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Toilet training and bowel habits in children up to 4 years: Insights from a population-based prospective cohort study

Demi Huijgen1, Tarik Karramass2,3, Hendt P Versteegh1

  • 1Department of Pediatric Surgery Erasmus University Medical Center-Sophia Children's Hospital Rotterdam the Netherlands.

JPGN Reports
|May 11, 2026
PubMed

Insights

Most children achieve toilet training by 36 months. This study details healthy toilet training timelines and bowel habits, noting variations by sex, socioeconomic status, and ethnicity to identify abnormal patterns.

Area of Science:

  • Pediatrics
  • Gastroenterology
  • Public Health

Background:

  • Establishing normal toilet training practices and bowel habits in children is crucial for identifying potential developmental issues.
  • Conflicting information often makes it difficult for parents and healthcare providers to assess typical milestones.
  • Understanding variations in toilet training and bowel function is essential for early intervention and support.

Purpose of the Study:

  • To provide a comprehensive overview of toilet training progression and typical bowel habits in healthy children up to four years of age.
  • To analyze demographic factors influencing the initiation and completion of toilet training.
  • To establish reference ranges for defecation frequency and stool consistency in early childhood.

Main Methods:

  • A large-scale prospective cohort study involving 6850 parent-child pairs (Generation R Study).
  • Data collection via questionnaires on toilet training and bowel habits.
  • Logistic regression analysis to determine associations between demographic factors and toilet training outcomes, with results presented as odds ratios [95% confidence interval].

Main Results:

  • By 24 months, 60.1% of children had started toilet training; by 36 months, 60.0% had completed it.
  • Initiation of toilet training by 24 months was associated with sex, maternal education, and child's ethnic background.
  • Defecation frequency stabilized to 1-2 times daily for 81.3% of children by 24 months; infrequent bowel movements (up to 6.3%) and hard stools (up to 14.3%) were observed.

Conclusions:

  • Approximately 60% of children achieve toilet training by 36 months, with significant variations influenced by sex, socioeconomic status, and ethnicity.
  • The study provides valuable insights into normal bowel habits and toilet training milestones in healthy children.
  • These findings can aid in distinguishing typical variations from potential abnormal patterns requiring further investigation.
Abstract

Keywords:
bowel controlconstipationcontinencedevelopmental milestoneslaxative

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