Personal and familial factors associated with toilet training

Toilet training achievements in children born with posterior urethral valves

OBJECTIVE

Boys born with posterior urethral valves (PUV) often experience bladder development issues due to urethral obstruction during gestation. Despite early surgical intervention, bladder dysfunction can persist, leading to detrusor overactivity and vesical overdistension. Successful toilet training is key in managing bladder function and controlling intravesical and upper urinary tract pressures. This study aims to evaluate toilet training outcomes in children with PUV.

STUDY DESIGN

This single-centre ambispective cohort study included 142 children aged 4 years and older who underwent PUV ablation between January 2003 and December 2021. The patients were categorised into two groups: those with cognitive comorbidities (group A), including autism spectrum disorder, attention deficit hyperactivity disorder and trisomy 21, and those without (group B).

RESULTS

Among the 142 children, 128 (90.1%) achieved daytime continence at a median age of 37 months (range 33-49 months) and 115 (81.0%) attained night-time continence at a median age of 42 months (range 34-60 months). Children in group A showed significantly lower rates of continence compared with group B (daytime: 74.2% vs 94.6%, p=0.0026; night-time: 67.7% vs 84.7%, p=0.0412). Additionally, children in group A completed toilet training significantly later than those in group B (daytime: 64 vs 36 months, p=0.0002; night-time: 60 vs 42 months, p=0.0139).

CONCLUSION

Boys with PUV can achieve daytime and night-time continence at ages comparable to those reported by their peers; the presence of cognitive comorbidities is associated with delays in achieving these milestones.

Classroom Toileting: A Collaborative Effort

Developmental norms suggest that children are ready for toilet training between the ages of 18 and 24 months; however, many children now enter school without this self-care skill. Many factors can contribute to delayed toilet training including child readiness, developmental disabilities, poverty, lower parental education levels, and higher rates of single and teen-aged parents who may lack parenting skills including toilet training. Most children enroll in a kindergarten program at 5 years of age. Because children will be accepted to kindergarten regardless of toilet training status, schools need to be ready for children who lack this self-care skill. Although school staff are willing to support these children, the main purpose of school is education. The school nurse can take an active role in classroom toileting programs by collaborating with school administrators, teachers, staff, and parents to promote successful toilet training and fostering a healthy learning environment.

A Delphi Exploration of Toileting Activity Performance in Individuals With Cerebral Palsy Within the ICF-CY Framework: Unveiling Influential Factors

Introduction: Cerebral palsy (CP) is a common motor and postural developmental disability impacting daily activities like toileting. Despite its importance, toileting has often been undervalued in healthcare. This study is aimed at identifying and assessing the level of influence of various factors affecting toileting in individuals with CP using the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) framework. Methods: The Delphi method was employed to reach a consensus on factors influencing toileting in individuals with CP. One hundred fifty-eight professionals from 17 countries, each with at least 3 years' experience in CP and/or toileting, participated in this two-round study. Ethical approval (IR.IUMS.REC.1400.1111) and informed consent were obtained. The questionnaire, available in Farsi and English, used a Likert scale (5 = very high impact to 1 = no impact). Factors with 75% agreement and a mean above 3.75 were included in the final list, while those with 50%-75% agreement or a mean between 2.5 and 3.75 proceeded to the second round. Factors were initially identified through a literature review and research team consultation and categorized according to the ICF-CY framework using the ICF 10 RULES. Validation and refinement were done through focus groups with caregivers and experienced professionals to ensure alignment with the framework and methodological rigor. Results: The study highlighted significant factors influencing toileting activities in individuals with CP. Within the ICF-CY framework, "neuromusculoskeletal and movement-related functions" scored highest at 94.5% in "body functions and structures." "Toilet environment" scored 90.5% in "environmental factors." Support and relationship factors scored 82.3%. Attitudes toward "menstruation" ranked highest at 92.9%. Associated deficits with CP ranked top in personal factors at 93.7%. Conclusion: The study identifies key factors influencing toileting activity performance in individuals with CP. "Main caregiver" emerges as a pivotal factor, followed by neuromusculoskeletal functions, personal factors, attitudes toward menstruation, the toilet environment, and support and relationships.

Toilet Training Readiness Scale for 0-5-Year-Old Children: A New Measurement Tool Based on a Child-Centred Approach

BACKGROUND AND OBJECTIVES

There is no standardised approach to toilet training in children. This study aimed to determine the factors affecting the duration of toilet training in children aged 0-5 years and to develop a tool to assess the child's readiness to start toilet training.

MATERIALS AND METHODS

This cross-sectional study was conducted on 409 children aged 0-5 years. Social, economic, behavioural, and developmental characteristics that are effective in toilet training in healthy children were evaluated. A scale assessing children's readiness for toilet training (Toilet Training Readiness Scale-TTRS) was developed and content validated.

RESULTS

The mean age of the 409 children included in this study was 44.69 ± 13.07 months (min = 4; max = 60 months). The mean age of initiation of toilet training was 26.8 months. Most frequently, urine and faeces trainings were started together (52.1%). In the logistic regression analysis performed to evaluate the factors affecting the duration of toilet training, it was found that the TTRS score, mother's employment status, family type, child's first reaction, toilet type, and continuity of training were important predictors. The duration of toilet training showed a weak negative correlation with the scores obtained from the TTRS and the number of children in the family but a weak positive correlation with the age at the beginning of toilet training. The TTRS scores were inversely proportional to the duration of toilet training.

CONCLUSIONS

Family characteristics, socioeconomic conditions, and readiness of the child for and no interruption in toilet training are important in completing toilet training in a short time and successfully. If a child-focused approach is adopted, evaluating the child from this point of view and initiating the training at the appropriate time may help to complete a more successful and shorter toilet training. We recommend that the scale we have developed be studied in other studies and different groups.

Evaluation of the effects of the toilet training process on the children's quality of life

BACKGROUND

Toilet training is a significant developmental milestone for children. During the process of toilet training, voiding and defecation problems may develop, which have a major adverse impact on the child's quality of life (QoL). The aim of this study was to assess voiding and defecation problems in the process of toilet training and evaluate how these issues influenced the children's QoL.

METHODS

The children included in the study were followed up at the Department of Social Pediatrics, Ankara University School of Medicine. Participants were surveyed via a questionnaire that included sociodemographic features, the toilet training process, and the Pediatric Quality of Life Inventory.

RESULTS

The study included 177 children and their parents. There was no correlation between the parents' age, sociodemographic features, or the timing of the start of toilet training. Voiding problems were found in 55.6% and defecation problems in 23.6% of the children included in the study. Urinary retention during play and nocturnal enuresis were more frequent in the children toilet trained at 25-36 months of age. The self-reported QoL scores in children with voiding problems and with both voiding and defecation problems were lower than those in children did not have any problems.

CONCLUSIONS

Even if a child has been toilet trained, it is essential to investigate daily urination and defecation habits at every follow-up visit and to discuss with families when a physician should be consulted.

Relationship between primary monosymptomatic enuresis and process toilet training: a case-control

OBJECTIVE

Primary monosymptomatic nocturnal enuresis (PMNE) is a prevalent condition in childhood, and the pathophysiology is multifactorial. This study investigated the relationship between the toilet training process (TT) and PMNE in children and adolescents.

PATIENTS AND METHODS

A case-control study was carried out from 2015 to 2020. The presence of PMNE was identified according to International Children's Continence Society criteria. A semi-structured questionnaire was applied to assess TT.

RESULTS

The study included 103 children and adolescents with PMNE and 269 participants with normal psychomotor development without PMNE (control group [CG]). Readiness signals were more remembered and less frequent in participants with PMNE (p=0.001) when compared to control group. No differences were found between the groups regarding the onset age of the daytime TT (p= 0.10), the nocturnal TT (p=0.08), the acquisition of daytime continence (p=0.06), and the type of equipment used for the TT (p=0.99). The use of Child-Oriented approach in group of children with enuresis was lower than in controls [87.4% (90/103) versus 94% (250/266)], respectively (OR= 0.44, 95% CI 0.21-0.94, p = 0.039).

CONCLUSIONS

The age of onset of TT, acquisition of daytime continence, and the type of equipment were not associated with higher occurrence of PMNE. On the other hand, the Child-Oriented approach was a protective factor for the occurrence of PMNE.

Toilet training methods in children with normal neuropsychomotor development: A systematic review

BACKGROUND

Toilet training (TT) is an important milestone in child development. The purpose of this review is to summarize the different TT methods found in the literature and determine their effectiveness for the TT process.

DATA SOURCES

Articles about toilet training were collected from databases, including PubMed and Scopus. The Preferred Reporting Items for Systematic Reviews (PRISMA) statement was used to guide the systematic review.

RESULTS

Two main classifications were used: a child-oriented approach and a structured behavioral approach. Most children were trained by the structured behavioral approach, with early onset, but at the age of completion of TT, similar to those who used a child-oriented approach. Success rates, in the few studies that reported, were better with the child-oriented approach. The lowest reported success rate was the daytime humidity alarm approach. There is no consensus on the best method to be used, as it involves a wide variety of parents' preferences and expectations and cultural differences, with studies showing great heterogeneity and methodological flaws that make meta-analysis unfeasible.

CONCLUSIONS

The approaches have not been directly compared, so it isn't possible to make definitive claims about one method's superiority over the other.