Yahoo Lifestyle Toilet training: Are kids staying in nappies too long?
Toilet. Training. They’re just two simple words, but they can be enough to send shivers down the spines of mums and dads across the country – and with good reason! Not only can training your child to use the loo be a messy and smelly affair sometimes ending in tears (yours, usually), it’s also riddled with controversy. Today everyone seems to have a varying opinion about how soon little cherubs should be out of nappies.
In the 1950s, the trend was to make it happen fast. In America, 90 per cent of kids were toilet trained by two years and many as early as 18 months – something closely matched in Australia. Then, the introduction of washing machines, disposable nappies and time-poor working mums saw the rules relax and more parents put the potty off.
This shift was partly led by US paediatrician Dr T. Berry Brazelton, an advocate for a gentler, child-centred approach. Since then, attitudes towards older toddlers still wearing nappies have relaxed and many parents are delaying toilet training even longer. Today, at least a third of kids are still in nappies at the age of three and beyond.
Training methods have also changed considerably. In the early days, mothers watched for their babies’ signals soon after birth, quickly moving them to a toilet or the garden when they looked ready to go.
Some taught bubs specific toileting signals to communicate when an evacuation was imminent, while others would hold their one-year-olds on the potty after meals, leaving them there until they finished. In extreme cases, kids were strapped to the potty, punished or shamed into ‘performing’.
Things are very different in this day and age. While some countries and cultures still practise early training, such as parts of Africa, Asia and South America out of necessity and parts of Europe out of cultural norms, most Australian children are trained between the ages of two and three-and-a-half years.
But is this ideal? When is the perfect age to train your little one?
Sooner or later?
Current government guidelines state that children aren’t ready to be toilet trained until they are at least two, and possibly as late as three, years of age. The general consensus is that kids should be an interactive and willing part of the process, with the physical, social, emotional and cognitive skills to alert their parents when they’re ready to go, take themselves to the loo and remove their clothes in time.
Under 12 months, children don’t have sufficient bladder and bowel control. This all makes sense to Dr Michael Fasher, a child-health expert and Western Sydney-based GP of 33 years. “I don’t believe there is a perfect age,” he says, “[but] it would be ridiculous to try under the age of 12 months. I think 18 months is pretty early and certainly by the age of four, if a child wasn’t toilet trained, you’d be concerned.”
Sydney-based clinical psychologist Vera Auerbach agrees that a child needs to show interest in order to be toilet trained. “I think at some point between two and three, kids become interested in what you do when you go to the toilet and that’s the time to start.”
But not everyone agrees. Sydney researcher Anna Christie has looked into what she calls the “abandonment of toilet training” in Australia and, in her research paper, says it’s harming the environment, community
health, our hip pocket and our little ones. She blames disposable nappies for pushing back the training age and says many parents have lost the art of early training.
Unless there’s illness or a domestic disruption, such as a new baby, Anna says the ideal window of opportunity for training is from 18 to 24 months of age. “If toilet training is commenced during this age
span, independent toileting is likely to be achieved more quickly and with less risk of the child developing resistance and difficult behaviours,” she says. “We must not forget the intangibles [too], such as the dignity of the child who is forced to endure a year or more of nappies beyond the age when [she] would have been trainable less than one generation ago,” she adds.
Psychologist and author of the bible on early training, Early-Start Potty Training ($23.95, McGraw-Hill), Dr Linda Sonna agrees that sooner is better than later. “Toddlers have a hard time sitting still long enough to learn, are attached to their [nappies] and many resist putting aside their toys for potty trips.”
Both Anna and Dr Sonna say there is growing research linking increasing childhood incontinence to urinary problems, unstable bladders, asthma, faecal contamination at daycare centres and constipation. Anna points to one study showing 41.7 per cent of late trainers develop chronic constipation, compared with 13.2 per cent of children trained before 42 months. Dr Sonna says delayed training may even be associated with undescended testicles and infertility. “Having children ‘wear their waste’ for years on end is a definite health hazard,” she says.
Not so fast
Dr Fasher disputes this, however. “I don’t think there’s any medical or health problem – it’s a social issue and it depends on the comfort of the kid and of the parents, really,” he says. “The preschool may be saying, ‘Please start training’, but there are no issues [surrounding] the child’s development or wellbeing.”
Nor does Dr Fasher believe that disposable nappies are the problem. “If people are delaying training, it’s likely to be because of family preoccupation – both parents working and everybody being frantically busy,” he says, “and disposable nappies make it easier for those families.” Delayed training simply indicates “that things need to be right for both the child and the family for the whole process to proceed in a relaxed, happy fashion,” he says.
Going to the toilet is a bit like eating, adds psychologist Vera. “You can not force it. It’s really important to not get into a battle of trying to control this, because it can go terribly wrong. This is where I see kids who are constipated because they withhold their poo. It’s much better to start training a child when she becomes interested.”
Vera also doesn’t think children should be trained with signals. “These are little human beings, not animals, and it’s about the child getting control over her own body,” she says.
In her book The Mighty Toddler ($39.99, Pan Macmillan), child-expert and nurse Robin Barker says it’s dangerous to push a child, especially if she’s between 14 and 24 months, when she’s testing her personal power. “It’s not a good time to push an issue that is not important enough to warrant so much attention. Pick a time somewhere between 18 months and three when you think the time is right.”
Getting started
If you do choose to start training early, there’s no medical reason not to, says Dr Fasher. “It all depends on the personality of the child and how the family functions. There’s really only one rule around
this whole area and that is avoiding parent coercion, irritability and punishment, because that will certainly delay toilet training.”
You’ll have to learn to watch for your child’s signals that she needs to go, prepare for mess and be patient. Never make it a battle and understand that children may regress when they’re feeling sick, stressed or pressured. If it’s not working, try again in a few months.
The key is to look for signals of readiness, says Dr Fasher. “One very simple parameter would be when a child has a dry nappy for more than two hours. That’s a clue that her bladder capacity is developing and she is in a position to get to the toilet.”
Other signs of readiness include showing an interest in the toilet or potty, pulling at wet or dirty nappies, telling you when a poo or wee is being done (or letting you know afterwards) and simply refusing to wear nappies anymore. If your child is showing none of these signs by the age of four, see your GP.
Some conditions can delay the process, such as constipation or, in rare cases, congenital abnormalities.
Most children take three to four weeks to learn, although some can take a matter of days, others years, and it’s common to continue bed-wetting from time to time – around 10 to 20 per cent of children in the younger primary school years still wet their beds – but most grow out of it naturally. “Though any child who is established and dry at night and starts bed-wetting again deserves to have a urine culture to make sure there is no urinary tract infection or glucose in the urine,” says Dr Fasher.
No matter when you start, all experts agree the trick is to go gently. So start when it feels right for your family and be supportive, flexible and full of praise. Good luck!
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