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Toilet Training
- Epidemiology
- Now: Toilet training occurs at a later age than in the past
- Previously training started at age 18 months and now starts at 21-36 months
- Toilet training is completed in only half of 36 month olds
- Prior: Usually occurs by end of third year (mean 2.5 years)
- Age 24 months: 26% daytime continence
- Age 30 months: 85% daytime continence
- Age 36 months: 98% daytime continence
- Gender impact on timing
- Girls often toilet train earlier than boys
- Now: Toilet training occurs at a later age than in the past
- Signs: Toilet-Training Readiness
- Child asks to wear underwear or to use toilet
- Able to put on and take off clothes, as well as more simple skills (sit, walk)
- Autonomy (e.g. Says 'No')
- Follows simple commands
- Observes parents using toilet
- Imitates parent's behavior
- Wants a clean diaper when soiled
- Diaper stays dry for at least 2 hours and after naps
- Bowel Movements occur at predictable times and are regular
- Child indicates they need to urinate or defecate
- Management: General (based on AAP, Dr Spock and Dr Brazelton methods)
- Start toilet training when signs of readiness (see above)
- Typically after 18 months
- Dr. Spock recommends after 24-30 months
- Offer positive reinforcement (praise)
- Process should be pleasant and non-threatening
- Avoid punishment, shaming or use of force
- Avoid negative comments or shaming
- Child uses potty-chair voluntarily
- Bring to potty-chair 2-3 times daily once child shows interest
- Start toilet training when signs of readiness (see above)
- Management: Specific Methods
- Brazelton Child-Oriented Toilet Training Method
- Azrin and Foxx Toilet Training Method (Toilet Training in A Day Method)
- Negative reinforcements incorporated in this method are discouraged by many pediatricians
- Method appears effective and can be modified to exclude negative reinforcements
- Complications
- See Enuresis
- See Encopresis
- Toilet training refusal
- Often related to Constipation and associated painful stools
- Consider fiber supplementation and Stool Softeners
- Describe stool in positive terms
- Positively reinforce stooling in diaper
- Stool withholding
- Similar management as toilet training refusal
- Aggresively manage Constipation
- Resources
- AHRQ Toilet Training Method Review
- References
Toilet Training (C0040365) | |
|---|---|
| Definition (MSH) | Conditioning to defecate and urinate in culturally acceptable places. |
| Concepts | Educational Activity (T065) |
| MSH | D014039 |
| English | Child continence training, Toilet Training, Toilet Trainings |
| Spanish | entrenamiento de la continencia en el nino |
| Parent Concepts | child-rearing practice (C0680053), Child Rearing (C0008091), Urinary bladder training (C0150474), Child health procedures (C0729313) |
| Sources | AOD, LCH, MSH, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
