Items in AFP with MESH term: Toilet Training
ABSTRACT: Nonretentive encopresis refers to inappropriate soiling without evidence of fecal constipation and retention. This form of encopresis accounts for up to 20 percent of all cases. Characteristics include soiling accompanied by daily bowel movements that are normal in size and consistency. An organic cause for nonretentive encopresis is rarely identified. The medical assessment is usually normal, and signs of constipation are noticeably absent. A full developmental and behavioral assessment should be made to establish that the child is ready for intervention to correct encopresis and to identify any barriers to success, particularly disruptive behavior problems. Successful interventions depend on the presence of soft, comfortable bowel movements and addressing toilet refusal behavior. Daily scheduled positive toilet sits are recommended. Incentives may be used to reinforce successful defecation during these sits. A plan for management of stool withholding should be agreed on by the parents/caretakers and the family physician before intervention.
Toilet Training - Article
ABSTRACT: Toilet training is a developmental task that impacts families with small children. All healthy children are eventually toilet trained, and most complete the task without medical intervention. Most research on toilet training is descriptive, although some is evidence based. In the United States, the average age at which training begins has increased over the past four decades from earlier than 18 months of age to between 21 and 36 months of age. Newer studies suggest no benefit of intensive training before 27 months of age. Mastery of the developmental skills required for toilet training occurs after 24 months of age. Girls usually complete training earlier than boys. Numerous toilet-training methods are available. The Brazelton child-oriented approach uses physiologic maturity, ability to understand and respond to external feedback, and internal motivation to assess readiness. Dr. Spock's toilet-training approach is another popular method used by parents. The American Academy of Pediatrics incorporates components of the child-oriented approach into its guidelines for toilet training. "Toilet training in a day," a method by Azrin and Foxx, emphasizes operant conditioning and teaches specific toileting components. Because each family and child are unique, recommendations about the ideal time or optimal method must be customized. Family physicians should provide guidance about toilet-training methods and identify children who have difficulty reaching developmental milestones.