When it comes to potty-training, parents’ methods vary greatly. Some take a regimented, reward-and-punishment approach, while others ease into it by encouraging poop talk. Is any one way better than the next?
Sorry, parents, there is surprisingly little evidence on the effectiveness of toilet training techniques, reports Dr. Darcie Kiddoo, a professor in the divisions of pediatric surgery and urology at the University of Alberta.
In her brief review of the available literature, published Monday in the Canadian Medical Association Journal, Kiddoo highlighted two main philosophies in potty-training technique: one, which was first introduced by pediatrician Dr. T. Berry Brazelton in 1962 — and later promoted by Dr. Spock — is child-oriented. Once children are mentally and physically ready to exert bladder and bowel control, and show interest in doing so, parents are encouraged to let the process unravel in an unregimented and child-focused way, generally using coaxing, repetition and encouragement, while avoiding absolute rules that could result in behavioral problems. In a group of 1,170 children who started potty-training this way at 18 months, Kiddoo reports, daytime continence was achieved by 28.5 months on average.
In 1973, Dr. Nathan Azrin and Dr. Richard Foxx prescribed a contrasting, parent-focused technique. The doctors also recommended beginning only when the child was psychologically and physiologically ready, then using a regimented, four-step process that includes a strategic increase of fluids, a bathroom schedule, positive reinforcement and strong correction of accidents. Two small studies using this method, of 34 and 49 children, respectively, suggested that the average time until continence was just 4.5 hours.
(Other methods noted by Kiddoo involve potty-training infants by holding them over the toilet after meals and “making a noise that is linked to elimination”; using rewards like affection and candy when kids stay dry, and using punishment or lack of positive attention when kids have accidents; or attaching daytime wetting alarms to diapers, which ring when wet and signal that it’s time for the potty. None have been adequately scientifically studied.)
Based on her review, Kiddoo concluded that there really isn’t enough evidence to recommend one training philosophy over another. There is some data to suggest, however, that higher rates of incontinence and urinary tract infections in children may be associated with reward-and-punishment techniques or with later potty training.
Despite the lack of hard evidence, pediatricians groups, including the American Academy of Pediatrics (AAP) and the Canadian Paediatric Society (CPS), recommend that parents use a child-centric approach, planning to get started at about 18 months of age, only if the child shows interest in toilet training.
Kiddoo offered some advice for parents who are anxious about their child’s bathroom behavior:
- Your kid will be O.K. Positive and consistent potty-training is unlikely to cause long-term harm. Existing evidence suggests that potty problems typically don’t last: in one study by Brazelton, only 1.4% of children had dysfunctional behaviors — problems like withholding their stool, hiding while defecating or refusing to use the toilet — after age 5.
- There’s no right or wrong way. “Accepted norms of toilet training relate more to cultural differences than scientific evidence,” Kiddoo writes.
- Make sure you’re ready too. Potty training should begin only when the child — and the parent — are emotionally ready, willing and able to participate.
For more information on potty training, check out the Mayo Clinic’s tips.
Meredith Melnick is a reporter at TIME. Find her on Twitter at @MeredithCM. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.