Contemporary toilet training derives from two accepted models: child-oriented gradual training and structured-behavioral, endpoint-oriented training. The former approach views toilet training as a process by which a parent systematically responds to a child's signals of toilet "readiness," whereas the latter views toilet training as a process of eliciting a specific chain of independent toileting behaviors. Practically speaking, contemporary theoretic constructs of toileting behavior diverge with respect to training endpoints (ie, defined differently or deemphasized altogether), emphasis on self-esteem, development of goals, and timing of initiation. A scientific basis cannot be established for a universal timeline for toilet training, because each method has its own definition of the toilet training process. It remains unclear, for example, how long children must remain bowel- and bladder-continent to be considered trained, and to what extent children should be able to toilet themselves independently of caregivers.¹

Both child-oriented gradual and structured-behavioral approaches to toilet training evolved in the United States during the past 40 years within a scientific milieu that came to accept toilet training as a developmental milestone requiring a child's active participation. This common view of toilet training as a developmental process has provided clinically useful overlapping concepts of mature toileting behavior. The child-oriented gradual method, proposed by T. Berry Brazelton in 1962, defined the parameters of toilet readiness; a decade later, N.H. Azrin and R.M. Foxx designed a structured-behavioral method that detailed the components of independent toileting. Widespread acceptance of readiness and independent toileting have since been supported by clinical experience and resulted in agreement that a child should be ready to participate in toilet training at approximately 18 months of age and be trained completely by 2 or 3 years old. Global trends continue to support this concept despite technologic advancements and conveniences such as diapers, which have enabled delayed training.

Toilet readiness is a powerful conceptual . . . [Full Text of this Article]