Studies on toilet training in healthy children. Including when to start,the use of readinees signs,current toilet training practices in day care and the relation between day care and parents.
详细信息
文摘
In the past sixty years, the Western world saw an evolution towards a later toilet training TT) start, causing economical, environmental, social and health problems. Nowadays, it is advised to wait with TT until the child shows readiness signs RS). However, there is no consensus on which RS to use for assessing TT readiness, causing further problems. We reviewed the literature on RS of the past 60 years. The literature is unclear and divided. Twenty-one RS were found. We checked the possibility of observing these RS. Not all RS were easy to assess. We made a shortened checklist with RS, which can be easily observed. We also investigated the interobserver reliability between researchers, childcare workers and parents. Next, we conducted a study to assess what the most reliable RS are for predicting successful TT. Our multivariate regression model based upon RS and accounting for covariates, with an area under the curve of 0.97, showed that the childs age, showing awareness of and expressing the need to evacuate, insisting on completing tasks independently and being proud of new skills, and being able to pull clothes up and down, are the important predictors of successful TT. The results of an inquiry of childcare workers reflect a positive image of how TT is dealt with in day-care and of the cooperation with parents. However, more than a third of the respondents thought that parents pass the responsibility for TT on to day-care and that parents do not pay enough attention to TT. We also inquired Flemish families using day-care. Parents felt that the cooperation supported them in guiding their child in the TT-process. However, many parents experienced uncertainty and stress related to TT, especially concerning the TT start. Parents also lacked time for TT their child. Some parents agreed that responsibility for TT is increasingly passed on to day-care. Also, 40% of the parents had no idea whether they used the same TT method as the day-care centre. More research to investigate RS and to understand what makes TT successful is required to reach consensus, obtain research-based guidelines and avoid problems.