How to toilet train healthy children? A review of the literature.
OBJECTIVE
To review the literature on toilet training (TT) in healthy children.


METHODS
Through an extended literature search, all data on developmental signs of readiness for TT, TT methods, definitions of being toilet trained, TT problems, and predictive factors for success were reviewed.


RESULTS
Specific studies on this topic are few. Two main methods for TT have been described so far in the last decades: the gradual child-oriented training and the structured, endpoint-oriented training. In the former method parents mainly respond to the child's signals of toileting "readiness". The latter method consists of actively teaching several independent toileting behaviors. Data are too few to be able to compare the methods. Literature does not give a consensus about the optimal age for starting nor on the expected mean age of completing TT. Recent studies show most children to start training between 24 and 36 months of age with a current trend toward a later completion than in previous generations. The consequence of this can be stress for the parents and more use of diapers, with its negative effect on the environment.


CONCLUSIONS
There are as yet little data to be found on this important topic, only few studies have been published in peer-reviewed journals. Standardization of terminology and critical evaluation of the described techniques in large sample sizes is needed. With this approach, general principles of training, evidence based and easy to use in the majority of children, may become available to parents.
Department of Urology, University of Antwerp, Belgium.
Alexandra
A
Vermandel
Marijke
M
Van Kampen
Chris
C
Van Gorp
Jean-Jacques
JJ
Wyndaele
D002652:Child Behavior; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D002666:Psychology, Child; D012737:Sex Factors; D013315:Stress, Psychological; D009626:Terminology as Topic; D013997:Time Factors; D014039:Toilet Training; D001743:Urinary Bladder / Q000254:growth & development*; D014554:Urination