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American Family Physician Nov 2008Toilet training is a developmental task that impacts families with small children. All healthy children are eventually toilet trained, and most complete the task without... (Review)
Review
Toilet training is a developmental task that impacts families with small children. All healthy children are eventually toilet trained, and most complete the task without medical intervention. Most research on toilet training is descriptive, although some is evidence based. In the United States, the average age at which training begins has increased over the past four decades from earlier than 18 months of age to between 21 and 36 months of age. Newer studies suggest no benefit of intensive training before 27 months of age. Mastery of the developmental skills required for toilet training occurs after 24 months of age. Girls usually complete training earlier than boys. Numerous toilet-training methods are available. The Brazelton child-oriented approach uses physiologic maturity, ability to understand and respond to external feedback, and internal motivation to assess readiness. Dr. Spock's toilet-training approach is another popular method used by parents. The American Academy of Pediatrics incorporates components of the child-oriented approach into its guidelines for toilet training. "Toilet training in a day," a method by Azrin and Foxx, emphasizes operant conditioning and teaches specific toileting components. Because each family and child are unique, recommendations about the ideal time or optimal method must be customized. Family physicians should provide guidance about toilet-training methods and identify children who have difficulty reaching developmental milestones.
Topics: Child; Child Development; Guidelines as Topic; Humans; Toilet Training; United States
PubMed: 19007052
DOI: No ID Found -
American Family Physician Oct 2019
Topics: Adult; Child, Preschool; Female; Humans; Infant; Male; Parent-Child Relations; Parents; Surveys and Questionnaires; Toilet Training; United States
PubMed: 31613579
DOI: No ID Found -
Pediatrics in Review Jun 2010
Review
Topics: Age Factors; Child Behavior; Child, Preschool; Cultural Characteristics; Female; Humans; Infant; Male; Parent-Child Relations; Pediatrics; Sex Factors; Toilet Training
PubMed: 20516240
DOI: 10.1542/pir.31-6-262 -
Journal of Developmental and Behavioral... Aug 2022Although the challenges of toilet training for children and adolescents with Down syndrome (DS) are well-known, details such as specific associations with comorbidities...
OBJECTIVES
Although the challenges of toilet training for children and adolescents with Down syndrome (DS) are well-known, details such as specific associations with comorbidities and related exacerbating factors are lacking. This study aims to characterize the nature of toilet training in a cohort of children and adolescents with DS and evaluate characteristics and comorbid conditions that may contribute to or prolong toilet training success in those with DS.
METHOD
This was a retrospective, cross-sectional study investigating toilet training in children and adolescents with DS. A survey was completed by 137 patients' parents or guardians as part of their care experience in the clinic.
RESULTS
Although toilet training on average began at age 3.40 years (SD = 1.47), children and adolescents with DS typically began telling caregivers they needed to use the toilet at 4.80 years (SD = 2.11), no longer used diapers during the day at 5.03 years (SD = 1.98) and night at 5.88 years (SD = 2.48), and were described by their caregivers as being fully toilet trained at 6.60 years (n = 28; SD = 2.43; range = 3.00-14.00 years). There was a linear trend in the age groups between 2 to 4 years (n = 37), 5 to 7 years (n = 42), 8 to 12 years (n = 39), and 13 to 17 years (n = 19) and the proportion of children and adolescents fully toilet trained (2 to 4 years = 0.040, 5 to 7 years = 0.211, 8 to 12 years = 0.278, and 13 to 17 years = 0.529). Typical readiness signs that children and adolescents with DS display and those most predictive of toileting success are reported. Placing the child on a schedule was the most successful (45.2%) training method identified by parents, with 55.8% of the families trying this approach. Children and adolescents aged 8 to 12 years with behavioral challenges were more likely (75.0%) to have daytime accidents compared with those without (25.9%), p = 0.006.
CONCLUSION
Children and adolescents with DS in this sample started toilet training at 3.4 years and completed toilet training at 6.6 years. Even after completing toilet training, many children and adolescents continue to require support from their caregivers with some aspects of toilet training. Skill loss associated with various life events, behavioral challenges, medical diagnoses, and inconsistencies in toileting expectations across settings are factors caregivers believe contribute to delayed toilet training. Caregivers found that a consistent toileting schedule, using reinforcers, and providing prompting to use the toilet were the most successful methods.
Topics: Adolescent; Child; Child, Preschool; Cross-Sectional Studies; Down Syndrome; Humans; Parents; Retrospective Studies; Toilet Training
PubMed: 35026787
DOI: 10.1097/DBP.0000000000001058 -
American Family Physician Oct 2019Toilet training is a significant developmental milestone in early childhood. Most U.S. children achieve the physiologic, cognitive, and emotional development necessary...
Toilet training is a significant developmental milestone in early childhood. Most U.S. children achieve the physiologic, cognitive, and emotional development necessary for toilet training by 18 to 30 months of age. Markers of readiness for toilet training include being able to walk, put on and remove clothing, and follow parental instruction; expressive language; awareness of a full bladder or rectum; and demonstrated dissatisfaction with a soiled diaper. Other readiness cues include imitating toileting behavior, expressing desire to toilet, and demonstrating bladder or bowel control (staying dry through a nap or through the night). Physicians should provide anticipatory guidance to parents beginning at about 18 to 24 months of age, noting the signs of toilet training readiness, and setting realistic expectations for parents. Parents should be counseled that no training method is superior to another. Parents should choose a method that is best suited to them and their child, and the method should use positive reinforcement. Complications of toilet training include stool toileting refusal, stool withholding, encopresis, hiding to defecate, and enuresis. These problems typically resolve with time, although some may require further investigation and treatment. Medical comorbidities such as Down syndrome, autism spectrum disorder, and cerebral palsy reduce the likelihood of successfully attaining full toilet training and often require early consultation with occupational therapists, developmental pediatricians, or other subspecialists to aid in toilet training.
Topics: Adult; Child, Preschool; Curriculum; Education, Medical, Continuing; Female; Humans; Infant; Male; Parent-Child Relations; Parents; Surveys and Questionnaires; Toilet Training; United States
PubMed: 31613577
DOI: No ID Found -
Indian Pediatrics Sep 2016
Topics: Child Behavior; Child, Preschool; Constipation; Humans; Infant; Toilet Training
PubMed: 27771661
DOI: No ID Found -
Jornal de Pediatria 2008To review both the scientific literature and lay literature on toilet training, covering parents' expectations, the methods available for achieving bladder and bowel... (Review)
Review
OBJECTIVE
To review both the scientific literature and lay literature on toilet training, covering parents' expectations, the methods available for achieving bladder and bowel control and associated morbidities.
SOURCES
Articles published between 1960 and 2007, identified via the MEDLINE, Cochrane Collaboration, ERIC, Web of Science, LILACS and SciELO databases plus queries on the Google search engine; a search of related articles, references of articles, by author and of pediatrics societies. A total of 473 articles were examined and 85 of these were selected for this review.
SUMMARY OF THE FINDINGS
Parents have unrealistic expectations about the age at which diapers can be withdrawn, not taking child development into account. Toilet training strategies have not changed over recent decades, and in the majority of countries the age at which children are trained has been postponed. Training methods are rarely used. Starting toilet training prematurely and stressful events during this period can extend the training process. Children who have not been trained correctly present with enuresis, urinary infection, voiding dysfunction, constipation, encopresis and refusal to go to the toilet more frequently. Literature intended for lay parents is both abundant and adequate, available in book form and on the Internet, but it is not widely available to the Brazilian population. Just three international pediatrics societies have published guidelines on toilet training.
CONCLUSIONS
Toilet training is occurring later in the majority of countries. The training methods that exist are the same from decades ago and are rarely used by mothers and valued little by pediatricians; incorrect training can be a causative factor for bladder and bowel disorders, which in turn cause problems for children and their families.
Topics: Child Behavior; Child Development; Child, Preschool; Constipation; Enuresis; Humans; Infant; Parent-Child Relations; Parents; Time Factors; Toilet Training
PubMed: 18264618
DOI: 10.2223/JPED.1752 -
Journal of Pediatric Urology Oct 2022Primary nocturnal enuresis (PNE) affects the quality of life of children and families and may lead to low self-esteem and social isolation. The pathophysiology of... (Review)
Review
INTRODUCTION
Primary nocturnal enuresis (PNE) affects the quality of life of children and families and may lead to low self-esteem and social isolation. The pathophysiology of enuresis is multifactorial. This systematic review aimed to investigate the relationship between toilet training (TT) and PNE in children and adolescents.
METHODS
We searched for articles about TT and PNE in MEDLINE (via PubMed), SCOPUS and WEB of SCIENCE databases. The Preferred Reporting Items for Systematic Reviews (PRISMA) statement was used to guide the systematic review. Prior to the study, the review protocol was registered and approved in PROSPERO under the protocol CRD42021270976. The Risk of Bias in Non-Randomized Studies of Exposures (ROBINS-E) was used to analyze the biases of the select studies.
RESULTS
A total of 570 studies were initially selected. Of these, eight articles were included in this systematic review, with a total number of 5990 participants aged between 5 and 18 years diagnosed with PNE. Seven of the eight articles reported that prolonged use of disposable diapers for more than one-year, late initiation of the TT process or non-acceptance of the Assisted Infant TT or Elimination Communication approach, use of coercive approaches, and complete of TT after 24 months of age increase the risk of enuresis. Only one of the selected studies did not find an association between the start of TT after 24 months of age and the presence of isolated PNE. Three studies did not mention the approach used in the TT process.
CONCLUSION
Most of the articles reviewed showed that prolonged diaper use, delay in the start or completion of the TT and use of coercive approaches increase the risk of enuresis. On the other hand, one study showed no relationship between the start of TT after 24 months of age and the presence of isolated enuresis.
Topics: Child; Adolescent; Humans; Child, Preschool; Toilet Training; Quality of Life; Enuresis; Nocturnal Enuresis
PubMed: 35987679
DOI: 10.1016/j.jpurol.2022.07.033 -
Pediatrics Jan 2004
Topics: Age Factors; Child Rearing; Child, Preschool; Humans; Infant; Time Factors; Toilet Training
PubMed: 14702482
DOI: 10.1542/peds.113.1.180 -
Journal of Developmental and Behavioral... Oct 1994The process of toilet training children has received surprisingly little attention in the medical research literature, and many parents may welcome guidance from their... (Review)
Review
The process of toilet training children has received surprisingly little attention in the medical research literature, and many parents may welcome guidance from their physician on how best to carry out this important parental duty. Theory and prescription for toilet training in the United States since 1900 has traced a pendulum's path between the polar opposites of passive permissiveness and systematic control. Since midcentury, the trend in the United States has been toward delayed toilet-training, typically between the child's second and third year. Like all trends, however, this one may reverse. Given children's developmental differences, a new trend toward early toilet training, if it emerges, may be accompanied by an increase in toilet-training problems. If so, physicians who advise parents and treat pediatric populations may wish to become more familiar with data-based behavioral management of toilet training and the implications of this approach for early toilet training and the treatment of toileting-refusal behavior.
Topics: Behavior Therapy; Child, Preschool; Female; Humans; Infant; Male; Personality Development; Toilet Training
PubMed: 7868706
DOI: No ID Found