Children today are becoming toilet-trained at much older ages than previous generations, and this may be a contributing factor in the increased rates of urinary dysfunction or incontinence, according to a new study.

Researchers from Belgium conducted a study in which a questionnaire was developed and completed by 321 people who had toilet-trained 812 children. The population was divided into three groups according to the age of those who trained the children.

Researchers discovered that:

• There has been a major change in toilet training in the last 60 years, with the age at which toilet training begins has been significantly postponed.

• One reason for starting training, i.e. bladder control during the afternoon nap (which can probably be considered as an indication of sufficient bladder capacity) has become less important.

• Season (summer) and starting school have become more important factors.

• Training by bladder drill (prompting the child), formerly widely used, was progressively abandoned and a more liberal attitude adopted by parents.

Some interesting findings were the % of children trained by 18 months:

• 40 to 50 years ago - 71% daytime trained, 61% nighttime trained

• Today - 17% daytime, 8% nighttime

The researchers conclude that "To start bladder training when the child stays dry during the afternoon nap and using bladder drill might help to avoid permanent bladder dysfunction. The lack of formal bladder training may be responsible for an increase in lower urinary tract dysfunction."

British Journal of Urology International August, 2000; 86: 248-252.

Dr. Mercola's Comments:

This is an interesting and unexpected study. Although it is a new theory, there certainly could be some truth to it. The issue of how to toilet train a child is a controversial one and parents must decide for themselves which method they feel is best. While it is certainly not in the child's best interests to be put under intense pressure or subjected to threats while attempting to toilet train, neither should they be encouraged to perform below their capabilities. One possible approach would be for a parent to make sure that the child knows that going on the toilet would make them very happy. After all, making parents happy is probably one of the most important things for a child, especially for those who are given plenty of love and attention. Another possible reason for the delay in toilet training is the change in the type of diapers used. Today's disposables keep the children so dry that they may not even realize when they go. Compared with the feeling of dampness and discomfort that the infants in the old cloth diapers had, there is not much incentive to toilet train. Additionally, for the parents, since changing disposables is so much easier than changing cloth diapers, and they don't need to be changed anywhere near as often, there is also less incentive for them to get the kids to train. Therefore, the "liberal" training practices that the authors refer to, may partly be due to convenience as well. One possible weakness in this study is it relied on recollection by parents, and the parents for the earliest infants averaged about 70 years old at the time of questioning. Therefore, there could be some inaccuracy in the data