bowel movement during early potty learning. Even one uncomfortable experience can create fear about pooping again. Children may begin holding stool, which makes constipation worse and creates a cycle of discomfort.
Improving stool consistency through hydration, diet, or medical support can help create more positive bathroom experiences.
When to Consider Extra Support During Potty Learning
Most children gradually develop potty skills over time. However, some situations benefit from extra support.
Pelvic floor physical therapy can help children with:
Ongoing constipation
Frequent accidents
Recurrent urinary tract infections
Difficulty recognizing body signals
Play therapists can help your child process emotional factors connected to potty learning, such as:
Persistent potty refusal
Anxiety around the bathroom
Regression during big life transitions
Strong fears related to body functions
In many cases, addressing both the physical and emotional pieces together helps children move forward more comfortably.
Bud to Bloom’s Pelvic Floor Therapy Referral
We’re honored and happy to refer families who work with us to Dr. Savannah at Rhea Physical Therapy. She first became interested in pediatric pelvic health as a PT student while working with families struggling with potty problems like chronic constipation and bed wetting. Through this experience, she began to understand the toll potty problems take on the entire family, as well as the life-changing impact of pelvic physical therapy for kids and their caregivers.
Dr. Savannah founded her private practice in 2023 after spending her early career at St. Louis Children’s Hospital. She earned her doctorate in physical therapy at Washington University in St. Louis, and she has a certificate of advanced practice in pelvic health PT. She is also a certified perinatal coach and registered yoga instructor. Last but not least, Dr. Savannah is a mom to a rambunctious toddler.
Free Potty Learning Workshop for Parents
Bud to Bloom Play Therapy in St. Louis, Missouri is thrilled to collaborate with Dr. Carlson to offer a FREE workshop for parents on this very topic!
Potty training learning can be stressful—even traumatic—but it doesn’t have to be. Leading with curiosity, learning through play, and understanding development can help you turn this process into a positive and joyful experience for your little one. In this workshop, you will learn:
Age-based norms to help you set reasonable expectations
The “what” and “how” of using the bathroom: it’s not as simple as it appears!
How to know if your child is truly ready
Strategies to make potty learning fun and successful
Common struggles and how to manage them
When to seek help
Offered virtually, parents from across the Midwest can join us for one free hour of learning and connection. This workshop will be held on Friday, May 15th, at 6 PM. Register below to receive the link to join.
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Most children begin developing awareness of bladder and bowel sensations between ages one and two, but many are not developmentally ready to start potty learning until ages two to three. Full daytime potty independence often develops closer to age five. Every child’s timeline is different. Starting before a child is cognitively and emotionally ready can lead to frustration, resistance, or accidents.
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Potty refusal is very common and often connected to fear, loss of control, or uncertainty about body sensations. Some children feel anxious about the toilet itself, while others worry about missing out on activities or feel pressured by adults. Leading with curiosity and reducing pressure can help. If refusal lasts for months or causes significant stress, support from a play therapist or pelvic health provider may help uncover what’s happening beneath the behavior.
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Yes, constipation can be one of the most common challenges during potty learning. Sometimes a child experiences a painful bowel movement and begins holding stool to avoid discomfort. This can create a cycle where stool becomes harder and more painful to pass. Increasing hydration, fiber, and supportive routines can help. If constipation persists, pediatric pelvic floor physical therapy can help children relearn healthy bowel habits.
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Play therapy can help when emotional factors are affecting potty learning. This might include persistent potty refusal, anxiety about the bathroom, regression after a life change, or strong fears about body functions. Because young children communicate through play, therapy can help them safely express concerns and build coping skills. Addressing the emotional side of potty learning often makes the physical process easier for children.
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Some potty challenges are normal, but certain signs may benefit from extra support. Consider consulting a provider if your child has ongoing constipation, repeated urinary tract infections, months of potty refusal, or frequent daytime accidents after age five. Bedwetting past age seven may also benefit from evaluation. Pediatric pelvic floor physical therapy and play therapy can work together to address both the physical and emotional aspects of potty learning.
