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Toilet training (controlling the bladder and rectal sphincters) is a very important moment in infancy. It marks the transition from infancy to toddlerhood and is the beginning of the child’s independence.

To master it, the following important skills are required:

• Acquisition of motor skills
• Acquisition of language skills
• Neurosensory skills
• Emotional maturity and autonomy

These skills, the time of their acquisition and the interaction between them are shown graphically in the following figure.

How do we know that our child is ready fortoilet training?

• He has long intervals with a dry diaper.
• He seems to be bothered by the wet full diaper.
• He expresses a desire to use the toilet.
• He shows imitation of behavior.
• Usual age at western “culture” 18-36 months.

It should be noted that the time of training can be influenced by the cultural habits of the family and the culture of each people. En addition, girls may acquire control of the sphincters 2-3 months earlier.

How can we help our child in the toilet training process?

Something that parents should keep in mind is that in addition to the biological parameters of readiness, there is also the psychological parameter in the process of learning to use the toilet.

Parents would do well to talk about using the toilet through appropriate audiovisual material (books or videos) some time before the start of the process.

• Within the family, the child is likely to see members of the family using the toilet.
• The appropriate equipment for training includes a potty or a rim – a potty seat.
• During the day, the child should receive plenty of fluids and foods rich in fiber.

When starting training, parents should keep the following in mind:

• The toilet area or the potty should be easily accessible to the child.
• Instead of a diaper, the child should wear underwear so that he or she can understand that he or she is wetting.
• The clothes the child will wear should be comfortable and easy to remove.
• Using the toilet should be part of the child’s routine. For example, use immediately after waking up, half an hour after eating and when changing activities. The child can be encouraged to use the toilet without pressure.
• If after 3-5 minutes the use does not work, the child should get up and have positive comments after the attempt.
• Any “accidents” should be treated with understanding and in no case with a reprimand towards the child.

What problems can arise in the toilet training process?

• “Regressions” during training are quite common. They should be treated by parents with understanding, patience and encouragement.
• It is best to avoid training when there are stressful events and major changes in the child’s life (e.g. moving house, birth of a younger sibling).
• It is also best to avoid forced training, because the child may not be ready when the parents plan to start the process.

In any case, anything that concerns the parents should be discussed with the pediatrician. Such issues may be:

• Chronic constipation that can be combined with involuntary leakage of feces (encopresis)
• Enuresis, which is characterized by episodes of involuntary loss of urine at night at least 2 times a month in children > 5 years old. There should be control during the night and no organic problem.
• Refusal to use the toilet.

Tackling toilet training issues is more effective with a multidisciplinary approach.

• The approach should be done with discretion, understanding, empathy and honesty.
• An important goal is to relieve any issues in the process.
• In the event of constipation, enuresis, or bedwetting, it is important to explain the cause of the problem to both the parents and the child.
• It is important to combine medication and psychological intervention for parents and child.
• The family should be helped to adopt new “toilet” habits.

Above all, reward and a positive attitude from everyone play an important role. of the parties and encouragement.