Friday, June 8, 2012

The Science Behind "Early" Toliet Learning

   We recently bought a potty for our 14-month-old.  For many in our culture, this may seem futile or even crazy.  However, many non-Western cultures begin the process of pottying at birth, raising children who never wear diapers.  Even within Western cultures, however, the average age that children achieve potty training has increased in the last 50 years.  In the 1980, the mean age was 26 months, while in 2003, the average age was 36.8 months.  The most recent numbers I can find seem to indicate that currently the average age of toilet training  is 35 months for girls and 39 month for boys.  As for the current advice from the medical community, the AAP states the following: "most children start to show an interest between the ages of 18 months and 24 months...Some children are not ready until they are 2 1/2 years old."
    We made our decision to initiate potty learning (I use this phrase in lieu of potty training in that we are not using any system of rewards or punishments, and we are using a very-child led method.) as Q-ball was signaling when she urinating, a clear readiness indicator. Following Dr. Montessori's idea of a sensitive period in which to master skills, I wanted to take advantage of this opprotunity. At least two Montessori resources (Montessori From the Start: A Child at Home from Birth to Age Three and How to Raise an Amazing Child the Montessori Way) list 12 to 18 months as the sensitive period of toileting.  However, given the mean ages of toileting for children in the Western world, this seems to challenge conventional wisdom.  So, for this Science Friday, I wanted to explore any research on the effects of "early" toileting. (A note- some parents practice infant potty training or elimination communication. While we are using some of the methods used in this practice, I would not say that we are practicing elimination communication with Q-ball as the optimal time frame for this method is between 4-5 months of age.  However, the research I found can be used when considering elimination communication.)
     I must say that I honestly had no idea what I would find in the research.  If anything, I thought that research would lead to be believe that we were starting too early, given that I've always heard that the "perfect time" to potty train is around age two because of muscle control.  However, little research has been conducted on the effect of age in toilet training, and the studies that have been conducted seem to focus on the effect of late starters (usually defined as after 32 months), not the effectiveness of infant potty training.   
Our new morning routine!
   One clear finding concerning age and potty training is that late starters typically take longer to achieve bladder and bowel control.  Beyond this, late training, even when controlling all other characteristics, is typically associated with increased in stool refusal, hiding while having bowel movements, constipation, and even delayed language development.   As I've stated, children in Western cultures are achieving toilet training later and later.  With this, constipation and stool refusal are also on the rise (Visits to the pediatrician for constipation doubled between 1958 and 1986.)  The research I read was not sure of the direction of causality as there are so many factors involved.
   One topic that is currently hot within pediatric urology is the possible relationship between later toileting and urinary track infections and other bowel problems.  I was very surprised to  read about this research.  One of the studies I found did find that late initiation of toileting is significantly related to urge incontinence later in life, but other studies are not as conclusive.  That being said, I did not see any studies that stated there is not a relationship between the two.
   I certainly did not find the amount of research that I would have liked.  However, given what I did find, I am happy with our decision to initiate potty learning now. Studies do agree that readiness indicators are important for initiating potty learning or training.  So, while we have yet to get any pee in our potty, I'm sure that Q-ball will get it one day soon!

Barone, J.G., Jasutkar, N., Schneider, D. (2009). Later toilet training is associated with urge incontinence in children. Journal of Pediatric Urology  5, 458e461
Blum, N., Taubman, B., & Nemeth, N. (2004). Why is toilet training occurring at older ages? A study of factors associated  with later training. Journal of  Pediatrics (145) 107–11.
Bouke, L. (2002). Infant potty training. White Bouke Publishing: Lafayette, CO.
Duong, T.H., Jansson, U., Holmdahl, G., Sille, U., & Hellstrom, A. (2010). Development of bladder control in the first year of life in children who are potty trained early. Journal of Pediatric Urology, 6, 501e505
It's Potty Time! (5 June 2012).
Kiddoo D, Klassen TP, Lang ME, Friesen C, Russell K, Spooner C, Vandermeer B. The Effectiveness of Different Methods of Toilet Training for Bowel and Bladder Control. EvidenceReport/Technology Assessment No. 147. (Prepared by the University of Alberta Evidence-based Practice Center, under contract number 290-02-0023). AHRQ Publication No. 07-E003 Rockville, MD: Agency for Healthcare Research and Quality. December 2006.  Retrieved from

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