❖ All anecdotal reports of a child being toilet trained early (before one and a half-year) are due to a “conditioned reflex” whereby the child becomes conditioned to strain reflexly whenever he feels the potty seat under him. The child is not conscious of the bowel movement nor has it come under his control. He has to be retrained later on in life, which will be a true and learned training. Retraining is harder, so don’t toilet train a child before he is ready for it.
❖ What is readiness for toilet training? It consists of the following 3 points:
1. Anatomical readiness: During the first year, the muscles controlling the bladder and bowel are not fully under the control of the nervous system. Obviously, the child should attain neurological control over his muscles for defecation and urination, before he can be toilet trained.
2. Psychological readiness: How do the parents judge that the child is ready psychologically? This is by clues provided by the child whenever he has the urge to eliminate; e.g. the child may pause in what he is doing or have a sudden fleeting change in his facial expression. Once the child is ready psychologically, the role of parents is to educate the child in toilet training, patiently, at his pace.
3. Educational process: Toilet training is an educational process, rather than being disciplinary. It is inherently obvious, but often overlooked, that the child is really the only person who can control the muscles and impulses of elimination.Therefore, equally obviously, the parent’s only role should be in helping the child to exercise this control. The child should be first made to understand the goal i.e. acceptance of the toilet as the appropriate place for elimination. Then on receiving a clue for elimination from the child, they should take him to the toilet.
❖ Enuresis (bedwetting): The child is unable to control urine voiding, usually during night, even after the age of 5 years. It is usually a psychological problem due to coercive toilet training. There is conflict and tension between the child and the parents over the issue of toilet training. The child is forced to be toilet trained and if he is unable to control his impulses, the parents get angry and humiliate the child. This undermines the confidence of the child and leads to his being a bed wetter.
❖ Cure: Parents should tell the child that quite a few children have this problem, which is transient and he will overcome it with time. The child should be praised and encouraged if he doesn’t bed wet (called positive reinforcement). Negative reinforcement, i.e. scolding or humiliating the child makes the cure difficult. Patience and tact on the part of parents helps.