Hope you are enjoying the fabulous spring weather this week! With all of the blooming, we can talk about a topic of toddler “blooming” (so to speak!)… toilet training. I'm grateful we've been done with the process for awhile at our house… and I can say it was pretty different for our two girls-each responding to a different general philosophy as described below. Attached are the case and discussion, thanks to our own fabulous gen peds development expert, Dr. Heather McPhillips, and a summary article.
Materials for this week:
- Case and discussion by Dr. McPhillips
- Review article from AAFP and In Brief from Pediatrics in Review
- Powerpoint shared by Dr. Grant
- Guide for parents shared by Dr. Morelli
Take home points on toilet training:
- Age of toilet training: Toilet training in the US has moved later in toddler years (combination of factors including availability of better disposable diaper options and children in child care settings). Average age at which toilet training begins has increased from earlier than 18 months to between 21 and 36 months. Some believe there is little benefit of intensive training before 27 months of age. Only 40 to 60 percent of children now complete toilet training by 36 months of age; the average age is 37 months.
- Earlier start is associated with longer time to potty train, but earlier completion: Generally the earlier that children start, the longer it may take to fully potty train. Earlier start has also been associated with earlier completion of toilet training. Girls usually begin and complete toilet training about 2-3 months before boys.
- Child-centered toilet-training approach: this is the most commonly used approach now in the US. As described by Dr. Barry Brazelton and recommended by the AAP, this approach suggests that children are more likely to be developmentally ready after 24 months. This approach follows the child’s lead, looks for developmental readiness cues and provides positive encouragement for attempts at toilet training but avoids forcing / coercing or any negative comments.
- “Train in a day” type approach: as described by Azrin and Foxx, this potty training "bootcamp" is often done in a dedicated day/weekend using an operant conditioning model with positive reinforcement and negative reinforcement for accidents. One element we found helpful at our house was to set a "potty timer" to remind when to go make an attempt-about every 45-60 minutes to avoid accidents.
- Different approaches work: both common approaches have been shown to work in practice to effectively teach typically developing children how to potty train. Different approaches are used around the world and can all be effective in context. In developing countries, some parents potty train children as early as 6 months based on parent use of watching infant cues and minimal to no use of diapers. We can help explore with families what they are comfortable with trying in their home.