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http://www.eurekalert.org/pub_releases/2003-04/chop-rfl040203.php

Contact: Erin McDermott

McDermotte@email.chop.edu

215-590-7429

Childrens Hospital of Philadelphia

Researchers find little benefit to toilet training before 27 months of age

Researchers at The Children's Hospital of Philadelphia report few benefits to starting toilet training in children younger than 27 months of age. Below that age, children took much longer to become toilet trained, and were not more likely to complete training earlier, than children who started training at a later age. Above that age, starting toilet training earlier led to early completion, but even then earlier training was likely to take longer. Earlier initiation of intensive toilet training was not associated with more toilet training problems such as constipation or stool withholding.

Children's Hospital researchers collected data from 378 families, most of them white, middle-class and from suburban Philadelphia. They particularly focused on intensive toilet training, defined as asking the child to use the toilet more than three times per day. The research is reported in the April issue of Pediatrics.

"Though we did not find more toilet training problems in the younger children, we found no clear benefit to beginning training earlier than 27 months," says Nathan Blum, M.D., a developmental pediatrician at The Children's Hospital of Philadelphia and lead author on the study. "In fact, earlier training is likely to take longer, which can be frustrating for both parent and child."

To document toilet training progress and completion, researchers conducted phone interviews with families every two to three months. In each follow-up interview, information was collected including how often parents asked or reminded the child to use the potty, the presence and frequency of constipation or painful defecation and information on toilet training behaviors.

Parents in the study reported beginning intensive toilet training at a mean of 28.7 months and completed training at a mean of 36.8 months. Children who began intensive training at less than 27 months took between 10 to 14.5 months to train, while those who began training at 27 months or later took between 5 and 9.5 months. Consistent with existing data, the boys in the sample completed training later than the girls, at mean of 38 months and 35.8 months respectively.

"Our study does not suggest that 27 months is a clear milestone for every child," states Bruce Taubman, M.D., study co-author and physician in the division of Gastroenterology and Nutrition at The Children's Hospital of Philadelphia. "Parents should consider their child's individual readiness, family situation and cultural beliefs when making the decision to initiate training."

In the field of child development, there is a lack of clear data on which developmental skills should be used to judge toilet training readiness, adds Dr. Blum. "We are hopeful that this study is useful in helping parents think about what age might be most appropriate and effective for their child."

In addition to Drs. Blum and Taubman, Nicole Nemeth, M.D., a third-year resident at The Children's Hospital of Philadelphia was also a co-author on the study.

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Founded in 1855 as the nation's first pediatric hospital, The Children's Hospital of Philadelphia is ranked today as the best pediatric hospital in the nation by a comprehensive Child magazine survey. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 381-bed hospital recognition as a leading advocate for children and adolescents from before birth through age 19.

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