Potty Training in children – what should you know about it?

[mme_highlight] Emotional, physical and psychological growth is an important determinant that helps parents in training their children. Healthcare providers suggest that after the second birthday, a child is normally mature enough to understand and tell his parents about his bowel movements. The normal range suggested to start potty training is between 22 and 30 months. [mme_highlight]

Potty training is an important milestone in the life of a child as well as of their parents’ and care-takers’. Most parents want to potty train their child before starting nursery or pre-schools; however, every child is different and the age at which a child learns to hold his bowel movements varies significantly. It is indicated by healthcare providers to start the process long before the schooling age to prevent future problems.

Research conducted by Thi Hoa Duong (3) suggests that children who are potty- trained earlier achieve early bladder coordination of detrusor muscles suggesting that potty training significantly influences micturition reflex as well. Duong also found the data below.

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Date of beginning of potty training (according to a study conducted in Vietnamese children)

70% of mothers begin potty training their baby as early as 3 month of age;
82% of mothers by 6 months;
91% mothers by 9 months;
Almost 100% have begun potty training by 12 months.

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Parents initiate potty training at different ages in different parts of the world; however, research suggests that very early potty training does not improve the outcome.

When is a perfect time to start potty training?

Emotional, physical and psychological growth is an important determinant that helps parents in training their children. Healthcare providers suggest that after the second birthday, a child is normally mature enough to understand and tell his parents about his bowel movements. The normal range suggested to start potty training is between 22 and 30 months. Research study conducted with children who were between 22 and 30 months have shown the age at which potty training is completed.

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Age of completion of potty training

85 to 95% boys get fully potty trained at the age of 38 months;
85 to 95% girls get potty trained by 36 months;
Children continue needing help in cleaning until the age of 4 to 5 years.

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What are the signs that suggest your child is ready for potty training?

It is necessary that the child has successfully passed cognitive and motor developmental milestones specific for the age before starting potty training to avoid overt frustration.

The child can control his bladder and bowel muscles (suggested by regular bowel movements at one time of the day and dry nappies at night or after naps)
The child is willing to work with you in the training process by indicating with signs and words that he needs to go to bathroom.

R.M. Foxx (1) conducted a study on 34 children who were experiencing trouble in potty training. Foxx devised an 8-step program that mainly dealt with maintenance of a distraction free environment, negative reinforcement of accidents and positive reinforcement when a learning goal is achieved. He was able to train all 34 children within 4 hours, suggesting that in the presence of a functional strategy, potty training is not a difficult task. He further concluded that:

All the children who are above 26 months of age require an average of 2 hour potty training to achieve fruitful results
Children as young as 20 months can be trained within hours.

A recent study conducted by Nathan J. Blum (2) suggests otherwise. According to Nathan, if intensive potty training is initiated at an earlier age, results can be achieved earlier; however, if potty training is initiated at an age earlier than 27 months, no additional benefit is achieved. Nathan conducted his study on 406 children younger than 17 months. Telephone interviews were then conducted periodically while children were being toilet trained by parents in domestic setting. Nathan identified that:

The biggest fear of parents (and of the researchers too) that early potty training is associated with a more than normal risk of stool toileting refusal, constipation and stool withholding is not true.
Age of initiation of toilet training is inversely proportional to the total time taken to train kids.

When should a parent seek medical assistance for the child who is not potty trained?

Potty training is dependent on a number of factors that include:

History of developmental milestones. Most babies who are in the normal range of their developmental history are likely to get potty trained earlier.
Risk factors like single parents or if both parents are working full time, which greatly influences the bowel habits of children.
Children who are verbally or physically abused usually take longer to achieve developmental milestones, among which is potty training.

A recent survey conducted by keepkidshealthy.com suggested that 26% of all children were not potty trained even after their 4^th birthday.

Accidents once in a while are okay, but you should seek the help of a healthcare provider if:

Your child never achieved the ability to hold his bowel movements by his 4^th birthday;
If your child was once potty- trained but has suddenly experiencing frequent episodes of soiling his pants – it may be necessary to rule out a physiological or psychological stressor or medical conditions like urinary tract infection.

Summary and Recommendations

Potty training should be initiated between 22 and 30 months.
The majority of girls are fully potty trained by 36 months and boys by 38 months.
Even after potty training is completed, children still need help in cleaning between 4 and 5 years old.
A child is ready to initiate potty training when she shows willing to and controlling sphincters.
Initiating potty training too early may not be beneficial.
You should take your child to a doctor if she/he cannot hold sphincters by 4 years of age or if your child looses a potty training skill which had been previously acquired.

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References

Foxx, R. M., & Azrin, N. H. (1973). Dry pants: A rapid method of toilet training children. Behaviour research and therapy, 11(4), 435-442.
Blum, N. J., Taubman, B., & Nemeth, N. (2003). Relationship between age at initiation of toilet training and duration of training: a prospective study. Pediatrics, 111(4), 810-814.
Duong, T. H., Jansson, U. B., Holmdahl, G., Sillén, U., & Hellstrom, A. L. (2010). Development of bladder control in the first year of life in children who are potty trained early. Journal of pediatric urology, 6(5), 501-505.

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