then be returned to diapers for 1–3 months before TT is
The use of prompting has changed over the years.
Sixty years ago, parents used to prompt children more
Also the reaction of the parents when the
child’s attempts to void were unsuccessful was signiﬁcantly
different. Parents who trained their children 30–40 years ago
used running water to provoke voiding and encouraged them
by making special noises, while most parents of later
generations just asked the child to try again later.
the child to stay on the potty as well as actively provoking
voiding, has a risk for the development of abnormal bladder-
Over the last three generations, only minor changes in the
use of punishing and/or rewarding have occurred.
gave a lot of importance to reinforcements, social,
and tangible. To discourage accidents, reprimands and a
short time-out of positive reinforcement were proposed.
According to Brazelton
pressure, punishment, and neg-
ative feedback will often prolong the process and cause
complications and stress for the child.
At age 1 year, if a child in the Digo tribe evacuates in the
living area he is at ﬁrst warned and then physically
Trends in TT have changed over the past decades. Although
some information is available on TT methods, almost no
procedures have been evaluated in studies published in peer-
reviewed journals. There is a lack of high-quality evidence-
based research to help guide clinicians in advising parents
on how to optimally train their children. One could get
the impression that the way training is done is of little
consequence as long as it has been ﬁnalized before children
attend school. However, the emotional negative and often
painful experience children and their families go through
when TT fails, shows the need to clarify further this important
Only limited research on the effectiveness of the different
methods has been described. Standardization of deﬁnitions,
such as ‘‘toilet trained’’, ‘‘success’’, and ‘‘failure’’, is an essential
ﬁrst step to high-quality evidence-based research. Studies
with larger sample sizes should be undertaken. This way,
sufﬁcient evidence might be gathered that permits to
conclusive answers regarding the optimal TT method.
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Neurourology and Urodynamics DOI 10.1002/nau
Toilet Training in Healthy Children 165