How to toilet train healthy children? A review of the literature.
ABSTRACT To review the literature on toilet training (TT) in healthy children.
Through an extended literature search, all data on developmental signs of readiness for TT, TT methods, definitions of being toilet trained, TT problems, and predictive factors for success were reviewed.
Specific studies on this topic are few. Two main methods for TT have been described so far in the last decades: the gradual child-oriented training and the structured, endpoint-oriented training. In the former method parents mainly respond to the child's signals of toileting "readiness". The latter method consists of actively teaching several independent toileting behaviors. Data are too few to be able to compare the methods. Literature does not give a consensus about the optimal age for starting nor on the expected mean age of completing TT. Recent studies show most children to start training between 24 and 36 months of age with a current trend toward a later completion than in previous generations. The consequence of this can be stress for the parents and more use of diapers, with its negative effect on the environment.
There are as yet little data to be found on this important topic, only few studies have been published in peer-reviewed journals. Standardization of terminology and critical evaluation of the described techniques in large sample sizes is needed. With this approach, general principles of training, evidence based and easy to use in the majority of children, may become available to parents.
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ABSTRACT: Confusion exists about when to start toilet training, which causes stress and anxiety. Another consequence can be the actual postponement of the toilet training process, which has created extra social problems. Therefore, in this review we will focus on the proper moment to start toilet training, more specific on readiness signs. This will clarify on which topics further research is necessary. We searched databases for publications on toilet training. Next, we gathered information about the normal development of healthy children and at which age skills needed for each readiness sign are acquired. Twenty-one readiness signs were found. Our results show that there is no consensus on which or how many readiness signs to use. Depending on the readiness sign, the moment to start toilet training can vary a lot. More studies are needed to define which readiness signs are most important and how to detect them easily.Neurourology and Urodynamics 03/2012; 31(4):437-40. · 2.67 Impact Factor
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ABSTRACT: Abstract Objective. The aims of this study were to check the possibility of observing readiness signs proposed in the literature (Study 1) and to investigate the interrater reliability of observing readiness signs between different researchers (Study 2). Material and methods. In Study 1, 24 healthy children, recruited in Flemish childcare centres, were observed. Each child was observed for 8 h. In this study a list of readiness signs was used as described in a recent literature review on readiness signs in young, healthy children. In Study 2, two observers independently evaluated an adapted list with readiness signs in another 24 healthy children recruited in a similar setting. SPSS was used to analyse the interrater reliability between these observations, calculating Cohen's kappa per readiness sign. Results. The results of Study 1 show that not all readiness signs are easy to assess. This resulted in a shortened checklist with 20 signs, which can be easily observed in young, healthy children during an 8 h period, and which was used in Study 2. The results of Study 2 show that, for most readiness signs, Cohen's kappa and the agreement between observers varied from good to perfect. Conclusions. This article presents the results of two studies that are the first in a series investigating the use of readiness signs. Further research on readiness signs is being conducted to reach consensus on when to start toilet training based on readiness signs, and to obtain evidence-based guidelines.Scandinavian Journal of Urology and Nephrology 07/2012; · 1.01 Impact Factor
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ABSTRACT: Influences on bladder health begin during infancy and continue throughout the lifespan. Bladder anatomy and physiology change as individuals age, and the risk and propensity for bladder conditions, including lower urinary tract symptoms, throughout life are related to factors specific to age, sex, and life events. Bladder habits and dysfunctions at one stage of life may affect bladder health in subsequent stages. However, bladder problems are neither a normal part of aging nor inevitable at any stage of life. Many of the factors that negatively impact bladder health at all ages may be modifiable, and healthy bladder habits may prevent or reverse bladder dysfunctions that can occur naturally or in response to life events. There are opportunities to further define and promote healthy bladder habits through focused research and heightened public awareness of the importance of bladder health, which may lead to improvements in overall health and quality of life. It is our hope that this paper will inform and encourage public health initiatives and research programs aimed at this goal.International Journal of Clinical Practice 05/2013; 67(5):397-406. · 2.43 Impact Factor