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FOR RELEASE MONDAY MAY 3, 1999
First-of-a-Kind Study Leads to Better Understanding Of Toilet Training Process
A new study by the Medical College of Wisconsin researchers in Milwaukee has found that the most effective methods for rapid toilet training progress resulted from moving a child out of diapers and providing intangible motivators and tangible rewards.
The results from the most comprehensive toilet training study ever completed were presented today at the Pediatric Academic Societies'1999 Annual Meeting in San Francisco. The study developed a first-of-its kind method known as "weighted progress scale" to identify three phases of progress in toilet training that will help pediatricians and parents understand the toilet training process.
"Toilet training is universal and the process is often frustrating and stressful for parent and child," according to Timothy R. Schum, M.D., associate professor of pediatrics, who headed the study at the Medical College. Dr. Schum practices at Children's Hospital of Wisconsin. "Toilet training takes time, understanding, and patience and is a common topic of discussion in the pediatrician's office."
In the two-year, longitudinal cohort study, parents of 267 developmentally normal children, ages 15-42 months, not currently toilet training but planning to start within three months, were asked to complete a weekly training status survey. The survey was based on four measures of toilet training success, product usage information and 28 toilet training behaviors and skills such as the child staying dry for more than two hours and showing interest in using the toilet. Parents returned 10,741 weekly surveys on the 267 children enrolled in the study.
The most commonly used techniques as reported by parents were praise, reminders, and use of a child's "potty" chair. Letting the child decide and encouraging the child to be a "big kid" also rated high. Techniques most highly rated as effective required parental involvement and commitment and included praise, reminders, and using a firm and consistent approach.
The researchers used the weighted progress scale, based on cluster analysis, to separate children on the continuum of toilet training, from not trained to completely trained. The scale is the first quantitative scientific tool to measure toilet training progress. The method is able to synthesize various types of measures into one simple scale and identify the stage a child is at in the toilet training process. Three phases of toilet training including pre-progress, progress and post-progress were discovered.
"Parents often ask for assurance that their child is progressing appropriately through the toilet training process, so it is truly exciting for pediatricians to be able to objectively measure toilet training progress and completion and share that information with parents," says Dr. Schum. "Parents should be comforted to know that our study showed there is great variability in the duration and 64 percent of children were in the slow or intermediate group of the toilet training rogress phase."
There was no significant difference between the three progress patterns in the commonly used demographic factors such as gender, race and age at completion of toilet training. Similarly, no significant difference was seen in the use of day care, number of siblings at home, prior toilet training experience or marital status. Hence the researchers could not predict which child would rapidly progress through toilet training.
While this study focused on toilet training behaviors in the child, future studies are needed to examine the role of parental effort expended in the toilet training process, Dr. Schum points out.
Timothy L. McAuliffe, Ph.D., research associate professor of biostatistics in the Health Policy Institute, is a co-investigator of the study.
The study was supported by a grant from Kimberly-Clark Corporation, makers of Huggies(r) Diapers and PULL-UPS(r) Training Pants.
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