Much has been written in the Pediatric literature about toilet training. 1,2 The child orientated approach to toilet training seems most accepted in our country and assumes that success is dependant on the child’s interest in gaining comfort with various aspects of independent toileting on their own schedule. Some parents prefer the structured approach that relies on the parents to teach the critical component skills needed by the toddler to successfully toilet. Clearly the child must be ready to participate in the process no matter the method chosen. From a Pediatric Urologic perspective toilet training requires both physiologic capability and psychological maturity. Physiologically the bladder must be able to hold a reasonable volume of urine for an adequate period of time. The child must be able to sense bladder (and rectal) fullness and the sphincters (rectal and urinary) must be able to relax in a timely fashion. While parents often wonder whether stool or urinary control will come first, the truth is that success is most often achieved simultaneously. Girls potty train before boys as they seem to be more influenced by socialization but no matter the gender, 98% of children will be successfully potty trained by 3 years of age. For a variety of reasons we once studied whether the age of potty training was affected by the prior occurrence of UTI. Interestingly we observed that a UTI 6 months prior to the age of potty training did delay the process a bit and that an early age of potty training in girls was associated with a greater likelihood of a subsequent UTI.3 In any event, awareness of toileting, once daily bowel movements, dry intervals of two to three hours are all reassuring details for those few children with apparent delays in toilet training. It is to be expected that occasionally accidents of urine and stool will occur after success in initially achieved. In fact the International Children’s Continence Society recognizes this by requiring that the term incontinence be reserved for those children who wet but are older than 5 yrs of age. 4 Absent UTI’s and provided that a normal bowel habit is present, there is not too much concern for children who still wet past the usual age of potty training but are younger than 5yr. With UTI or with an abnormal bowel habit the daytime wetting becomes of more import and raises consideration for further evaluation with a Renal and Bladder Ultrasound (RBUS). To be sure temperament (ranging from simple stubbornness to profound personality disorder) has a poorly characterized but never the less important relationship with success in potty training. While parents of such children often want to know for certain if their child “can” potty train the sophisticated urodynamic testing is certainly intrusive and often equivocal. As mentioned above knowing that the child can have a dry interval, that there is awareness of stooling and urinating with both occurring at normal intervals and that the bladder empties completely (assessed with a RBUS) all reassure that physiologically the tools for control are present.
- Schum t, McAuliffe T, Simms M, Walter J, Lewis M, and Pupp R: Factors Associated with Toilet Training in the 1990′. Ambulatory Pediatics 1: 79, 2001.
- Brazelton T, Christophersen ER, Frauman a, Porski P, Pool J, Statdler a, and Wright C: Instruction, timeliness and Medical Influences Affecting Toilet Training. Peds 103: 1353, 1999.
- Chen JJ, Ahn HJ and Steinhardt GF: Is Age at Toilet training Associated with the Presence of vesicoureteral reflux or the Occurrence of Urinary tract Infection? J Urol; 182,2009
- Chase, J, Austin P, Hoebeke P et al.: The Management of Dysfunctional Voiding in Children; a Report from the Standardisation Committee of the International Children’s Continence Society. J Urol, 183: 1296, 2010
