Toilet training and enuresis

Abstract

A retrospective inquiry concerning toilet training was undertaken into 165 “wet” families comprising 225 enuretic children and 174 dry siblings, and the findings were compared with 174 “dry” families containing 384 children as controls. The results were as follows. 1. The age at which “potting” began was virtually the same in the enuretics, dry siblings, and controls (30% under 3 months, 42% between 3 and 9 months, and 28% over 9 months). It was concluded that the time of beginning training bears no relation to the problem of enuresis. 2. Strict methods were adopted in a minority of children, but were more prevalent if training began below the age of 3 months and more common in enuretics who were first-born or “only” children; nevertheless, enuresis was found less often among those trained very early. Later-born enuretics were not trained more strictly than their dry siblings or the controls. For these reasons it is doubtful whether coercive training is an important factor in the production of enuresis. 3. Children trained in the later period (over 9 months) were handled leniently as a rule, but no difference in this respect was found between the enuretic and control groups, indicating that lax methods were likewise not more conducive to enuresis. 4. Strict training was more often associated with resistance, both active and passive, in all children. Enuretics resisted much more often than the controls even if training had been lenient; most resistance was encountered if potting began after 3 months of age. It to enuresis than early training, but coercive methods played some part in producing it. 5. Early training seemed to lead to earlier sphincter control, but if resisted at any training period some delay occurred not only in enuretics but in dry children as well. Possible reasons for this delay and for the resistance apparently causing it have been tentatively put forward. It was concluded that, while toilet training has no fundamental bearing on the causation of enuresis, resistance to training is often a contributory factor. © 1959, British Medical Journal Publishing Group. All rights reserved.