Toilet training is accomplished when a child uses a potty chair or toilet for bladder and bowel functions during waking hours. Nighttime bladder control usually occurs later because it requires the ability to suppress the urge to void during sleep or the advanced skill of awakening from sleep to the signal of a full bladder. Even at 6 years of age, 10% of children still wet their bed.
Successful toilet training is good for both parents and children. Not having to change diapers and wash off a bottom frees up considerable parental time. (And, lest we forget, some parents still wash diapers.) Toilet training also saves a significant amount of money. In bulk, disposable diapers cost about 25 cents each; pull-ups, 40 cents. Once a child is toilet trained, the options for travel, babysitters, day care, and preschool multiply. From the child's standpoint, using the toilet can enhance a sense of mastery and self-esteem as well as prevent the discomfort of diaper rash. From a medical standpoint, using the toilet reduces the spread of enteric pathogens such as Giardia and Rotavirus.
Yet many parents in the United States postpone toilet training. The predominant reason seems to be the availability of disposable diapers. Manufacturers of disposable diapers and pull-ups now market large-sized pull-ups, so not being toilet trained at 4 years of age is not a problem. In advertisements, children in pull-ups are extremely happy. Delayed toilet training has been legitimized, and that's good for business. Other factors are busy, dual-career families and normal procrastination.
To keep toilet training in perspective, remember that more than 50% of children around the world are toilet trained at about 1 year of age. (1) They are toilet trained by necessity because many families can't afford disposable diapers and don't have the time or facilities to wash cloth diapers. In my experience, even in the US, low-income families toilet train their children earlier than the middle class. Single mothers also toilet train their children earlier. (2)
The age of onset and completion of toilet training
The timing of starting and completing toilet training in the US has been changing (Table l). (3) Some parents are unaware that toilet training before 2 years of age is even possible. Some have been advised by their health-care provider not to start toilet training before 3 years. Has the pendulum swung too far? Let's review three studies.
The largest study in this country was reported by Brazelton in 1962 on 1,170 children in Boston (Table 2). (4) Toilet training was begun by 18 months of age in 19% of the children, by 21 mouths in 40%, and by 24 months in 94%. Using Brazelton's child-oriented, gentle, and gradual approach to toilet training, 26% of the children were trained by 24 months, 52% by 27 months, 85% by 30 months, and 98% by 36 months. The sequence of completed training was bladder and bowel control simultaneously in 79.5% of the children, bowel control first in 12.3%, and bladder control first...
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