What the scientific evidence reveals about the timing of toilet training

© 2007 Gwen Dewar, all rights reserved

Part 1: A recent history of toilet training attitudes

Early potty training got a bad reputation because it was once associated with bad training methods. In the 1920s and 1930s, parents were urged to impose a rigid toilet training regimen on children before they could walk. Techniques were coercive, even abusive. One government manual instructed parents to enforce “absolute regularity” of bowel movements by inserting a soap stick in the infant’s rectum at precise times of the day (United States Department of Labor 1935). Other prevalent tactics included scolding and physical punishments for accidents (Hushka 1942; Stendler 1950; Luxem and Christophersen 1994.)

After World War II, the medical establishment began to reject early potty training. Freudians claimed that early, rigid training caused emotional problems and neuroses later in life. Pediatricians, like Benjamin Spock and T. Berry Brazelton, argued that pushing children may cause a variety of problems, including stool withholding, stool toileting refusal, regression, and long-term bedwetting (Leiberman 1972; Brazelton 1962; Brazelton and Sparrow 2004). Child development researchers argued that training should not begin until kids could actively cooperate with the process (Brazelton et al 1999). Strict timetables for training were abandoned. Instead, parents were encouraged to let their children’s spontaneous curiosity set the pace.

These changes probably saved many children from harsh training methods. But reformers seem to have confused methods with timing. In one historical study I’ve read, the author clearly stated that that any training before 10 months is, by definition, coercive (Hushka 1942). The important point is that “when to train” and “how to train” are different questions. Bad training methods can cause problems. But does early timing cause problems? Based on modern studies, the answer appears to be “no.”

Part 2: Modern scientific studies

The evidence for “advanced” training in older children tells a similar tale. Earlier training is not associated with behavioral problems.

A recent American study tracked over 400 children to learn what, if any, effects timing has on toilet training success (Blum et al 2003). Children were enrolled in the study at 17-19 months. Their parents were interviewed every 2-3 months until they completed daytime potty training. Researchers compared children who began “intensive” training—-defined as being asked to use a potty chair or toilet more than three times a day—-before 27 months with those who began intensive training after 27 months.

The earlier starters were no more likely than later starters to experience constipation, stool toileting refusal, stool withholding, or hiding from parents (Blum et al 2003). The only negative finding was that children trained earlier tended to take longer to complete training. Kids who starting training between 18-24 months took, on average, 13-14 months. Kids who trained after 27 months took 10 months or less (Blum et al 2003). The authors infer from this result that there is “little benefit” in beginning potty training between 18 and 27 months (Blum 2003). However, the study directed parents to use a gradual, child-oriented approach to potty training. As a result, the younger participants might have been less prepared for training, which would have slowed their progress. If parents had been instructed to actively prepare their children for training, the results might have differed. Moreover, the study by Bloom and colleagues didn’t address training before 18 months. When infant training is the goal, children may finish within 5-9 months (Smeets et al 1985; Boucke 2003).

Other research suggests that earlier training is associated with fewer problems. One study of stool toileting refusal reported a link with late training (Taubman 1997). Of the 19 participating children who trained by 24 months, none refused to poop in the toilet. Only 4 of the 90 kids who finished training between 24 and 30 months were “refusers.” The vast majority of refusers (101) came from the remaining 373 kids who finished training after 30 months.

Another study collected questionnaires from parents of children finishing grade school in Belgium. Based on parent recollections, school-age children with bladder problems (like daytime accidents, bedwetting, and recurrent urinary tract infections) were more likely to have started toilet training after 18 months than were children without these problems (Bakker et al 2002b). These findings were replicated in a similar Belgian study on urinary tract infections in 10-14 year olds: Children with recurrent urinary tract infections started toilet training significantly later than other children did (Bakker et al 2002a).

The results of the Belgian studies should be interpreted with caution because they depend on parent’s recall many years after the fact. Perhaps, for instance, parents with symptom-free children are more likely to minimize the effort of toilet training and to forget how early the process began.

But it makes sense that earlier training could reduce the incidence of urinary tract infections. Toilet training helps children learn to completely empty their bladders—-an ability that reduces the risk of infection (Janson et al 2000; Sillen and Hanson 2000). As a result, some researchers recommend that children with dysfunctional bladders should start training early (Hellstrom and Sillen 2001).

As for Freud, it’s interesting to note that Freud never singled out early training as the cause of personality disorders. He was concerned about any approach to training that might be regarded as extreme—too early, too late, too strict, too “libidinous” (Fenichel 1945, p. 305).

In any case, I can find no scientific studies that link the timing of toilet training with the later development of emotional disorders. Freud identified certain personality types that have been confirmed by modern scientific studies. However, these personality types have NOT been linked to childhood toilet training experiences (Fisher and Greenberg 1977; Masling 1999).

References

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Bakker W. 2002. Research into the influence of potty training on lower urinary tract dysfunction. Unpublished MD dissertation, Department of urology, University of Antwerp, Belgium.

Bakker E, van Gool JD, van Sprundel M, van der Auwera JC, and Wyndaele JJ. 2002b. Results of a quaestionaire evaluating the effects of different methods of toilet training on achieving bladder control. British Journal of Urology, 90: 456-461.

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