Observing signs of toilet readiness: results of two prospective studies

Area of Science:

• Child Development
• Pediatric Health
• Behavioral Observation

Background:

• Assessing readiness signs is crucial for effective toilet training.
• Existing literature provides a basis for identifying readiness signs in young children.
• Reliability of observing these signs needs empirical validation.

Purpose of the Study:

• To evaluate the observability of proposed readiness signs in young children (Study 1).
• To determine the interrater reliability of observing readiness signs among researchers (Study 2).
• To refine a checklist of observable readiness signs for practical use.

Main Methods:

• Study 1 involved observing 24 healthy children for 8 hours each, using a literature-based list of readiness signs.
• Study 2 assessed interrater reliability using an adapted checklist with 24 healthy children and two independent observers.
• Statistical analysis, including Cohen's kappa, was employed to measure observer agreement.

Main Results:

• Not all initially proposed readiness signs were easily observable, leading to a refined checklist of 20 signs.
• The refined checklist demonstrated good to perfect interrater reliability for most signs.
• High agreement between observers suggests the practicality of the shortened readiness sign checklist.

Conclusions:

• The developed 20-item readiness sign checklist is observable and reliable for use in research and practice.
• These findings are foundational for a series of studies aiming to establish consensus on readiness signs for toilet training.
• Further research will focus on developing evidence-based guidelines for initiating toilet training based on validated readiness signs.