Completion Of Toilet Training Research Articles

Toilet Training Readiness Scale for 0-5-Year-Old Children: A New Measurement Tool Based on a Child-Centred Approach.

There is no standardised approach to toilet training in children. This study aimed to determine the factors affecting the duration of toilet training in children aged 0-5 years and to develop a tool to assess the child's readiness to start toilet training. This cross-sectional study was conducted on 409 children aged 0-5 years. Social, economic, behavioural, and developmental characteristics that are effective in toilet training in healthy children were evaluated. A scale assessing children's readiness for toilet training (Toilet Training Readiness Scale-TTRS) was developed and content validated. The mean age of the 409 children included in this study was 44.69 ± 13.07 months (min = 4; max = 60 months). The mean age of initiation of toilet training was 26.8 months. Most frequently, urine and faeces trainings were started together (52.1%). In the logistic regression analysis performed to evaluate the factors affecting the duration of toilet training, it was found that the TTRS score, mother's employment status, family type, child's first reaction, toilet type, and continuity of training were important predictors. The duration of toilet training showed a weak negative correlation with the scores obtained from the TTRS and the number of children in the family but a weak positive correlation with the age at the beginning of toilet training. The TTRS scores were inversely proportional to the duration of toilet training. Family characteristics, socioeconomic conditions, and readiness of the child for and no interruption in toilet training are important in completing toilet training in a short time and successfully. If a child-focused approach is adopted, evaluating the child from this point of view and initiating the training at the appropriate time may help to complete a more successful and shorter toilet training. We recommend that the scale we have developed be studied in other studies and different groups.

Effectiveness of Bowel Management Program for Functional Constipation in Children

Functional constipation (FC) is a common problem in childhood, with an estimated prevalence of 3% worldwide. Objective: To determine the effectiveness of bowel management program in children with functional constipation. Methods: This quasi-experimental study was conducted at Department of Pediatric Surgery, NICH, Karachi, from September 2019 to November 2021. 91 children were included in the study. Informed consent was taken. A plain X-ray abdomen prior to the start of bowel management program was done to assess the fecal loading in the colon. Effectiveness of program was assessed in terms of stool frequency of 1, 2 per day and non-loading of rectum radiologically after one month of treatment. High dose laxatives were started after the patient had recovered from the first impact in older kids who had previously completed toilet training but now suffer soiling from faux incontinence or severe constipation without soiling. Daily big volume enemas were used in children who had never been toilet trained, had a history of soiling, or had a megarectum. Results: The mean age was 5.26 ± 2.20 years (95% confidence interval [CI]: 4.80-5.72), the mean weight was 17.49 ± 3.24 kg (95% CI: 16.82-18.17), the mean height was 107.27 ± 19.32 cm (95% CI: 103.24-111.29). The average duration of functional constipation was 88.11 ± 68.79 days (95% CI: 73.78-102.44). In terms of gender distribution, 63 (69.2%) patients were male, while 28 (30.8%) were female. Conclusions: The results of this study provide evidence that a bowel management programme is successful in treating functional constipation in young children.

Tubularized incised plate repair in 473 primary distal hypospadias cases: An evaluation of outcomes according to coverages and stent types

AimWe have previously employed the tubularized incised plate (TIP) repair technique in distal hypospadias cases with a few modifications because of its excellent cosmetic results. In this study, we aimed to evaluate the effects of spongioplasty and dorsal dartos flaps, in addition to short urethral stents on the outcomes of TIP repair. Materials and MethodsOnly distal hypospadias cases were involved in this study. Eligible patients were divided into two groups: group A included patients repaired with both spongioplasty and dorsal dartos flap placement, while group B included patients repaired with dorsal dartos flap placement alone. Group A was further divided into two subgroups according to the type of catheter used (bladder catheter or short urethral stent). ResultsA total of 473 patients were included in this study. There was no statistically significant difference observed in the complication rates between the two groups. In Group A, a bladder catheter was used in 107 patients and a short urethral stent was used in 135 patients. When the results of the two groups were compared, there was no statistically significant difference. ConclusionsSpongioplasty could be combined with dorsal dartos flap placement to reduce the need for dorsal plication rather than to reduce the fistula rate. Short urethral stents can be used safely with no postoperative effects in children who have completed toilet training.

Toilet Training in Children and Adolescents with Down Syndrome.

Although the challenges of toilet training for children and adolescents with Down syndrome (DS) are well-known, details such as specific associations with comorbidities and related exacerbating factors are lacking. This study aims to characterize the nature of toilet training in a cohort of children and adolescents with DS and evaluate characteristics and comorbid conditions that may contribute to or prolong toilet training success in those with DS. This was a retrospective, cross-sectional study investigating toilet training in children and adolescents with DS. A survey was completed by 137 patients' parents or guardians as part of their care experience in the clinic. Although toilet training on average began at age 3.40 years (SD = 1.47), children and adolescents with DS typically began telling caregivers they needed to use the toilet at 4.80 years (SD = 2.11), no longer used diapers during the day at 5.03 years (SD = 1.98) and night at 5.88 years (SD = 2.48), and were described by their caregivers as being fully toilet trained at 6.60 years (n = 28; SD = 2.43; range = 3.00-14.00 years). There was a linear trend in the age groups between 2 to 4 years (n = 37), 5 to 7 years (n = 42), 8 to 12 years (n = 39), and 13 to 17 years (n = 19) and the proportion of children and adolescents fully toilet trained (2 to 4 years = 0.040, 5 to 7 years = 0.211, 8 to 12 years = 0.278, and 13 to 17 years = 0.529). Typical readiness signs that children and adolescents with DS display and those most predictive of toileting success are reported. Placing the child on a schedule was the most successful (45.2%) training method identified by parents, with 55.8% of the families trying this approach. Children and adolescents aged 8 to 12 years with behavioral challenges were more likely (75.0%) to have daytime accidents compared with those without (25.9%), p = 0.006. Children and adolescents with DS in this sample started toilet training at 3.4 years and completed toilet training at 6.6 years. Even after completing toilet training, many children and adolescents continue to require support from their caregivers with some aspects of toilet training. Skill loss associated with various life events, behavioral challenges, medical diagnoses, and inconsistencies in toileting expectations across settings are factors caregivers believe contribute to delayed toilet training. Caregivers found that a consistent toileting schedule, using reinforcers, and providing prompting to use the toilet were the most successful methods.

Tubularización e incisión de la placa uretral para reparación de hipospadias distal primario en 473 casos: evaluación de los resultados según la cobertura y el tipo de sonda

AimWe have previously employed the tubularized incised plate (TIP) repair technique in distal hypospadias cases with a few modifications because of its excellent cosmetic results. In this study, we aimed to evaluate the effects of spongioplasty and dorsal dartos flaps, in addition to short urethral stents on the outcomes of TIP repair. Materials and methodsOnly distal hypospadias cases were involved in this study. Eligible patients were divided into two groups: group A included patients repaired with both spongioplasty and dorsal dartos flap placement, while group B included patients repaired with dorsal dartos flap placement alone. Group A was further divided into two subgroups according to the type of catheter used (bladder catheter or short urethral stent). ResultsA total of 473 patients were included in this study. There was no statistically significant difference observed in the complication rates between the two groups. In Group A, a bladder catheter was used in 107 patients and a short urethral stent was used in 135 patients. When the results of the two groups were compared, there was no statistically significant difference. ConclusionsSpongioplasty could be combined with dorsal dartos flap placement to reduce the need for dorsal plication rather than to reduce the fistula rate. Short urethral stents can be used safely with no postoperative effects in children who have completed toilet training.

Point-of-Care Ultrasound-Guided Versus Conventional Bladder Catheterization for Urine Sampling in Children Aged 0 to 24 Months.

It can be difficult to obtain urine samples, especially in children aged 0 to 24 months who have not yet completed toilet training. Bladder catheterization is a common method for urine sampling in this age group. However, if the bladder is not adequately filled, this process fails and repeat catheterization is necessary. Point-of-care ultrasonography (POCUS) is often used to assist invasive procedures in the pediatric emergency department. This study aimed to compare success rates of bladder catheterization in patients with and without POCUS to guide the timing of the procedure. This was a prospective cohort study of children 0 to 24 months presenting to a pediatric emergency department in a tertiary center hospital. Patients were divided into 2 groups; the one group received conventional catheterization (CC group) without POCUS and the other group had catheterization after POCUS (POCUS group). The transverse and anterior-posterior diameter measurements of the bladder were obtained from one view in the transverse orientation using the (6-3 MHz) convex probe. Successful catheterization was defined by obtaining 3 mL or more of urine. A total of 110 patients were included in the study, with 56 in the POCUS group and 54 in the CC group. There was no difference between the mean age and sex of the groups. The success rates of obtaining urine samples were 93% and 78% in the POCUS group and CC group, respectively. This difference was statistically significant (P = 0.03). No significant difference was found between measurements of bladder catheterizations with and without obtaining 3 mL or greater urine volumes in the ultrasound group (P > 0.05). The use of POCUS during bladder catheterization in children was found to be effective and successful. In addition, the detection of any amount of urine in the bladder using POCUS increases the success rate of bladder catheterization.

Assessment of defecation function beyond infantile period for transanal single-stage endorectal pull-through in Hirschsprung disease.

PurposeTransanal single-stage endorectal pull-through (TERPT) procedure for patients with Hirschsprung disease (HD) has favorable outcomes, with a lower complication rate. Nevertheless, various degrees of bowel dysfunction and fecal incontinence can persist for a long time in some patients. The aim of this study was to assess the mid- and long-term outcomes of TERPT performed during the infantile period after the completion of toilet training.MethodsWe retrospectively reviewed 82 patients aged ≥4 years who underwent TERPT during the infantile period after the pathological diagnosis of HD between 2001 and 2013. Functional outcomes were investigated according to the answers of the Bowel Function Score (BFS) questionnaire, a previously validated 7-item questionnaire about bowel habits. Normal values were obtained in a previous study on BFS for children in Western countries, and a one-sample t-test was used for statistical analysis.ResultsOverall, BFS was similar in all investigated age groups. On comparing fecal soiling and social problems between the HD and normal populations, a lower score at an early age in patients with HD was noted; however, the scores became similar when the patients were 7 years of age. Stool frequency decreased continuously but was not significantly different between the 2 groups.ConclusionThe functional outcomes of TERPT performed during the infantile period, after completing toilet training, were similar to that of the normal population. In most cases, uncomfortable symptoms were diminished and functions improved with age.

Implementing a new method of group toilet training in daycare centres: a cluster randomised controlled trial.

Despite the existing methods, a trend towards a later initiation and completion of toilet training has been seen in Western society. This study is the first to investigate prospectively the efficacy of intensive group toilet training in daycare centres. The primary outcome of interest is the duration until the child is toilet trained. A cluster randomised controlled trial was established in daycare centres; clusters of participants were randomly allocated to an intervention or control group. Intervention group was subjected to an intensive toilet training session. Innovative aspects of this toilet training method were a 2-h training on two consecutive days, carried out in small groups in daycare centres. Parents of children in the control group were encouraged to start TT in their own manner. Children were monitored until they were considered to be fully toilet trained during the day. Median toilet training duration in the intervention group was 2weeks compared to 5weeks in controls (p value log rank test = 0.007). The hazard of being clean during the follow-up of 6weeks was twice as high in the intervention compared to controls (p = 0.018).Conclusion: The intervention had a significant influence on the duration of toilet training in healthy children, with a median duration of 2weeks. Our findings are clinically relevant for daycare educators, having a considerable responsibility in the development of children.Trial Registration Number: ClinicalTrials.gov NCT04221776. What is Known: • Despite different existing methods, a later initiation of toilet training has been seen in Western society and coherent to this an increasing age of acquiring full bladder control. • Child daycare centres have a growing role in the toilet training process. What is New: • This is the first prospective report describing the results of a new method of toilet training healthy children in small groups in daycare centres. • The intervention had a significant influence on the duration of toilet training, with a median duration of 2weeks.

Psychological differences between toilet trained and non-toilet trained 4-year-old children.

Late to complete toilet training has been associated with many psychological factors including behavior and mood problems. Unfortunately, the majority of the research is specific to children with elimination disorders or children identified as incontinent after the age of 7 years. The current study addressed gaps in the literature by comparing the psychological functioning of children not toilet trained by their 4-year-old well child care visit with their toilet trained peers. Parent reports of internalizing and externalizing behavior using the Child Behavior Checklist (CBCL) were compared across groups, non-toilet trained and toilet trained, for 150 children recruited during their 4-year-old well child health care visit. Independent samples t tests of group means and χ2 analyses were performed on all CBCL scales. Results found no clinically or statistically significant differences between groups on parents' reports of internalizing and externalizing behavior. The current study provides no evidence that delays in successfully completing toilet training by 4 years of age were related to psychological problems for this sample of children. Nursing professionals in primary care settings are positioned to provide anticipatory guidance to parents of children not yet toilet trained. Findings from the current study offer evidence that delays in toilet training might not be related to psychopathology, and these children are not likely to require intervention outside the pediatric setting and could be effectively managed by primary care health providers employing evidence-based toilet training protocols.

Delayed in toilet training association with pediatric lower urinary tract dysfunction: A systematic review and meta-analysis

Globally, attitudes and practices towards toilet training have changed several decades ago and children are completing toilet training at a later age compared to previous generations. Concurrently, there has been an increase in the incidence of pediatric bladder bowel dysfunction (BBD), including lower urinary tract dysfunction (LUTD). Whether the fact of delayed toilet training may negatively impact the ability of children to obtain bladder and bowel control and cause LUT dysfunction remains controversial. To investigate the association between age at initiation of toilet training or approach to toilet training and the risks of lower urinary tract (LUT) dysfunction. A comprehensive search of the CENTRAL, EMBASE and MEDLINE via Ovid SP, and CINAHL via EBSCO databases was conducted to identify RCTs, cohort or case-control studies investigating the association between age at initiation of toilet training, approach used for toilet training, and pediatric LUT dysfunction. A total of 10 studies with 24,121 participants (aged 5-17) were included for pooled analysis. Overall, the odds ratio (OR) with 95% confidence interval (95%CI) of LUT dysfunction in children who initiated toilet training at a younger age when compared to those who initiated toilet training at an older age, was 0.71 (0.63-0.81), P<0.001), irrespective of the approach used for toilet training (Table). Subgroup analysis for day-time incontinence (persistent daytime wetting) was 0.77 (0.62-0.95), P=0.014; although the outcomes for enuresis fluctuated, favorable results were still observed in the earlier training group (OR:0.63, 95%CI:0.43-0.94, P=0.023). Subgroup analysis for age at initiating toilet training vs LUT dysfunction also showed favorable results in children who were trained earlier, i.e., before 24 months (OR:0.77, 95% CI 0.63-0.94, P=0.009). Sensitivity analysis confirmed that the results were robust. Although the definition about the age of initial toilet training varied greatly in studies, findings from the current study suggested that the optimal time for initiating toilet training may be prior to the age of 24 months; if toilet training was initiated after 24 months or later, it may result in increased prevalence of LUT dysfunction. Since no RCTs studies were included in the current meta-analysis, well-designed longitudinal studies with larger sample size and from different cultural background are needed to confirm these results. This meta-analysis presents preliminary findings that show the incidence of LUTD may be decreased by initiating toilet training in children at a younger age.

Evaluation of lower urinary tract symptoms in children with Down syndrome: A prospective, case-controlled cohort study.

In children with Down syndrome (DS) which causes cognitive impairment and intellectual disability (ID), dysfunctional voiding is proposed to be more common than in the normal population. In this study, we aimed to compare the voiding symptoms of DS children with a control group by validated questionnaires. Thirty-seven DS children without any previous urological complaints and 59 non-DS healthy children as control group was included in the study. Overactive bladder symptoms and dysfunctional voiding were evaluated with validated Overactive Bladder Questionnaire (OAB-V8) and Dysfunctional Voiding Symptom Score (DVSS) questionnaire, respectively. Data were arranged, descriptive and comparative statistical analysis were performed. Demographic data of the two groups were similar except age of completing toilet training being higher in DS group. Total OAB-V8 and DVSS scores were significantly higher in the DS group. The mean scores of questions regarding voiding frequency, urgency and urgency incontinence in OAB-V8 were significantly higher in the DS group. The mean daytime incontinence, urgency, urgency incontinence, and quality of life scores in the DVSS were also significantly higher in the DS group. DS children have more frequent dysfunctional voiding than the normal population. ID of these children may prevent the expression of these symptoms. Awareness and early detection of these symptoms are crucial to prevent devastating complications such as renal failure. Therefore, validated questionnaires are simple, useful, and noninvasive methods.

Development Signs in Healthy Toddlers in Different Stages of Toilet Training: Can They Help Define Readiness and Probability of Success?

There is much uncertainty about when to start toilet training. Age cannot be a strict stand-alone criterion, as every child has its own pace of development. We observed toilet training (TT) related development signs (DS) in healthy toddlers and determined which can help to define the proper time to start TT and to predict success. The study group consisted of 269 healthy children, in different stages of TT: not started, during, and after completion. Sitting stable, picking up small objects, and spontaneously putting objects in containers were present in all children and had no predictive value. All other DS were significantly more present in those who had started and became more prevalent during completion of TT. Age had a significant association with 13/15 DS. Understanding and following instructions, and having a broader vocabulary were significantly more present when TT had been started. Dry during midday nap reached no significance.

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

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.

Effect of Early Oxybutynin Treatment on Posterior Urethral Valve Outcomes in Infants: A Randomized Controlled Trial.

We studied the effect of oxybutynin on bladder and upper urinary tract outcomes in infants following posterior urethral valve ablation. Patients younger than 12 months old who had undergone primary endoscopic valve ablation for posterior urethral valves were screened for eligibility. Patients who had undergone urinary diversion or had other conditions that could affect lower urinary tract function were excluded. Study patients were randomized to either oxybutynin (0.2 mg/kg 3 times daily) until toilet training or active observation. The study end points were serum creatinine, estimated glomerular filtration rate, hydronephrosis improvement, vesicoureteral reflux resolution, febrile urinary tract infection and toilet training. A total of 49 infants (24 receiving oxybutynin and 25 undergoing observation) were enrolled between December 2013 and September 2015 and completed at least 1 year of followup. Oxybutynin was discontinued before toilet training in 5 patients due to facial flushing in 2, bladder and upper tract dilatation in 2, and cognitive changes in 1. After a median followup of 44.2 months (range 12 to 57.6) median serum creatinine and estimated glomerular filtration rate were not significantly different between the groups (p=0.823 and p=0.722, respectively). Renal units in the oxybutynin group had a greater likelihood of hydronephrosis improvement (61.9% vs 34.8%, p=0.011) and resolution of vesicoureteral reflux (62.5% vs 25%, p=0.023). Febrile urinary tract infection (29.2% vs 40%, p=0.404), completion of toilet training (70.8% vs 76%, p=0.748) and age at toilet training (p=0.247) did not differ significantly between the oxybutynin and observation groups. Oxybutynin enhances hydronephrosis improvement and vesicoureteral reflux resolution following primary endoscopic valve ablation in infants but periodic monitoring is warranted.

Prevalence of enuresis and its impact in quality of life of patients with sickle cell disease.

ABSTRACTIntroduction Evidence indicates an increase in the prevalence of enuresis in individuals with sickle cell disease. The present study aims to evaluate the prevalence and impact of enuresis on quality of life in individuals with sickle cell disease.Materials and Methods This cross-sectional study evaluated individuals with sickle cell disease followed at a reference clinic, using a questionnaire designed to evaluate the age of complete toilet training, the presence of enuresis and lower urinary tract, and the impact on quality of life of these individuals.Results Fifty children presenting SCD (52% females, mean age ten years) were included in the study. Of those, 34% (17/50) presented as HbSC, 56% with HbSS (28/50), 2% Sα-thalassemia (1/5) and 8% the type of SCD was not determined. The prevalence of enuresis was 42% (21/50), affecting 75% of subjects at five years and about 15% of adolescents at 15 years of age. Enuresis was classified as monosymptomatic in 33.3% (7/21) and nonmonosymptomatic in 66.6% (14/21) of the cases, being primary in all subjects. Nocturia was identified in 24% (12/50), urgency in 20% (10/50) and daytime incontinence 10% (5/50) of the individuals. Enuresis had a significant impact on the quality of life of 67% of the individuals.Conclusion Enuresis was highly prevalent among children with SCD, and continues to be prevalent throughout early adulthood, being more common in males. Primary nonmonosymptomatic enuresis was the most common type, and 2/3 of the study population had a low quality of life.

Information as a crucial factor for toilet training by parents.

Toilet training (TT) is a milestone in a child's development. Nowadays, children complete TT later than previous generations. This can have detrimental consequences for the child, the parents, and the environment. TT is experienced as difficult and time-consuming; parents could benefit from guidelines to assist in this process. Focus group discussions (FGDs) were used to explore parents' experiences in an inductive approach applying purposive sampling. The FGDs aimed to explore the type of information parents wanted to receive on TT, from whom and how. After six FGDs, including 37 participants with personal experience in TT, data saturation was achieved. The findings of this qualitative study show that reputable agencies, family, friends, day-care workers, and nursery school teachers were considered very helpful and trustworthy sources. TT information should be easily understandable and not contain scientific terms or much text. A colourful and illustrated brochure sent by regular mail is preferred. Our study allows to develop a source of correct and wanted information about TT that parents can and want to use, which helps them completing this training more easily and timely.

The effect of tonsillectomy and adenoidectomy on enuresis nocturna in pediatric patients

Aim: Enuresis nocturna (EN) is a condition that is characterized by frequent intermittent night-time incontinence in children. The aim of this study was to investigate the effect of tonsillectomy and adenoidectomy on EN in patients with tonsil hypertrophy and adenoid hypertrophy. Material and Method: Thirty pediatric patients who were admitted to urology clinic between May 2015 and May 2016, who had completed toilet training and who were diagnosed with enuresis nocturna between the ages of 5 and 16 and had open mouth, snoring, breathing in sleep, were included in the study. A detailed ear,nose,throat examination and flexible endoscopic examination were performed in all patients. Patients were grouped according to tonsil and adenoid size. Demographic and examination findings of the patients were recorded. Patients were operated according to the condition of tonsils and adenoids, and 6 months later, control was performed. Results: The mean age of the participants was 9.36 ± 2.85. While 21 (70%) patients underwent adenoidectomy, 5 (16.6%) patients underwent tonsillectomy and 4 (13.3%) underwent tonsillectomy and adenoidectomy. Postoperative follow-up 6 months later, 15 (71.4%) patients underwent adenoidectomy and 1 (20%) underwent tonsillectomy, and 2 (50%) patients who underwent tonsillectomy and adenoidectomy were completely followed by the disappearance of complaints nocturnal enuresis. Thus, in the preoperative and postoperative 6th month evaluation, there was a statistically significant difference in the improvement of complaints of enuresis nocturna after surgery (p‹0.01). Conclusion: In conclusion, surgery for upper airway obstruction due to tonsil and adenoid hypertrophy in enuresis nocturna patients may contribute to the reduction of complaints of enuresis nocturna.

The Evaluation of Primary School Readiness Levels of the Children Aged 66 - 72 Months with the Denver II Test

Background: Primary school can lead to compatibility problems in children without an early childhood education because they experience separation from their families for the first time. Objectives: In order to detect developmental delays that may arise at the school and to plan the necessary support, it was aimed to determine primary school readiness levels of the children aged 66 - 72 months. Methods: This study included 91 children aged 66 - 72 months who were admitted to the Pediatric Outpatient Clinic of Beyhekim State Hospital between June 2016 and August 2016. The Denver Developmental Screening Test II which consists of 134 items was performed. The Test items are divided into four main sections and surveys whether the chilren are ready for the first grade of primary school. The test results were interpreted as normal, suspect and abnormal. Results: 36 (39.6%) of 91 patients were female and 55 (60.4%) were male. There was no statistically significant difference between the test results in terms of gender. When examining the distribution of children according to months, there was no statistically significant difference. Data for the child's age, the mother's age, the father’s age, duration of breastfeeding, the age (month) at which the child started talking, walking or completed toilet training was expressed as mean ± standard deviation. When these values were examined and also the mean values containing normal and abnormal results were compared, there was a statistically significant difference only between the months when the children started talking. When examining the results of the Denver II test, it was found that 64 (70.3%) children had abnormal development and 27 (29.7%) normal development. Conclusion: In the study evaluating primary school readiness levels of the children aged 66 - 72 months, the substantial proportion of the children who were admitted to the hospital, had a developmental delay. In light of this study, all pre-school children should be evaluated before admission to primary school.

Prolonged toilet training in children with Down syndrome: a case‐control study

ObjectivesChildren with Down syndrome have delayed psychomotor development, which is a factor that influences the level of difficulty in toilet training. The current study aims to estimate the age toilet training starts and completes in children with DS compared to children with normal psychomotor development and to evaluate the method and type of toilet training most frequently used, as well as its association with lower urinary tract symptoms and functional constipation. MethodsA case‐control study was carried out from 2010 to 2015. All parents completed a questionnaire designed to assess the toilet training process. Lower urinary tract symptoms were assessed through the application of the Dysfunctional Voiding Symptom Score. The presence of functional constipation was assessed according to the Rome III criteria. ResultsThe study included 93 children with Down syndrome and 204 children with normal psychomotor development (control group [CG]). The mean age of toilet training onset was 22.8 months in those with DS and 17.5 months in the CG (p=0.001). In children with DS, the mean age when completing toilet training was 56.2 months and 27.1 months in the CG (p=0.001). Among children with DS, females completed toilet training earlier (p=0.02). The toilet training method used most often was child‐oriented approach in both groups. No association was observed with the presence of lower urinary tract symptoms or functional constipation and the age of beginning and completing toilet training in both groups. ConclusionChildren with Down syndrome experienced prolonged toilet training time. Prospective longitudinal studies are essential to gain insight into the toilet training of these children.

Toilet training practices in Nigerian children

Background . This study reports on toilet training with a focus on the effect of age, methods used, and factors that can affect urinary incontinence in Nigerian children. Methods . This was a cross-sectional hospital-based study carried out in public and private hospitals in South-Western Nigeria. A questionnaire was used to obtain information about toilet training practices from 350 adults, who toilet trained 474 children. Results. The adults had previously toilet trained children 1 - 18 years old. In this study, toilet training commenced at ≤12 months, during the day and night in 40.6% and 33.4% of children, respectively. Of the 350 parents/guardians, 141 (47.7%) commenced toilet training by waking children from their afternoon nap. The most common method was allowing the child to urinate at fixed time intervals, while the least common was a reward/punishment system. Furthermore, age was considered as the most common indicator to commence toilet training. For 36.9% of the children, training lasted 1 - 6 months. Daytime continence was achieved by 33.4% of children at ≤12 months old, and night-time continence was achieved in 29.7% of children between 12 and 18 months old. By 30 months, 91.1% and 86.9% had attained day- and night-time continence, respectively, and only 8.6% of the children were incontinent at night. Conclusion. Assisted infant toilet training is still practised among Nigerian parents despite the influence and the trends in the developed countries. The age at initiation and completion of toilet training was lower than those reported for developed countries.