Toilet training is a significant milestone in the development of every child. It is an important stage that must be handled with sensitivity and patience. A child of any age can be said to have been fully toilet trained when they are capable of voluntarily withholding urine. The essence of toilet training is to teach the child bladder control. The ideal age to begin toilet training depends on the training method to be applied. There is no evidence showing that the age of initial toilet training can negatively affect a child emotionally. However, children who begin to be toilet trained early can avoid urinary tract infections. Early toilet training also lowers the risk of a child developing urinary incontinence and other bladder problems in later years (Jacob et al., 2016).
Epidemiology
In past years, parents would initiate toilet training between the ages of 18 months up to the age of 25 months. Currently, parents and caregivers delay the starting age range to 21-36 months. The largest percentage of children overcoming diurnal enuresis, do so at the average age of 3 years. About 80% meet this goal earlier at 2 to 5 years while less than 30% meet this goal by 2 years of age. Statistics show that girls learn toilet training faster and earlier than boys (Tarhan et al., 2015).
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Determining if a child is ready for toilet training
Toilet training should be initiated once the child has shown the ability to actively participate in the process. This criterion cannot be characterized by a specific age group because children meet their developmental goals at different ages. A child who is able to walk and move around without much help is also able to cooperate in the process of toilet training. A parent can begin this process at any age which meets this criterion. Additional indicators of readiness to participate in toilet training are as follows (Jacob, 2016).
A child who requests to go to the bathroom.
The child who mimics action that is performed by the parent can begin this process.
A child who recognizes that their diaper is soiled and requests for a change
If a child wakes up from a nap with a dry diaper, then this is one of the initial signs of being ready.
A child who has regular bowel movements at specific times of the day is ready for training.
Setting the ground for toilet training
Caregivers can prepare children for toilet training by teaching them how to dress themselves. This is especially important if an emphasis is placed on removing and putting on the trousers and underwear. The child should be taught the words that are associated with toilet training. The child can also be trained on how to respond to verbal instructions. Children with a history of good discipline and interaction with those in authority are easier to train than their counterparts.
Methods that can be used
The Azrin and Foxx Toilet Training in Less Than a Day Method is one of the most popular method used. It is based on positive reinforcement to help encourage the behavior and act of toilet training. The methods incorporates giving rewards immediately after carrying out a given correctly. Tasty snacks and soft drinks are the best rewards for a child. This can be done each time a child requests to use the toilet, removes their pant correctly and voluntarily sits on the potty. Praise every successful use of the potty by telling the child how proud you are of their achievement. The first steps involve demonstrating toilet use with the aid of a doll. A doll is used to show the child how a person sits on a toilet. During this demonstration, the child should be fed with liquids so that they will soon have a chance to use their observed skills. Once the demo with the doll is done, instruct the child to walk to the potty and remove his pants and sit. The child should be rewarded if he urinates in the potty. Lack of action should not be rewarded. This sequence should be repeated until the child fully learns to control his bladder (Warzak, et al., 2016).
Another method used is the Brazelton Child-Oriented Toilet Training Method. This method also uses a potty but there is no demo with a doll. Instead, a child is accustomed to the potty by using it as a chair. He sits on it while fully dressed at the same time while the parent is using their toilet. The potty chair is used anywhere until the child is comfortable with it. After 1-2 weeks, the child's soiled diaper is emptied into the potty so that the child understands its significance. From this point on, the child can sit on the potty without a diaper. This can be done 2-3 times a day. The child can then be frequently reminded to sit on the potty and use it. The last step involves teaching the child to remove and wear their training pants on their own.
Complications of toilet training
The involuntary leakage of urine is commonly called enuresis. Enuresis can be classified into two stages. Involuntary urine leakage during the day is known as primary or diurnal enuresis, while leakage at night is known as nocturnal or secondary enuresis. A child who exhibits diurnal enuresis after the age of 48 months should undergo a medical examination. Evaluation should also be done if the urine of the child changes in consistency or smell. A change in the normal streaming of urine should also be examined (Jackson et al., 2016).
A psychological evaluation of stress should be done if the child who had been fully trained for more than 3 months regresses. This is commonly called secondary diurnal enuresis. It is often experienced by preschoolers who are struggling with adjusting to changes in school or family life. Such a situation should be handled with patience because it affects the child's confidence. It may also be caused by medical conditions such as diabetes mellitus or a urinary tract infection. A child over the age of four years who soils his undergarments with faeces is said to be experiencing encopresis. This is an aspect of toilet training that is proven when the child's caregivers rule out involuntary leakage of faeces due to a medical problem such as diarrhea. A child under this condition may refuse to pass stool and he may suffer from severe constipation as well as pain and discomfort. Medical treatment of the conditions responsible for encopresis and enuresis will help a child be able to undergo successful toilet training (von, 2015).
Refusal to cooperate in toilet training exercises is also experienced sometimes. This could be due to unpleasant or painful experiences in the past. They include constipation, where the child experiences pain when they visit the bathroom. This can be determined through observation and then remedied by including fibre supplements in the diet. Stooling can then be encouraged in a diaper before the toilet training resumes. Efforts to permanently manage constipation should be intensified so that the child does not lose the initial gains. All children should be regularly monitored to ensure that they are progressing well with the training. Primary caregivers can further monitor progress by checking for soiled clothing and bedding.
References
Jacob, H., Grodzinski, B., & Fertleman, C. (2016). Fifteen-minute consultation: problems in the healthy child—toilet training. Archives of Disease in Childhood-Education and Practice, edpract-2015.
Jackson, K. W., Gilgenbach, A. M. N., Eisele, C. M., & Dreyer, A. H. (2016). U.S. Patent No. 9,530,332 . Washington, DC: U.S. Patent and Trademark Office.
Tarhan, H., Çakmak, Ö. Akarken, İ., Ekin, R. G., Ün, S., Uzelli, D., & Cun, S. (2015). Toilet training age and influencing factors: a multicenter study. The Turkish journal of pediatrics, 57, 172-176.
von Gontard, A. (2015). Paediatrics: nocturnal enuresis, daytime urinary and faecal incontinence in children with special needs. Australian and New Zealand Continence Journal, the, 21 (2), 54.
Warzak, W. J., Forcino, S. S., Sanberg, S. A., & Gross, A. C. (2016). Advancing continence in typically developing children: Adapting the procedures of Foxx and Azrin for primary care. Journal of Developmental " Behavioral Pediatrics , 37 (1), 83-87.
