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PEDIATRICS Vol. 113 No. 1 January 2004, pp. 180-181

Toilet Training

Simone Rugolotto, MD
Min Sun, PhD
Section of Pediatrics Mother and Child Department School of Medicine University of Verona 37134 Verona, Italy

The first 20% of the full text of this article appears below.

To the Editor.—

Toilet training is normally considered a milestone in child development and rearing. Very little evidence-based literature is available on this topic, and many studies are retrospective or based on personal experience only. Therefore, we read with interest the prospective study by Blum et al,1 in which the authors discuss the relationship between age at initiation of toilet training and duration of training. One of the main issues in toilet training was age at initiation. Since Brazelton published his well-known paper in 1962,2 in western countries toilet training is started after 18 months of age ("later is better"), when motor milestones, psychological attitudes, and sphincter control are achieved. Recent American Academy of Pediatrics (AAP) toilet training guidelines recommend to start toilet training at 18 months of age as well.3 Moreover, there has been concern that early toilet training could be related to important adverse effects.2 However, other studies have shown that toilet training completion can be obtained much earlier and without any side effects when an early initiation is provided.4–7 An early toilet training is even recommended in cases of congenital vesicourethral reflux.8 Blum’s article is the first prospective study that confirms that earlier toilet training is not associated with constipation, stool withholding, or stool toileting . . . [Full Text of this Article]