Toilet training: situation at 3 years of age in a birth cohort

Abstract

OBJECTIVES: Acquisition of bladder and bowel control is influenced by physiological, psychological and sociocultural factors. The objective of this study was to evaluate the prevalence of children out of diapers by 24 months of age and the factors associated with this finding. METHODS: A total of 3,281 children born in Pelotas, RS, Brazil in 2004 were enrolled on a longitudinal study. At 24 months their mothers were visited at home and replied to a questionnaire containing questions about sociodemographic data and the characteristics of their children's urinary and intestinal evacuation habits, with special attention to toilet training. Multivariate analyses were carried out using Poisson regression. RESULTS: From the total, 24.3% were out of diapers during the day, with the female sex predominating (27.8 vs. 21.1%, p < 0.001) and 8.6% were out of diapers at night, also with the female sex predominating (10.6 vs. 6.8%, p < 0.001). The abilities needed to start toilet training were present in 85.5% of the children. Guidance was received from a pediatrician in 10% of cases, and more frequently among richer mothers than among poorer mothers (22.9 vs. 4.8%). Mothers who spent more years in education (13.2%) and were from higher social classes (14%) took their children out of diapers later; a greater number of children living at home (relative risk = 1.32) and being able to communicate the need to go to the toilet (relative risk = 11.74) both increased the probability of being out of diapers; previous unsuccessful attempts delayed removal of diapers (relative risk = 0.59). CONCLUSIONS: Although the abilities needed for acquisition of bladder and bowel control were already present at 24 months, indicating that toilet training could be started, the majority of children had not yet started this training. Better-informed mothers delayed training the most.