Toilet Training in Children: How Does it Work?
The human body has a group of muscles called sphincters, which prevent fecal matter and urine from escaping. These muscles have voluntary control when the nervous system is working properly. However, toilet training in children is a habit that must be developed, but how does it work?
Most of a child’s organs aren’t completely developed at birth, and they keep growing over the first few months. One of the structures with the most changes is the central nervous system, and its evolution allows the acquisition of functions such as the identification of sounds and the recognition of faces.
Some research has shown that toilet training in children is a fundamental part of their growth and development. In fact, regression in this area can create problems in a child’s family and on a personal level, especially due to the social connotation that it has.
Urination and defecation in the first few months
All adults, with the exception of some elderly or ill people, have voluntary control over their rectal and bladder sphincters. People can voluntarily relax their sphincters, releasing feces and urine – it’s all controlled by a cortical process.
Their urinary dynamics are very different in the first months of life as a result of their nervous system’s lack of maturity. At this stage, the release of the bowels and bladder is involuntary; there’s incomplete bladder emptying, and it is mediated by a parasympathetic reflex arc. The entire process is under the control of the spinal cord for at least the first year of life.
The Pediatric Society of Asturias, Cantabria and Castilla y León establishes that the maturation of brain nerve centers occurs between 18 months and 3 years. In this way, most children have adequate toilet training between 2 and 4 years of age.
Beginning of toilet training in children
Generally speaking, continence, or total control over urination and defecation, is achieved when the child is able to control the contraction of the external sphincter of the urethra. The age at which a child reaches continence can vary depending on social, cultural, and family factors, although it shouldn’t exceed 4 years.
This sphincter control is a gradual process and usually begins with fecal control at night and then fecal control during the day. At this stage, most children begin to regulate their bowel movements, making defecation a little more predictable.
The next step is bladder control during the day, and bladder control at night is the last goal, and the most difficult one to achieve. Bedwetting, or nocturnal urinary incontinence, is a common problem that affects millions of children and is associated with incomplete maturation of the brain nuclei.
Nighttime incontinence usually goes away on its own after a while, although drugs such as amitriptyline may be necessary. It’s important to note that the process described isn’t a strict rule, and so some children can achieve fecal and bladder continence simultaneously.
When should you start training children?
As previously mentioned, learning to go to the bathroom is closely related to the maturation of the child’s nervous system. The ideal thing here is to start the stimuli after 18 months. It’s also important to ensure that the child is able to walk, express themselves verbally, and is able to follow precise instructions.
There are certain very characteristic signs that can show us that children can start training for sphincter control, among which the following stand out:
- If their diaper stays dry for at least an hour and a half
- They’re able to follow 2-step instructions
- They show interest in sitting on a potty or toilet
- They demand a diaper change after defecating
- They can pull their pants up and down on their own.
It’s always important to bear in mind that all children mature differently, and so the appearance of the aforementioned signs is highly variable. The baby’s entire cognitive development will depend on various social, cultural, and hereditary factors, in addition to the stimulation received from the family.
How to achieve toilet training in children
Parents should keep in mind that this is a process that can take a long time, and so they should be very patient. It’s important to start the process at a point where there aren’t many changes in the child’s life, nothing that could be too stressful for the child.
Family members should reward them with praise and small rewards every time the child is able to go to the bathroom, and, in this way, they’ll reinforce the behavior with positive stimuli. Accidents are very frequent during this process. However, they shouldn’t be reproached or exaggerated, as they can cause negative effects such as constipation.
There’s no specific method that can guarantee that the child will learn to urinate and defecate on their own quickly, and everything is a constant and long learning process.
First of all, the child needs to get used to using the potty, and, in order to do this, they must be put on it and encouraged to stay there for at least 5 minutes.
Once the previous step has been repeated several times, the child should be seated for 5 or 10 minutes on the potty but without any underwear, while the whole process is explained to them. When the mentioned time elapses, the child should be dressed and the step repeated as many times as necessary.
Parents should just try to anticipate when the child wants to go to the bathroom by placing them on the potty. This is a very long process, and can take 3 to 12 months before children have full toilet training.
A long process where the patience of the parents is essential
Toilet training in children is a process that can take several months in most cases. Parental support and patience play a fundamental role at this stage. For this reason, it’s important that the little ones are in an atmosphere of harmony and that they feel that they’re part of the process.
Although children achieve the goal at different ages, it’s important that established limits are respected. In this sense, medical help should be sought when a child older than 4 years of age still can’t control the urge to go to the toilet and when a child older than five suffers from nighttime incontinence.
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- Sociedad de Pediatría de Asturias, Cantabria y Castilla y León. Control de esfínteres en los niños. 2005. Documento disponible en: https://www.sccalp.org/documents/0000/0380/esfinteres.pdf.
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