potty training myths

7 myths about Potty Training that you probably still believe

Separating fact from fiction isn’t always easy where potty training is concerned. So how much of what you think is based on research? Explore these 7 common myths about potty training and test your knowledge.

Here at Little Bunny Bear we take evidence-based advice very seriously. We don’t just provide opinion, but instead bring you information based on sound research, so you can make up your own mind based on the facts.  You’re welcome!

Myth 1: Early potty training causes constipation, withholding, toileting refusal and psychological damage

Fact: It is the way a child is potty trained that counts, not how soon you start. Using a gentle approach that works at your child’s own pace does not cause these problems. There is no proven link in the research between constipation, withholding and toileting refusal and early potty training. Instead, earlier potty training is shown to reduce the risk of constipation, stool holding and toileting refusal (Blum 2003).

Research shows that starting to learn potty skills even as early as birth has many benefits (Kaerts 2013, Rogers 2002). When done gently and in response to a childs natural instincts, infants can be potty trained by 12 months with no reported side effects and can potty independently by 24 months (Duong 2013).

The things that are proven to be harmful include: provoking voiding by running the tap,  encouraging “pushing,” (Bakker et al, 2002),  power struggles and the use of rewards and punishment (Stadtler 1999, Taubman 1997.) Many of these problems can be avoided by starting early and ensuring that using a potty is a normal part of your child’s every day routine.

Myth 2: a child must be “ready” before they start potty training

Fact: Before disposables were invented in the 70’s, most babies in Western cultures started using a potty as soon as they could sit up. 47% of babies were out of nappies at 12 months and 83% were fully potty trained by 18 months (Douglas & Blomfield 1958).  Many similar statistics exist for other Westernised cultures such as North America and Canada. This evidence suggests that children are capable of potty training from around 18 months and that the best time to ditch nappies is between 18-30m (Brazelton 1962, Kaerts 2012, Taubman 2003, 1997, Bakker 2000, Blum 2003, Vermandel 2008, Joinson 2009, Hellstrom 2001, Barone 2009, Blum 2004, Shei-Dei Yang 2011).

The concept of “readiness” was originally proposed by a paediatrician called Terry Brazelton who developed his theory in the 1960s (Brazelton, 1962.) Whilst the ideas underpinning ‘readiness’ are good, they are not well-defined in the literature which can be confusing for parents and result in them missing key markers which may indicate the optimum time to ditch nappies (Kaerts 2012.)  Because Brazelton was later paid to endorse Pampers, many authors argue that the concept of readiness was used as a clever marketing ploy promoted by the disposable nappy companies to encourage parents to purchase their product for longer (Olson, 2016, Kachmar, 2018, Mottram, 2018.)

We know that babies are born ready to learn all sorts of things and that what they learn is largely culturally and socially dependent. The age at which they are “ready” to learn different skills also depends on the skill being learnt.  Although there are some common markers in the literature which identify the skills necessary to be independent (motors skills, a desire to use a potty, the ability to communicate needs etc), this does not stop parents starting the journey towards learning these skills before the child could accomplish them independently. After all, we approach learning other skills gradually – so why not potty skills?

Myth 3: Early potty training can damage the bladder

Fact: Regular potty voiding protects the bladder (Bakker 2000) and supports the healthy development of sphincter control from a very young age (Benjasuwantep 2013.) Potty training between 15-24 months reduces the risk of bladder and wetting problems (Joinson 2009) and improves bladder function (Hellstrom 2001.)

Remember, the bladder is a muscle so using it regularly in a conscious way strengthens it and ensures a well-functioning messaging system between the brain and the body to help develop awareness and control. Research shows that sphincter control is present from birth, and that children can learn to co-ordinate micturition (weeing) by 9 months of age (Duong et al,. 2010).

Myth 4: your child should decide when to potty train

Fact: When it comes to potty training,  experts propose that it should be done at the child’s own pace (Brazelton, 1962.) However, research shows that when parents lead the process it is completed quicker (Berk 1990) and that the risk of problems developing are reduced when parents devote time and consistent daily effort to potty training (Lane, 2006.) Children’s interest in the potty is directly related to the onset of potty training and is not an innate “readiness” (Largo, 1996.) In other words, your child will be interested in the potty if you help nurture that interest and they are capable of potty training if you teach them the necessary skills.

Taking a liberal attitude to potty training is shown to increase the risk of developing toileting problems later on and results in a delay in training completion (Bakker, 2002.) Initiating potty training after 24 months is associated with a higher risk of daytime wetting, delayed bladder control and relapse (Johnson, 2009.) In particular, postponement of potty training beyond age 3 creates social, economic and environmental problems (Kaerts 2012.)

myth 5: pull-ups help potty training

Many parents like the idea of pulls ups as a way to avoid messy accidents at the start of potty training. However, I found no clinical evidence showing them to be an effective tool. Because pull-ups feel dry when wet and in all other ways are exactly like disposable nappies, they do not help the potty training process (Rogers, 2002.) Compared to underwear, using pull-ups were shown to be less effective in developing urinary continence (Simon and Thompson, 2006.) Potty training authors such as Olson (2016) and Glowacki (2018) argue that it is confusing for children to learn the new way whilst also using the old and therefore it is better to stop using nappies completely at the beginning of potty training, including pull-ups.

Myth 6: Children can’t be dry at night until their hormones are properly developed

Fact: Hormones at night help suppress urine production by around 50% and for the vast majority of children, these hormones work very effectively (Sureshkumar, 2009.) Research shows that children who are dry in the day are very likely to be capable of being dry at night (Largo and Stutzle, 1977.) Babies can be dry at night from 6 months if they regularly use a potty instead of a nappy (DeVries and DeVries, 1977.)

Myth 7: If you start potty training later, it will be done quicker

Fact: The average time it takes to potty train is the same whether your child is 19-24m or after 25 months (Koc, 2008.) Potty training after age 3 is shown to increase the risk of wetting and soiling problems developing (Joinson 2009, Hellstrom 2000, Bakker, 2000 & 2002, Barone 2009, Van Gool 1989, Taubman 2003.) Earlier potty training is associated with early attainment of both day and nighttime urinary continence and is not associated with bladder dysfunction (Yang 2011.) Children who begin potty training earlier ask to use the potty verbally and non-verbally much sooner (Largo 1996.)

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References

Barone, J et al. (2009). Later toilet training is associated with urge incontinence in children. J. Pediatric Urology. (5) 458-461.

Bakker, E et al. (2000). Changes in the toilet training of children during the last 60 years: the cause of an increase in urinary tract dysfunction? BJU Int. 86(3) 248-252)

Bakker, E et al. (2002). Results of a questionnaire evaluating the effects of different methods of toilet training on achieving bladder control. BJU Int.. 90 456-461.

Benjasuwantep B, Ruangdaraganon N. (2011). Infant toilet training in Thailand: starting and completion age and factors determining them. J. Med Assoc. Thai. 2011 Dec; 94(12):1441-6

Berk (1990). Epidemiological Aspects of Toilet Training. Clinical Pediatrics. Vol 2 (5) 278-282. 

Brazelton, T (1962). A Child-orientated Approach to Toilet Training. Pediatrics. (29). 121-128.

Blum, N et al. (2003). Relationship between Age at Initiation of Toilet Training and Duration of Training. Pediatrics. (111) 4. 810-814.

Blum, N et al. (2004). Why is Toilet Training occurring at older ages? A study of factors associated with later training.  Pediatrics. July. 107-110. 

deVries MW and deVries MR. (1977). Cultural relativity of toilet training readiness: A perspective from East Africa. Pediatrics. 60: 170-177.

Douglas & J M Blomfield (1958) Children Under Five. Allen and Unwin. Book. 

Duong TH et al. (2010). Development of Bladder Control n the First Year of Life in children who are potty trained early. J. Pediatric Urology. (5) 501-505.

Duong, TH et al. (2013). Vietnamese mothers experiences with potty training predictive for children from birth to two years. J. Pediatric Urology. (9) 808-814.

Glowacki, J. (2018). Oh Crap Potty Training (book). 

Hellstrom et al. (2001). Early potty training advantageous in bladder dysfunction. Decreases the risk of urinary tract infection. Lakartidningen. 111, 98 (28-29) 3216-9.

Joinson, C et al. (2009). A Prospective Study of Age at Initiation of Toilet Training and Subsequent Daytime Bladder Control in School-age Children. J. Dev. & Behav. Pediatrics. 30 (5) 385-393.

Kaerts, N et al. (2012). Readiness signs used to define the proper moment to start toilet training: a review of the literature. Neurology and Urodynamics (31) 437-440

Kachmar, Maria. (2018). Lose the Diapers: The No Fuss Early Potty Training Alternative. Book

Koc, I et al. (2008). Toilet training in Turkey: the factors that affect timing and duration in different sociocultural groups. J. Child Care, health and Dev. (34) 445-481

Lane, W. et al. (2006). An Approach to Daytime Wetting in Children. Advances in Pediatrics. (53) 323-365. 

Largo RH, Stutzle W. (1977). Longitudinal study of bowel and bladder control by day and at night in the first six years of life. II: The rôle of potty training and the child’s initiative.Dev. Med. Child Neurol. Oct;19 (5):607-13. 

Largo, R. et al. (1996). Does a profound change in toilet training affect development of bowel and bladder control? Dev. Medicine and Child Neur. (38) 1106-1116.

Mottram, R. (2018). The dangers of early potty training: Do they really exist? Blog post

Olson, Andrea. (2016). Go Diaper Free a simple handbook for elimination communication. Book

Rogers, J (2002). Toilet Training: lessons to be learnt from the past? Nursing Times. 90 (43) 56-59.

Shai-Dei Yang, S. et al. (2001). Early Initiation of Toilet Training for urine was associated with early urinary continence and does not appear to be associated with bladder dysfunction. Neurology and Urodynamics. (30) 12523-1257. 

Simon JL, Thompson RH (2006).  The effects of Undergarment Type on the Urinary Continence of Toddlers. Journal of Applied Behavior Analysis; 39: 3, 363-368. 

Stadtler, A et al. (1999). Toilet Training Methods, Clinical Interventions, and Recommendations. Pediatrics. 103 (6) 1359-1361.

Sureshkumar et a. (2009). Risk factors for nocturnal enuresis. J. Urology.  182(6) 2893-9

Taubman, B et al (2003). Children who hide whilst defecating before they have completed toilet training. Arch. Ped. Adolesc. Med. (157) 1190-1192.

Taubman, B et al. (1997) . Toilet Training and Toileting Refusal for stool only: a prospective study. Pediatrics (99) 54-58. 

Van Gool and de Jonge. (1989) Urge syndrome and urge incontinence. Arch. Dis. Childhood. (64) 1629-1634. 

Vermandel, A et al. (2008). How to Toilet Train Healthy Children? A Review of the literature. Neurology and Urodynamics (27) 162-166.

Yang, SDS et al. (2001). Early initiation of toilet training for urine was associated with early urinary continence and is not associated with bladder dysfunction. Neurology and urodynamics. (30) 1253-125

 

2 thoughts on “7 myths about Potty Training that you probably still believe

  1. Kari Rose says:

    This is awesome. I don’t understand how it has ever become a thing that someone would believe that gentle and noncoercive EC causes constipation. Diapers can cause constipation. If I had to poop in a diaper, it would be much harder to get it out than if I went freely on a potty while squatting…I really woudn’t prefer to be smeared in poop, and might hold it in to avoid that. Babies are just tiny humans, so I cannot imagine they feel so differently…

    • littlebunnybear says:

      Thank you and yes! Its about the that these things became more commonly accepted. Thank you for your comment. Rebecca

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