The Bottom Line on Toilet Training

From the WebMD Archives

March 30, 2001 -- Toilet training can be a difficult and stressful time for parent and child alike. But if your child fits into a certain category, a new study finds he may have a leg up on early toilet training.

The study, published in the journal Ambulatory Pediatrics, finds that girls, nonwhites, and children from middle-class, single-parent households are the kids most likely to be toilet trained at an earlier age. The research, which included assistance from diaper manufacturer Kimberley-Clark, raises interesting questions about the role ethnicity plays in this often-frustrating parental task.

Of equal interest, though, and great news for working parents is that day care and the mother's work status had no influence on the completion of toilet training.

Ethnicity did have a clear influence, though. "The [ethnic] differences are real," says study author Timothy R. Schum, MD, of the Medical College of Wisconsin and the Downtown Medical Clinic, both in Milwaukee. "One of the questions we did ask to get at parent's beliefs about toilet training ... the African-American parents agreed more with the statement that toilet training was important by the age of 2. Caucasian parents did not agree with that statement at all."

In fact, Schum says he's actually having trouble finding black children to participate in a follow-up study that takes a longer view of toilet training, because many already have been trained. One possible reason -- aside from parental viewpoints on toilet training -- is that black children have been noted to develop motor skills more rapidly in infancy than whites, Schum writes.

Still, that parental influence factor may be a big one. Schum points out that the general age of toilet training in the U.S. has been rising during the last 40 years because the "child orientation" method of toilet training -- otherwise known as "they'll do it when they're ready" -- has been in vogue.

In this study involving almost 500 parents with children aged 15-42 months, average toilet-trained ages reached their highest levels yet: 35 months for girls and 39 months for boys -- this despite the fact children always have had the learning ability to toilet train at 21 months.

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"Some children get so used to life in diapers they could get to be 3, 3½ and they are still in them," Schum says. "I usually tell parents this child is already too old. Get them out of diapers."

Specifically, from the one-time survey of the families with children of the varying ages, the researchers found black children had the highest rate of toilet-training completion at 39%. Other ethnicities followed with 14% trained completely, while white parents reported a 7% trained rate.

The study also provided data for the association between day care and mother's work status, and toilet training. Schum and colleagues write, "It should be reassuring to parents that the child's participation in day care does not seem to affect the acquisition of completing toilet training within the standard time frame." Whether the mother worked or not also was an unimportant variable.

Finally, the study found higher rates of toilet-training completion in children from single-parent homes. The researchers say further study is needed to discover why single parents are more successful at training.

Many methods for toilet training have been put forth, including one that you could say fast-tracks the "child orientation" theory. That would be family psychologist John Rosemond's "naked and $75" method -- in which unclothed children are allowed to walk around the house, dropping urine and stool. Their aversion to having excrement dripping down their legs, as well as parental reminders that they need to remember to use a nearby potty next time, gets them trained in days, he claims. (The 75 bucks is to clean the rugs).

Schum has another method: "We have developed a parent-coach method," he tells WebMD. "Once you see a sign of readiness, get them out of diapers," but not naked. Instead, put them in something like pull-ups, he says. Then, be consistent, praise the child and provide tangible rewards for doing the right thing. Signs of readiness usually appear between 22 and 30 months old.

"What we have published is an American experience," Schum clarifies. "In other parts of the world, children are toilet trained at an earlier age, and there is no evidence of psychological or physical damage."

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Lawrence Balter, PhD, editor of Parenthood In America: An Encyclopedia and professor of applied psychology at New York University, says the study raises some interesting points but also some questions. For example, whether other unexplored variables were involved in the differing success rates for early toilet training. "Some people let their children remain a child. They allow them to stay on the bottle or breastfeed -- to sleep in a bed with the parents -- these things hang together [with toilet training]."

Still, he agrees there is an age at which all healthy kids ought to be using the toilet. "The average age of 3 seems to be where most kids get completely toilet trained; girls a little earlier, boys a little later. Once you get past 4 ... if the child is normal, they understand what they have to do. They have the muscle control, and it becomes a question of their willingness to do it."

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