One area of pediatric care that strongly presents an opportunity for anticipatory guidance and clinical intervention is that of toilet training. Because most toilet training problems presenting to the health care practitioner reflect inappropriate training efforts and parental pressure, providers can, by consulting with parents, elucidate and address misconceptions parents have about the toilet training process, help parents to develop appropriate expectations about toilet training, and provide information, guidance, and support to parents for managing this potentially frustrating process. And although there already exists a plethora of information on child development in toilet training that parents can access and refer to, parents often solicit the support of health care providers at this particular stage in their child's development.

The health care provider's role in toilet training is really a combination of needs assessment, information-gathering, education, counseling and support, short-term strategizing, and follow-up measures. This article focuses on approaches to and strategies for advising and guiding parents through supporting their child during the toilet training process.

	TOILET TRAINING: A DEVELOPMENTAL MILESTONE

Toilet mastery is truly a developmental milestone in a child's life; it is a time when children are discovering and enhancing their physical abilities, understanding and responding to relationship dynamics, and confronting and reacting to external pressures. Meanwhile, as each step is achieved, their self-esteem also is developed. Toilet training also can be one of the most difficult developmental phases that both children and parents experience together, because pressures for the child to conform to parental and social expectations occur simultaneously with a child's burgeoning need for self-actualization and independence. Parental control over the child to train, concurrent with the child's will to be in control, leads to conflict and anxiety. Power struggles ensue that impact negatively the parent-child relationship and may lead to physical complications such as enuresis, encopresis, and child abuse.

	A CHILD-ORIENTED APPROACH

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