Toilet learning: Anticipatory guidance with a child-oriented approach

Question 1

When do most children in western countries achieve bladder and bowel control?

Answer 1

Between 24-48mo

Question 2

What is the average time from initiation of toilet learning to attainment of independent toileting?

Answer 2

3-6m

Question 3

What are signs of a child’s toilet learning readiness?

Answer 3

1. Able to walk to the potty chair (or adapted toilet seat)
2. Stable while sitting on the potty (or adapted toilet seat)
3. Able to remain dry for several hours
4. Receptive language skills allow the child to follow simple (one- and two-step) commands
5. Expressive language skills permit the child to communicate the need to use the potty (or adapted toilet seat) with words or reproducible gestures
6. Desire to please based on positive relationship with caregivers
7. Desire for independence, and control of bladder and bowel function

Question 4

How can parents facilitate a child’s toilet learning?

Answer 4

1. Decide on the vocabulary to use.
2. Ensure the potty chair and position are easily accessible. Allow the child to watch his or her parents use the toilet.
3. If a regular toilet is used, use a toilet seat adapter and a foot stool.
4. Encourage the child to tell a parent when he or she needs to void. Give praise upon success, even if the child tells the parent after the fact. Learn the child’s behavioural cues when he or she is about to void.
5. Encourage the child with praise. Do not expect immediate results; expect accidents. Avoid punishment and/or negative reinforcement.
6. Ensure the cooperation of all caregivers to provide a consistent approach.
7. After repeated successes, suggest the use of cotton underwear or training pants. Make this a special moment.

Question 5

How should the child be introduced to the toilet?

Answer 5

Stepwise approach:

1. Sit on it fully dressed
2. Sit on it after a soiled diaper has been removed
3. Sit several times a day without wearing a diaper
4. Sit on it at specific times in the day with a routine

Question 6

What is the suggestion for toileting refusal?

Answer 6

1-3m break from toilet training

Question 7

When should you consider referral to a general or developmental pediatrician?

Answer 7

If repeated attempts are unsuccessful or if the child is >4yo

Question 8

Why might a referral be necessary?

Answer 8

Explore aspects of parent-child relationship

r/o physical and/or neurodevelopmental abnormalities

Question 9

What physical problem might complicate toilet learning readiness?

Answer 9

Constipation