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Chapter 1 Index
A. General Information
about the well child examination B. Nutrition Issues
C. Sleep Issues
D. Dental Issues
E. Anticipatory Guidance
--Discipline: Normal
Toddlers
--Discipline: To Spank
or Not to Spank |
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Toilet Training: or Once Upon a Potty
Drs. Nesbit, Parente, Moore, C. Stallworth, Kelly
Introduction: Pediatricians are often asked about when and
how children should be toilet trained. In 1962, Brazelton introduced the
“child-oriented approach”: i.e. “when they are ready.”
Normal milestones in bladder and sphincter control:
- birth-6 months: bladder emptying frequently as an uninhibited reflex
action
- 6 mos-12 mos.: bladder emptying is less frequent due to CNS maturation
and reflex inhibition
- 1-2 years: CNS inhibition of bladder contractions increases: child
feels full bladder.
- 3-5 years: child can inhibit the need to void, and also can void upon
command.
Readiness of children for toilet training:
- children must be able to understand and follow instructions
- children must be able to get to potty quickly and be able to undress
- bowel movements should be somewhat regular and predictable
- often children are uncomfortable with soiled diapers and want to be
changed
- children are dry at least 2 hours at a time during the day or are dry
after a nap
- children show psychological readiness: desire to please parents, gain
control, etc.
Conclusion: most children are ready between 2 and 2-½ years
of age. Always use positive reinforcement including but not limited to star
charts, stickers, toys, BMWs, etc.
Steps for success in toilet training: Always be relaxed and never
punish a child. +reward
- obtain a potty-chair and place it in the child’s room or in the
nearest bathroom
- can let child sit on the potty fully clothed for a few weeks and
explain what it is for; after
- child sits on it willingly, then try with diaper off. Have child’s
feet flat on the floor. Boys should start out sitting on potty as well as
girls.
- let child watch older siblings and parents in the bathroom and “model”
their behavior.
- make going to the potty part of the regular routine e.g. after naps,
meals; early AM
- even if diaper full, empty it in toilet to show child where it was
supposed to go.
- use praise and positive reinforcement whenever possible; use tinkle
targets.
- switch from diapers to pull-ups to training pants after started to
have some success.
- some suggest letting children go naked near the potty, and thus learn
in that manner.
Problems with Toilet Training:
Stool withholding: can lead to constipation and encopresis; seen in
1 of 5 late trained children. Pediatricians need to intervene with these
children as well as those not trained at 42 mos.
Study has shown that those who begin training before 18 months of age
aren’t fully trained at age 4 vs those whose training starts around 2 years
of age.
Other Information:
- Boys trained later than girls, though introduced at an earlier age.
- age at which trained not associated with attendance at day care,
presence of siblings, or a working mother.
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