Implementing a New Method of Group Toilet Training in Daycare Centers: a Cluster Randomised Controlled Trial

Abstract

Background: Over the past 100 years, toilet training (TT) methods have oscillated between rigid and permissive programs, but despite the existing methods, a trend towards a later initiation and completion of TT has been seen in Western society (3, 8-18) . This study is the first to investigate prospectively the efficacy of intensive TT in small groups in daycare centers . The primary outcome of interest is the duration until the child is toilet trained. Methods: A cluster randomized controlled trial was established in daycare centers, clusters of participants were randomly allocated to an intervention (IG) or control group (CG). The IG was subjected to an intensive TT group session. In the CG, parents of the children were encouraged to start TT in their own manner. The TT process was monitored until the child was considered to be fully toilet trained during the day. Findings: The median TT duration in the IG was 2 weeks compared to 5 weeks in controls (p-value log rank test = 0·007). The hazard of being clean during the follow up of 6 weeks was twice as high in the IG compared to the CG (p=0·018) and almost three times higher in girls compared to boys. Interpretation Innovative aspects of this TT method were a two-hour training on two consecutive days, carried out in small groups in daycare centers. This experimental intervention of group TT had a significant influence on the duration of TT in healthy children, with a median duration of 2 weeks. Our findings are clinically relevant for daycare educators, becoming more accepted as a third educational environment in the development of children. Trial Registration: nr. B300201630079). Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Conflicts of Interest: All authors declare that they have no conflict of interest.