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Published on: January 23, 2017
Toilet training: situation at 2 years of age in a birth cohort
Denise M Mota1, Aluisio J D Barros
1Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil. denisemmota@gmail.com
Insights
Most 24-month-old children possess the skills for toilet training, yet many haven't started. Parental education and socioeconomic status influence the timing of diaper removal, with better-informed mothers delaying training the most.
Area of Science:
- Pediatrics
- Child Development
- Public Health
Background:
- Bladder and bowel control acquisition is multifactorial, involving physiological, psychological, and sociocultural elements.
- Early childhood development includes achieving continence, a key milestone for independence.
Purpose of the Study:
- To determine the prevalence of children out of diapers by 24 months of age.
- To identify factors associated with the acquisition of bladder and bowel control in early childhood.
Main Methods:
- A longitudinal study of 3,281 children born in Pelotas, Brazil, in 2004.
- Home visits at 24 months with maternal questionnaires on sociodemographic data and toilet training habits.
- Multivariate Poisson regression analysis to identify associated factors.
Main Results:
- 24.3% of children were daytime dry and 8.6% were nighttime dry by 24 months; females predominated in both.
- 85.5% of children had the necessary abilities for toilet training.
- Maternal education and higher social class were associated with later diaper removal, while children living at home and communicating toileting needs increased the likelihood of being out of diapers.
Conclusions:
- Despite developmental readiness at 24 months, most children had not commenced toilet training.
- Maternal knowledge and information access appeared to influence delayed toilet training initiation.
Objectives:
Acquisition of bladder and bowel control is influenced by physiological, psychological and sociocultural factors. The objective of this study was to evaluate the prevalence of children out of diapers by 24 months of age and the factors associated with this finding.
Methods:
A total of 3,281 children born in Pelotas, RS, Brazil in 2004 were enrolled on a longitudinal study. At 24 months their mothers were visited at home and replied to a questionnaire containing questions about sociodemographic data and the characteristics of their children's urinary and intestinal evacuation habits, with special attention to toilet training. Multivariate analyses were carried out using Poisson regression.
Results:
From the total, 24.3% were out of diapers during the day, with the female sex predominating (27.8 vs. 21.1%, p < 0.001) and 8.6% were out of diapers at night, also with the female sex predominating (10.6 vs. 6.8%, p < 0.001). The abilities needed to start toilet training were present in 85.5% of the children. Guidance was received from a pediatrician in 10% of cases, and more frequently among richer mothers than among poorer mothers (22.9 vs. 4.8%). Mothers who spent more years in education (13.2%) and were from higher social classes (14%) took their children out of diapers later; a greater number of children living at home (relative risk = 1.32) and being able to communicate the need to go to the toilet (relative risk = 11.74) both increased the probability of being out of diapers; previous unsuccessful attempts delayed removal of diapers (relative risk = 0.59).
Conclusions:
Although the abilities needed for acquisition of bladder and bowel control were already present at 24 months, indicating that toilet training could be started, the majority of children had not yet started this training. Better-informed mothers delayed training the most.
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