Initiation Of Toilet Training Research Articles

The Assessment and Management of Childhood Masturbation: An Analysis of 90 Cases.

The child's self-stimulating pleasure behavior is defined as childhood masturbation (CM). Diagnosis of CM is mainly based on behavior and analysis of video recordings. This study aims to investigate etiological factors, movement patterns, and treatment options.Medical records and video recordings of CM in our clinic between 2015 and 2020 were retrospectively reviewed. Ninety patients aged 8 months to 9 years were included in our study. The male-to-female ratio was 23/67. The mean age at onset of masturbation (mean ± standard deviation) was 21.42 ± 18.44 (6-107) months. Note that 27.7% (32) of the patients were taking antiepileptic drugs before admission.Eight of the 90 patients had abnormal electroencephalograms. The time of onset of CM was related to cessation of breast milk in 24.4%, separation from the mother in 43.3%, new siblings in 16.6%, initiation of toilet training in 7.7%, and parental divorce in 6.6%. Behavioral therapy was sufficient in 71.1%. Hydroxyzine hydrochloride in 19 (21.1%) and risperidone in 9 (10%) were given in the remaining cases. Overall, 23/28 of the cases receiving medication improved during follow-up. Physicians may have difficulty identifying repetitive movements in CM. Misdiagnosis or delayed diagnosis may lead to unnecessary use of antiepileptic drugs, delayed initiation of treatment, and prolonged treatment duration. Video recordings are important in the differential diagnosis of CM. CM may have psychosocial causes and can often be effectively treated with behavioral therapy. Pharmacological treatment (hydroxyzine hydrochloride and risperidone) may be considered in cases that do not respond to behavioral treatment.

Pattern of child faeces management and disposable diaper usage among under-fives in an Urban Slum of Bandung, Indonesia

Abstract Children's faecal waste is a major environmental health issue despite increasing access to sanitation facilities and sanitary products in Indonesia. This cross-sectional study investigated child faecal management practice and disposable diaper usage among under-fives living in an urban slum of Indonesia. Data on household socio-demographics, child characteristics, and child faeces management practices were collected from 184 randomly selected pairs of mothers and children through interviews and observations. Findings revealed children's common defaecation sites as improved toilet, disposable diaper, and reusable diaper at 33.7, 33.2, and 16.3%, respectively. However, hygienic child faeces disposal was at 45%. Multivariate logistic regression indicated that the common use of disposable diapers and bathroom floor as the child's defaecation site increased unhygienic disposal. This prevalence decreased for mothers with higher education and those who had initiated toilet training. Promoting mothers' disposal of child faeces from disposable diapers, preventing child defaecation on the bathroom floor, and initiating toilet training as soon as a child can walk alone are thus potential interventions.

Does the development and use of modern disposable diapers affect bladder control? A systematic review

During the last decades, the development of the modern disposable diaper (DD) has changed the way we diaper our children, as they are safe, easy to use, comfortable and easy to dispose, compared to cloth diapers used earlier. Concurrently, the age of initiating toilet training (TT) is rising. We aimed to investigate the connection between DD usage and the tendencies seen in TT and childhood urinary incontinence, with specific interest on studies evaluating the effect of diapering on enuresis. A literature search was conducted in PubMed and Embase. A systematic literature search was conducted, revealing 309 studies in Embase and 269 studies in Pubmed. After removing duplicates, 400 studies were eligible for screening. All abstracts were screened, and 12 relevant abstracts where identified, but only eight studies were eligible. No prospective intervention studies specifically evaluating the effect of diaper on enuresis were identified. Literature on TT and diapers in general was identified using the respective search terms on both databases. The eight studies identified showed a tendency towards diaper use being related to a delay on obtaining continence in children, but no secure conclusions can be made, as the literature is inadequate. Based on the available literature no secure conclusions can be drawn although an association is suggested. In order to evaluate the effect of diapers on incontinence, prospective randomized studies are needed.

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.

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.

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.

A prospective cohort study of biopsychosocial factors associated with childhood urinary incontinence

The objective of the study was to examine the association between biopsychosocial factors and developmental trajectories of childhood urinary incontinence (UI). We used developmental trajectories (latent classes) of childhood UI from 4–9 years including bedwetting alone, daytime wetting alone, delayed (daytime and nighttime) bladder control, and persistent (day and night) wetting (n = 8751, 4507 boys, 4244 girls). We examined whether biopsychosocial factors (developmental level, gestational age, birth weight, parental UI, temperament, behaviour/emotional problems, stressful events, maternal depression, age at initiation of toilet training, constipation) are associated with the trajectories using multinomial logistic regression (reference category = normative development of bladder control). Maternal history of bedwetting was associated with almost a fourfold increase in odds of persistent wetting [odds ratio and 95% confidence interval: 3.60 (1.75–7.40)]. In general, difficult temperament and behaviour/emotional problems were most strongly associated with combined (day and night) wetting, e.g. children with behavioural difficulties had increased odds of delayed (daytime and nighttime) bladder control [1.80 (1.59–2.03)]. Maternal postnatal depression was associated with persistent (day and night) wetting [2.09 (1.48–2.95)] and daytime wetting alone [2.38 (1.46–3.88)]. Developmental delay, stressful events, and later initiation of toilet training were not associated with bedwetting alone, but were associated with the other UI trajectories. Constipation was only associated with delayed bladder control. We find evidence that different trajectories of childhood UI are differentially associated with biopsychosocial factors. Increased understanding of factors associated with different trajectories of childhood UI could help clinicians to identify children at risk of persistent incontinence.

Tuvalet Eğitimine Başlamayı ve Tamamlamayı Etkileyen Faktörler

Objective: The aims of this study were to determine the timing of initiation and completion of toilet training (TT) and affecting factors in a group of Turkish children aged 24-60 months. Material and Methods: This survey was performed in an outpatient clinic at Turgut Ozal University Hospital. A questionnaire containing 35 items were applied to the parents who have children aged 24-60 months. The children who couldn't completed TT and had developmental retardation or genitourinary and gastrointestinal system anomalies were excluded. Results: A total of 418 children were taken to the study. Mean the initiation and completion ages were 25.2±5.6 and 27.2±5.8 months, respectively. Mean of TT duration was 56.2±52.5 days. Only 6% of the children were started to the TT at under aged 18 months. Most parents had considered to child's age and readinees for TT. We didn't find any significant association between the age at starting and completion of TT and gender, gestational age, being first born, emplooyed mother, family type, undergoing circumcision, applying reward and punishment during training. Later age of starting and completion TT were associated with higher education level of parents and consulting to an expert during TT. Later age at completion of TT was associated with attending daycare. Conclusion: This study showed that most Turkish families prefer to start on recomended time for the age at initiation of TT and implementing to child-oriented approach in Turkish families.

Early initiation of toilet training for urine was associated with early urinary continence and does not appear to be associated with bladder dysfunction

To report the relationship between the ages initiating toilet training for urinary continence (TTU) and bladder function in healthy kindergarteners. In 3 years, we evaluated urinary continence status and bladder function in 318 healthy kindergarteners. Children with congenital anomaly, neurological disorder, or developmental disability were excluded. A parent completed the questionnaire including the age at initiation and the duration of TTU, the current status of daytime and nighttime continence, the age of attaining daytime and nighttime continence, frequency of defecation and Bristol Stool Scale. All children underwent uroflowmetry and post-void residual urine (PVR) examinations. Finally, 235 respondents (106 boys/129 girls, mean age = 4.8 ± 0.9 years) were eligible for analysis. The mean age initiating TTU was 24.4 ± 8.4 months (range: 1-52 months). Girls started TTU earlier than boys (23.3 months vs. 25.7 months, P = 0.03). Children started daytime TTU earlier (≤ 18, 19-24, and >24 months, N = 66, 71, and 98, respectively) was associated with earlier attainment of both daytime and nighttime continence (correlation coefficient = 0.60 and 0.31, respectively, P < 0.01). Children started nighttime TTU earlier (<30 months vs. ≥ 30 months) was associated with early attainment of nighttime continence and lower rate of enuresis (14.3% vs. 33.3%, P < 0.01). The prevalence rate of repeat abnormal uroflow patterns and repeat elevated PVR (>20 ml) was not different between early and late TTU. Early toilet training for urine was associated with early attainment of both daytime and nighttime urinary continence, and does not appear to be associated with bladder dysfunction.

A Prospective Study of Age at Initiation of Toilet Training and Subsequent Daytime Bladder Control in School-Age Children

A Prospective Study of Age at Initiation of Toilet Training and Subsequent Daytime Bladder Control in School-Age Children

Assessment of Parental Satisfaction in Children Undergoing Voiding Cystourethrography Without Sedation

Approximately 50,000 children undergo voiding cystourethrography annually. There is a recent trend toward using sedation or delaying voiding cystourethrography due to the anticipated distress to the patient. We hypothesized that with adequate preparation and proper techniques to minimize anxiety, voiding cystourethrography can be performed without sedation. We assessed parental satisfaction associated with patient and parent experience of voiding cystourethrography without sedation. We used a 33-question survey to evaluate parental satisfaction with patient and parent experience of voiding cystourethrography without sedation. Children were divided into 3 groups according to toilet training status. Statistical analysis was performed using Stata®. A total of 200 surveys were completed. Of the children 54% were not toilet trained. Of the parents 90% reported adequate preparation. More than half of parents classified the experience of voiding cystourethrography as equivalent to or better than a physical examination, immunization, ultrasound and prior catheterization. Most parents were satisfied with the ability of the child to tolerate the procedure and considered the experience better than expected. Children in the process of toilet training had the most difficulty with the procedure, correlating with lower levels of parental satisfaction. Voiding cystourethrography performed with adequate preparation and support can be tolerated without sedation. Children in the process of toilet training and females tolerate the procedure least.

The Effects of the Age Initiating Toilet Training on Urinary Continence and Voiding Function in Children

Purpose To report the effects of the age initiating toilet training on urinary continence and voiding function in children. Material and Methods In three years, we enrolled 318 healthy kindergarteners. One of the parents completed the questionnaire including the age initiating and the duration of toilet training, the current status of daytime and nighttime continence, the age of attaining daytime and nighttime continence, Dysfunctional Voiding Symptom Score (10 parameters, score 0–3), and Bristol Stool Scale. All children underwent uroflowmetry and post-void residual urine (PVR) tests. Results Finally, 235 respondents (106 boys/129 girls, mean age = 4.8 ± 0.9 years) were eligible for analysis. The mean age initiating toilet training was 24.4±8.4 months. Based on the age initiating toilet training, children were classified as Early (≦18months, n=67) or Late Group (>18 months, n=168). Early Group had higher rates of daytime and nighttime continence before 30 months of age than Late Group (89.6% vs. 42.9%, p 20ml) between two Groups. Conclusions Early toilet training was associated with early attainment of both daytime and nighttime continence. The children with early toilet training had normal voiding function and a trend of lower DVSS.

A Prospective Study of Age at Initiation of Toilet Training and Subsequent Daytime Bladder Control in School-Age Children

This study investigates the association between age at initiation of toilet training and development of daytime bladder control. The main aim is to examine whether initiation of toilet training after 24 months is associated with increased odds of daytime wetting in school-age children. The study is based on more than 8000 children, aged 4.5 to 9 years, from a UK birth cohort--The Avon Longitudinal Study of Parents and Children. Using multinomial logistic regression, the analysis examined the association between age at initiation of toilet training and 4 previously established trajectory groups representing different patterns of development of daytime bladder control (described as "normative development," "delayed acquisition," "persistent daytime wetting," and "relapse"). Compared with children whose toilet training was initiated between 15 and 24 months, initiation of toilet training after 24 months was associated with higher odds of membership to the trajectory groups representing persistent daytime wetting (1.52 [1.23-1.88], p < .001), delayed acquisition of daytime bladder control (1.47 [1.29-1.66], p < .001), or relapse in daytime wetting (1.52 [1.28-1.80], p < .001). Adjustment for confounding variables, including sex, developmental delay, difficult temperament, and the mother's self-reported depression, did not alter the main conclusions. There is evidence that initiating toilet training after 24 months is associated with problems attaining and maintaining bladder control. It is possible that delaying the onset of toilet training until after 2 years prolongs the exposure time to potential stressors that could interfere with the acquisition of bladder control, resulting in delays in achieving continence and susceptibility to relapses in daytime wetting.

A study on the toilet training and influencing factors

Purpose : We aimed to determine the ideal age for initiating toilet training and investigate the factors influencing the training. Methods : The study population comprised 1,370 children aged 2-6 years, who visited the pediatric clinics in Jeonju, Iksan, and Gunsan. Their parents were given questionnaires in order to gather data about the types of diapers used, ages when toilet training was initiated and completed for each day and night, its adverse effects, and the educational level and employment and economic status of the mothers. Results : The toilet training initiation age was low for those living in the country, having an elder sibling(s), and using cloth diapers, and for those whose mothers were employed and had a low economic status. The training completion age was 22.9 months when the training was initiated before the age of 18 months; this was lower than the training completion ages of 25.9 and 31.0 months when the training was initiated at the age of 18-24 months and after 25 months, respectively. However, the required durations in these cases were 8.4, 5.6, and 3.8 months, respectively. Encopresis and refusal occurred more often when the training was initiated before the age of 18 months than when initiated after this age. Conclusion : Toilet training should begin at least after the age of 18 months considering the developmental status of infants. It is recommended for the future researchers to develop specific guidelines regarding toilet training.

Beliefs about the appropriate age for initiating toilet training: Are there racial and socioeconomic differences?

Beliefs about the appropriate age for initiating toilet training: Are there racial and socioeconomic differences?

Beliefs about the appropriate age for initiating toilet training: Are there racial and socioeconomic differences?

To examine racial and socioeconomic differences in parental beliefs about the appropriate age at which to initiate toilet training. A cross-sectional survey of 779 parents visiting child health providers in 3 clinical sites in Washington, DC and the surrounding metropolitan area completed a self-report survey. The main outcome variable was parental beliefs about the appropriate age at which to initiate toilet training. Using multiple linear regression, differences in beliefs were assessed in relation to race, family income, parental education, parental age, and age of the oldest and youngest children. Among respondents, parents felt that the average age at which toilet training should be initiated was 20.6 months (+/-7.6 months), with a range of 6 to 48 months. Caucasian parents believed that toilet training should be initiated at a significantly later age (25.4 months) compared with both African-American parents (18.2 months) and parents of other races (19.4 months). In the multiple regression model, factors predicting belief in when to initiate toilet training were Caucasian race and higher income. Race and income were independent predictors of belief in age at which to initiate toilet training. More research is needed to determine what factors contribute to toilet training practices in diverse populations.

Why is toilet training occurring at older ages? A study of factors associated with later training

Recent studies suggest that children are completing toilet training much later than the preceding generation. Our objective was to identify factors associated with later toilet training. Children between 17 and 19 months of age (n=406) were enrolled in the study. At enrollment, parents completed the Parenting Stress Index and the Receptive-Expressive Emergent Language Scale. Follow-up parent interviews were conducted every 2 to 3 months until children completed daytime toilet training. Information obtained at follow-up interviews included steps parents were taking to toilet train their child, child toilet training behaviors, presence and frequency of constipation, birth of a sibling, and child care arrangements. In a stepwise linear regression model predicting age at completion of toilet training, 3 factors were consistently associated with later training: initiation of toilet training at an older age, presence of stool toileting refusal, and presence of frequent constipation. Models including these variables explained 25% to 39% of the variance in age at completion of toilet training. In conclusion, a later age at initiation of toilet training, stool toileting refusal, and constipation may explain some of the trend toward completion of toilet training at later ages.

Relationship between age at initiation of toilet training and duration of training: a prospective study.

Relationship between age at initiation of toilet training and duration of training: a prospective study.

Relationship between age at initiation of toilet training and duration of training: a prospective study.

To study the relationship between age at initiation of toilet training, age at completion of toilet training, and the duration of toilet training. A total of 406 children seen at a suburban private pediatric practice were enrolled in a study of toilet training between 17 and 19 months of age, and 378 (93%) were followed by telephone interviews with the parents every 2 to 3 months until the child completed daytime toilet training. Information obtained at follow-up interviews included how often parents were asking their child to sit on the toilet or potty and where the child urinated and defecated. Parents were considered to have initiated toilet training when they first took out a potty chair and discussed some aspect of training with the child. Intensive toilet training was defined as asking the child to use the toilet or potty >3 times per day. Age of initiation of toilet training correlated with age of completion of training (r = 0.275). The correlation between age at initiation of intensive training and age at completion was even stronger (r = 0.459). Younger age at initiation of intensive toilet training was not associated with constipation, stool withholding, or stool toileting refusal. However, age at initiation of intensive toilet training was negatively correlated with duration of toilet training (r = -0.481), indicating that initiation of training at younger ages was associated with a longer duration of training. In addition, the correlation between age at initiation of intensive toilet training and age at completion of training was not significant for those who began intensive training before 27 months of age (r = 0.107). Early initiation of intensive toilet training correlates with an earlier age at completion of toilet training but also a longer duration of toilet training. Although earlier toilet training is not associated with constipation, stool withholding, or stool toileting refusal, initiation of intensive training before 27 months does not correlate with earlier completion of toilet training, suggesting little benefit in beginning intensive training before 27 months of age in most children.

Toilet training.

Toilet training.