title: Observing signs of toilet readiness: results of two prospective studies.
abstract: OBJECTIVE
  The aims of this study were to check the possibility of observing readiness signs proposed in the literature (Study 1) and to investigate the interrater reliability of observing readiness signs between different researchers (Study 2).
  
  
  METHODS
  In Study 1, 24 healthy children, recruited in Flemish childcare centres, were observed. Each child was observed for 8 h. In this study a list of readiness signs was used as described in a recent literature review on readiness signs in young, healthy children. In Study 2, two observers independently evaluated an adapted list with readiness signs in another 24 healthy children recruited in a similar setting. SPSS was used to analyse the interrater reliability between these observations, calculating Cohen's kappa per readiness sign.
  
  
  RESULTS
  The results of Study 1 show that not all readiness signs are easy to assess. This resulted in a shortened checklist with 20 signs, which can be easily observed in young, healthy children during an 8 h period, and which was used in Study 2. The results of Study 2 show that, for most readiness signs, Cohen's kappa and the agreement between observers varied from good to perfect.
  
  
  CONCLUSIONS
  This article presents the results of two studies that are the first in a series investigating the use of readiness signs. Further research on readiness signs is being conducted to reach consensus on when to start toilet training based on readiness signs, and to obtain evidence-based guidelines.
authors: Department of Urology, Faculty of Medicine, University of Antwerp, Antwerp, Belgium.
authors: Nore
authors: N
authors: Kaerts
authors: Alexandra
authors: A
authors: Vermandel
authors: Frauke
authors: F
authors: Lierman
authors: Ans
authors: A
authors: Van Gestel
authors: Jean-Jacques
authors: JJ
authors: Wyndaele
mesh_terms: D002652:Child Behavior; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D011446:Prospective Studies; D009626:Terminology as Topic; D014039:Toilet Training