Toilet training and enuresis

Toilet training is often taken for granted because it appears to occur so readily in such a large majority of children. It would be easy to hypothesize some internal mechanism which, if triggered at the right point in time, results in the initiation of a preprogrammed process that terminates with the child being trained. Variations across cultures regarding the age at which children are trained, the multitude of training procedures used by parents, and the variety of problems encountered during toilet training suggest that such is not the case. Toilet training has not been the focus of extensive systematic research as incontinence appears to impose no immediate or uncompromising physical threat to the child. Our apparent insensitivity to the emotional and psychological discomfort is perhaps highlighted by our rather cavalier attitude regarding the necessity of treating the younger (6 to 10 year old) child. Enuresis takes on added significance to the extent that it seems to be the symptom of some underlying neurologic or urologic abnormality. Once the enuresis is determined to be functional in nature, we are often satisfied with allowing the child and family to deal with the matter on their own and to return if the problem persists into adolescence. If treatment is begun at an early age, it seems to have a greater chance of success with fewer complications. It need not be particularly time-consuming once an adequate assessment has been carried out. Nurses, paraprofessionals, mental health technicians, and so forth, can be trained and utilized effectively in following the process of the parent and child. A compassionate, understanding, and systematic approach encourages compliance and patients on the part of the child and parents.