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Specific Behaviors of Young Healthy Children During Toilet Training and Their Associations With Functional

Laura Naenen1, Tinne Van Aggelpoel1,2, Ella Roelant3

  • 1Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.

Journal of Developmental and Behavioral Pediatrics : JDBP
|August 15, 2025
PubMed

Insights

Certain toilet training behaviors like stool toileting refusal (STR), hiding, and asking for a diaper are significantly linked to functional constipation (FC) in children. Early identification of these behaviors can help prevent FC development.

Area of Science:

  • Pediatric Gastroenterology
  • Child Development
  • Behavioral Pediatrics

Background:

  • Functional constipation (FC) is a common pediatric issue.
  • Toilet training (TT) is a critical developmental milestone.
  • Specific TT behaviors may influence the development of FC.

Purpose of the Study:

  • To investigate the association between specific toilet training behaviors and functional constipation in young children.
  • To identify potential risk factors for functional constipation during toilet training.

Main Methods:

  • A cross-sectional descriptive study was conducted with 1218 children from nursery schools in Flanders.
  • Questionnaires were administered to parents regarding child's TT behaviors (stool toileting refusal, hiding, requesting a diaper) and stool issues.
  • Stool consistency was assessed using the Bristol Stool Chart.

Main Results:

  • The prevalence of functional constipation was 16.8%.
  • Significant associations were found between FC and stool toileting refusal (STR), hiding defecation, and requesting a diaper.
  • Children exhibiting these behaviors had a 2.8 to 3.7 times higher odds of developing FC.

Conclusions:

  • Behaviors such as refusing to defecate, hiding, and requesting a diaper are significantly associated with functional constipation in children.
  • These findings are clinically relevant for parents and pediatricians in identifying potential signs of FC.
  • Awareness of these TT behaviors can aid in early intervention and prevention of functional constipation.
Abstract

Keywords:
child healthfunctional constipationpotty trainingtoddlertoilet trainingtoilet training behavior

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