Introduction:

Toilet training is one the most important social and physiological milestones in development of a child.Inappropriate training can lead to conflict between child and parent leading to frustration and anger in the child.

Physiological basis of toilet training:

Normal development of bladder control:

  • 18 months-child can tell mother that he wants to pass urine,but cannot hold it and passes the urine in garments.
  • 24-30 months-child is dry during the day.
  • 36 months-50%children are dry in night.
  • 42 months-75%children are dry.
  • ability to start and stop urine flow voluntarily develops at around 54 months.

Normal development of bowel control:

  • the gastrocolic reflex decrease by 5-6months of age and is absent at 7 months of age.
  • 18 months-child can pass stools in the lavatory.
  • 24 months-trainable.
  • 36 months-with holding/postponing of passage of stools possible.

Phases of toilet training:

Brazelton’s child oriented approach has proved very effective,toilet training is first discussed with parents during the ninth month visit and the parents are counselled.

phase1:started by 18-24 months.child is introduced to potty chair.at any convenient day time the child is brought to sit on the potty with clothes on. the child can leave at any moment he desires.Compliance is rewarded with a cookie or other reinforcer.

phase2:after about a week, the child is allowed to sit on a potty chair with his diaper off.No force is used to make the child to sit on the potty.Child is rewarded for his compliance. No attempt to catch stool or urine is done yet.

phase3-after another week or so,the child is brought to the potty chair a second time during the day after he has wet or soiled.his diaper is removed in the bathroom and the dirty diaper is placed on the potty chair pointing out that the chair is a receptacle to the waste.

phase4:potty chair is removed into the child’s play area.periodically the child’s pants and diapers are removed and he is advised to use the potty chair for passage of urine or stool. the child usally becomes excited about the newly acquired skill at this moment of time.

phase5:child is trained to remove pants and replace them. boys should to taught to urinate standing up.the child is encouraged to use the potty chair for himself

problems encountered :

constipation.

enuresis.

encopresis