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New research on the timing of potty training shows problems for pushing children too soon or waiting too long.
By Whitney L.J. Howell
The frustrating journey of toilet training a child is a struggle every parent faces. Starting kids down this path early can be tempting, but a new study from Wake Forest University found that pushing the topic too soon – or too late – can cause physical problems and lead to wetting accidents.
Children who are toilet trained prior to age 2 or after age 3 have significantly more daytime and nighttime accidents than children trained between the two ages, the study showed.
“Toilet training seems like a religious topic,” said study leader Steve Hodges, a pediatric urologist at Wake Forest Baptist Medical Center. “People can get so mad and say they trained their child at age 2 or 1, and [that] everything is fine. But training too early or late is a risk factor, and we want to prevent toileting problems in all kids with maximal effect.”
As long as a child stays in diapers, his or her bladder continues to grow in size. Being able to urinate freely increases the bladder’s fluid capacity and actually helps it learn to function more effectively, he said. Once toilet training is introduced though, that growth stops. So, according to research from the University of Oklahoma Health Sciences Center, children who toilet train earlier will automatically have smaller bladders, potentially setting them up for future toileting problems.
But the real culprit behind wetting accidents, Hodges said, is constipation. Increased fullness in the bowels presses on the bladder, making it harder for children to control the flow of urine. Over longer periods, that same fullness can also stunt the bladder’s growth, further inhibiting capacity. In addition, the muscles used to restrict bowel movements are connected to muscles that control urination; constriction can make it harder for children to learn proper toileting behaviors.
This study is the first research to connect constipation to wetting accidents in younger children.
“Across the board, most voiding complaints in kids are due to incompletely emptying the colon, not anything to do with the bladder,” Hodges said. “There’s nothing inherently bad about pooping rarely as long as everything leaves the colon. It’s when the colon doesn’t empty that we start to see bladder problems, such as daytime wetting and urinary frequency.”
In some cases, constipation occurs when a child resists parents’ efforts to introduce toilet training. Other times, outside influences, such as a new sibling, can stall a child’s progress.
Hodges’ team followed the toileting habits of 112 children aged 3 to 10 for six months. The majority were toilet trained between ages 2 and 3, and parents reported 38 percent had a history of constipation and 45 percent had experienced daytime wetting.
Although anecdotal evidence shows girls can toilet train earlier and easier than boys, Hodges’ research found being male didn’t increase the likelihood of constipation or daytime wetting.
According to the findings, the children who toilet trained before age 2 were more than three times as likely to suffer from constipation than children who trained between ages 2 and 3. Children who trained after age 3 experienced constipation seven times as often. In addition, when compared to other children, kids who trained early and late had daytime wetness nearly four times and five times as often, respectively.
These problems can frequently be overlooked, said Triangle Center for Behavioral Health clinical psychologist Rebecca Dingfelder, because parents aren’t comfortable broaching the subject with their child’s physician. Dingfelder has expertise in working with children who have toilet-training difficulties.
“A lot of problems stem from parents being embarrassed to talk with pediatricians – not about toilet training but about the constipation that might be going on,” she said. “Parents need to discuss with their pediatricians how things are going with pooping, especially if there are problems with wetting the bed or wetting at school.”
It’s important to remember, Dingfelder said, that children develop at their own paces. Currently, the N.C. Department of Health & Human Services – the agency that oversees day-care center licensures in the state – doesn’t require that children be toilet trained by a certain age in day-care or pre-school environments. However, many such facilities maintain a policy that children must be fully trained before progressing to a 3-year-old classroom.
In some cases, she said, that mandate puts unrealistic expectations on the child and family.
“If a child is cognitively and socially ready to move on, and if toileting is the only thing getting in the way, then day-cares need to cooperate with families to see how they can make it work,” she said.
For example, if day-care facilities don’t have a changing table in the older classes, then arrangements could be made for the child to return to the younger class for diaper changes.
Ultimately, Dingfelder said, she hopes Hodges’ research will relieve much of the stress and anxiety parents feel around toilet training their children as soon as possible. Toilet training isn’t a race to the finish line, she said, and parents shouldn’t feel pressure to push their toddlers too soon.
“Parents these days will say, ‘My kid will read when they read and ride a bike when they ride,’” she said. “We need the same acceptance for toilet training – that it’s OK to start later, and that it’s OK to talk about the stumbling blocks along the way.”