Toilet Training Begun at a Younger Age Takes Longer to Complete

Children who start toilet training at a younger age take longer to achieve daytime dryness than kids who start later, say researchers from The Children's Hospital of Philadelphia (CHOP).

The parents of 378 children between 17 and 19 months of age completed an initial questionnaire about whether they were trying to toilet train their child. In follow-up interviews conducted every 2 to 3 months, parents were polled about how often they asked or reminded their child to use the potty and whether their child had problems with constipation or painful bowel movements. They also answered questions about where their child usually urinated and how many accidents their child had each day or week.

When parents took out a potty chair and began discussing toilet training with their child, it was considered the start of toilet training. When parents asked their child to use the potty more than three times a day, a child was considered to have begun intensive toilet training. When a child wore underwear during the day and urinated and defecated in the toilet with few accidents, a child was considered to have completed toilet training.

The children in this study completed toilet training at an average age of almost 37 months. In general, the boys in the study completed toilet training later than the girls. The parents in the study reported starting toilet training at an average of 21 months, and the average age for beginning intensive toilet training was about 29 months. Although they began toilet training at about the same time as the other children in the sample, 81 children never underwent intensive toilet training. However, this group of children completed toilet training earlier, at an average age of 34 months. Researchers also noted that earlier or later toilet training did not affect the risk of constipation or withholding stool - two problems that were thought to be associated with toilet training initiated at an early age.

What This Means to You: According to the results of this study, beginning intensive toilet training at an earlier age may lead to a longer overall duration of toilet training, although it does not appear to increase the risk of problems such as constipation and stool withholding. According to the American Academy of Pediatrics (AAP), you should look for the following signs in your child before beginning toilet training:

• Your child stays dry at least 2 hours at a time during the day or is dry after naps.
• Bowel movements become regular and predictable.
• Facial expressions, posture, or words reveal that your child is about to urinate or have a bowel movement.
• Your child can follow simple instructions.
• Your child can walk to and from the bathroom and can help to undress.
• Your child seems uncomfortable with soiled diapers and wants to be changed.
• Your child asks to use the toilet or potty chair.
• Your child asks to wear grown-up underwear.

If you have questions about whether your child is ready to start toilet training or how you should begin, talk to your child's doctor or nurse.

Source: Nathan J. Blum, MD; Bruce Taubman, MD; Nicole Nemeth, MD; Pediatrics, April 2003

Reviewed by: Steven Dowshen, MD
Date reviewed: April 2003

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