Potty Training (Toilet Training)
Medical Author: John Mersch, MD, FAAP
What is potty training?
Potty training is assisted learning for a child to develop controlled elimination of urine and stool. Potty training is also referred to as toilet training. Toilet training incorporates the ability of a child to anticipate the need to urinate or have a bowel movement and successfully void or eliminate stool into the toilet. Successful toilet training is an important milestone for both the child (gains independence and self-mastery of his body) and his parents (freedom from diapers). This implies awareness of body sensations and a purposeful behavioral response. For this reason, successfully remaining dry while asleep is often not considered a prerequisite to being considered to be toilet trained. A more stringent definition would imply complete control during both sleep and wakeful periods.
Are there cultural differences in potty training?
During the 20th century, American parents approached potty training with a broad array of techniques. In the early 1920s and 1930s, a somewhat rigid schedule popularized by Parents Magazine promoted the belief that a child should be toilet trained by 8 weeks of age. In the 1940s, Dr. Benjamin Spock recommended a more developmental approach and encouraged parents to notice a series of developmental signs before beginning the process of toilet training. He argued that a more rigid approach would commonly lead to behavior problems. In the 1960s, developmental pediatrician T. Berry Brazelton refined the Spock approach, combining the natural maturation of the child's physiology and emotional maturity and characteristic desire for independence.
Expectations have been shown to exist in different American racial groups. Most African-American parents believe potty training should be started at 18 months of age, while Caucasian parents more commonly propose 24 months of age as a starting time. Recent American epidemiologic studies note that approximately 25% of 2-year-old children are daytime potty trained, 85% by 30 months of age, and 98% by 3 years of age.
In contrast to the American approach, the Digo culture of East Africa begin toilet training during the first few weeks of life and have achieved urination and stooling on command by 4 to 5 months of age. Anthropologists note that this culture maintains essentially constant physical contact between mother and child during the first year of life. Pediatricians have noted the difference between urination and stooling on parental command (Digo culture) with a self-motivated and completed activity with limited parental involvement (Western culture).