Toilet training – or rather, lack of it – is increasingly hitting the headlines. This year started with parents in Blaenau Gwent in Wales being told that they had to go into school to change their children's nappies and pull-ups unless there was a ‘medically recognised need’.
Then, 70 per cent of 1,000 primary school teachers reported that rising numbers of children starting school before they were toilet trained was having a negative impact on their classes.
The survey on school readiness by early years charity Kindred Squared1 found that one in four children who began Reception in September 2024 needed help with toileting. This resulted in 45 per cent of teachers saying they had needed to allocate more time or staff to deal with children's personal care and hygiene.
The headlines are backed by research that shows, over the past century, the age of children being toilet trained has moved from 12 to 18 months to an average of around three or even four years old. ERIC, the children's bowel and bladder charity, carried out research with the Association of Teachers and Lecturers in 2016 and the National Day Nurseries Association in 2018. Both surveys found that children are being toilet trained later and that more children are starting school wearing nappies and pull-ups. Anecdotally, it has got steadily worse since the pandemic.
In line with the rising age of toilet training is the rising size of nappies. Mark Smith, co-founder of Green Bottoms, which specialises in providing eco-friendly nappies and nappy disposal to nurseries, reports that, while size 5 nappies (around 11-16kg) are the most popular, it is experiencing greater customer demand for size 7 and 8 nappies. One of his suppliers recently even broached introducing a size 9 pull-up.
Only three-quarters of the parents questioned by Kindred Squared thought that children should be out of nappies before they started school, showing a big shift in attitudes around when toilet training should occur. Felicity Gillespie, Kindred Squared director, said the report findings suggested ‘too many parents are failing to support the development of their children, in spite of – we know – having their best interests at heart.’
Children's nurse and potty training adviser Rebecca Mottram is adamant that parents are not at ‘fault’ for late toilet training. ‘Mainstream advice around potty training oft en does not match with the guidance, and when parents get stuck – around 40 per cent of children really struggle with potty training for all kinds of reasons – the advice isn't there to help them, so the solution is to put them back into nappies,’ she says.
WHY IS TOILET TRAINING BEING DELAYED?
ERIC CEO Juliette Rayner says it is receiving a rise in calls to its helpline from parents whose children are due to start school but are still in nappies or require a nappy to poo. ‘Th ere are several possible reasons for this,’ she says. ‘One is the introduction of disposable nappies, which are so absorbent children oft en don't feel when they are wet and so don't make the connection with needing to use the toilet as easily.
‘Potty training can also be more difficult now than in previous generations, due to many social and economic factors affecting families. For example, it's more common now that both parents go out to work, which means children spend longer in childcare settings or are looked after by more than one adult, as opposed to previous generations primarily cared for at home. Disruptions to routine and a lack of consistency around potty training can lead to difficulties.
‘Th is is compounded by a lack of local paediatric continence services and fewer health visitors, which means families who are experiencing problems are finding it more difficult to get advice. The knock-on effects of the pandemic and cuts to essential children's services in recent years have also contributed to this issue.’
Mottram says there is a long history around nappies and the age that children start toilet training. She explains that in the 1950s and 60s, 97 per cent of children were out of nappies by 18 months. Disposable nappies were invented in the 1960s with limited success, but they grew in popularity as the designs got more efficient and they became cheaper to buy.
Alongside increased disposable nappy use was a marketing message that children should be allowed to decide when the time was right to potty train, which is thought to have contributed to parents beginning to delay toilet training, especially as being ‘ready’ is difficult to define. Pull-ups aimed at older children have also played a role in normalising later toilet training.
‘Th is concept of “readiness” has really taken hold, plus disposable nappies have become widely available, relatively cheap and good at what they do,’ says Mottram. ‘It's slipped and slipped and now most children are two before parents start doing anything.’ Rayner adds that many children, particularly those with additional needs, will never show any sign that they are ready to toilet train.
SHOULD TOILET TRAINING BE STARTED EARLIER?
Delayed toilet training can have major consequences for children's health, development and wellbeing, with research showing:
- Initiation of toilet training after 24 months was strongly associated with daytime wetting alone, delayed bladder control and persistent wetting at school age, but not bedwetting alone.2
- The incidence of lower urinary tract dysfunction may be decreased by initiating toilet training in children at a younger age.3
- There is evidence that initiating toilet training after 24 months is associated with problems attaining and maintaining bladder control.4
- Later toilet training can hide bowel and bladder problems such as constipation, which affects one in three children in the UK.5 This can cause problems from pain to missed schooling. It also makes potty training harder.
Mottram says there are more than 40 different skills involved in learning to use a toilet, which can be categorised under four headings:
- Body awareness: understanding the signals the body sends, such as recognising the sensation of a full bladder or bowel and identifying the need to urinate or defecate.
- Communication: being able to communicate toileting needs.
- Understanding: understanding when to act and what needs to happen where, such as undressing to use a potty and sitting on it for long enough.
- Physical skills: including the ability to hold and release wee or poo intentionally and being able to move to and use a potty or toilet.
‘Each category presents complex skills that require time and teaching to master,’ Mottram explains. ‘This is why it's best to start learning as early as possible. In fact, there is no lower age at which children can start learning these skills – developmentally they are designed to begin from birth.’ She adds that the earlier a child starts, then the more time there is to identify and support any potential problems.
Mottram and Rayner are both calling for a shift in attitudes to using nappies alongside introducing children to toileting skills from a much earlier age. This will support children with the self-care skills they need for staring Reception, along with the positive impact it can have on family finances, parents and early years practitioners’ time, plus the environment (see box, page 20).
‘Most parents find that a good time to start helping their child learn potty skills is from the time they can sit up, usually around six to nine months,’ says Mottram. ‘By starting the process early and gently, when the time comes to stop wearing nappies, children will already have some skills to make this transition easier and less daunting for all involved.’ She adds that it is key to think of toilet training as a ‘process’ rather than an ‘event’. ‘Think about potty or toilet training in the same way we support children to develop other skills such as brushing their teeth or using a spoon. It's not something you expect them to grasp overnight, it takes time to develop the awareness and the skills,’ she explains.
‘The three-step potty training approach adopted by ERIC – practice, preparation, stopping using nappies – is evidence-based. The foundation of this approach is that children are born ready to learn new skills. Parents should start early so their child can learn as you go along.’
Mottram agrees, ‘Potty learning begins at birth and you can either train them to use a nappy or a nappy and the potty together. I would choose the latter because it makes more sense.’
WHAT CAN PRACTITIONERS DO?
‘The role for early years practitioners is to raise awareness and be able to give parents good advice. So it is important for them to educate themselves and know what the research says,’ says Mottram. ‘In an ideal world, I'd be incorporating potty learning into the nursery day. Having children who can sit up to sit on the potty once or twice a day would be really helpful, especially after meals.’
Environmental campaigner Elisabeth Whitebread agrees, ‘It's great to feel that you have proactive support from nursery. Historically most nurseries have wanted to be led by parents when they decide to start toilet training. But early educators know what's best for children and lots of parents feel really stuck with toilet training, unsure what's the right method. It's really important that nursery staff feel empowered to step up and share their approach.’
She is currently developing an education programme for nurseries that aims to lower the age at which children are nappy-free.
Some nurseries have already started to work with parents to support children being toilet trained at a younger age, including Busy Bees and Tops Day Nurseries (see Case study). Cheryl Hadland, CEO of Tops Day Nurseries, says, ‘Earlier potty training is one of the most sustainable things we can do in the early years sector, with considerable impacts economically, socially, environmentally and, most importantly, for the children.’
case study: Tops Day Nurseries
Tops Day Nurseries, with 33 settings, has pledged that by 2026, no pre-schoolers will be in nappies unless there is a medical or SEND reason.
‘We have seen that parents are potty training later, but we try not to let it get too late otherwise children can get too comfortable in their nappies,’ says operations director Diane Wycherley.
‘We used to start having conversations with parents and start encouraging potty training when children were around 18 months to nearly two years old. If we had resistance from parents, we'd return to it later.
‘After noticing a rise in children going into pre-school in nappies, we've revisited our whole toileting programme. Now when children attend Tops, it is an expectation that they will be encouraged to use the potty from the baby room all the way through. It is a gentle approach working with the child and the parents.’
Gradual skills
During nappy changes, staff put babies who are developmentally ready to sit on a potty for a short time. This helps familiarise them with the potty as a place to go to the toilet, allowing them to get used to the sensation of sitting on it and potentially start to recognise the cues that signal they need to do a wee or poo.
‘We celebrate that they are sat on the potty and, if they don't produce anything, they still get a celebration, so it's a positive thing,’ says Wycherley. ‘They then have their nappy put back on and wash their hands before they return to play. It's all about getting into a routine.’ Staff are alert to when children are indicating that they want to use the potty, which they find can be as young as 18 months old.
Wycherley adds that occasionally accidents can upset children and delay their transition out of nappies. Staff are trained to act positively in these instances, reassure the child that it is OK and make sure they feel supported.
Regional manager Jessica Beach adds, ‘Sometimes, between the age of two and three, children can be terrified of the potty or toilet, so by starting at a younger age it can prevent that fear and make it the norm.’
Beach was prepared for some staff to be reluctant to the change of policy but she says that, once the logistics were in place, they responded positively. ‘Many have even commented that they can see a difference,’ she says. ‘In a couple of our baby rooms we have babies that are almost potty trained, ready to move to the next room.’
They are also already seeing the wider benefits. Children are gaining a greater understanding of their own bodies, which brings self-confidence and independence. In addition, parents are noticing the financial benefits of buying fewer nappies or having less washing.
Environmentally friendly
Alongside the move to toilet training children sooner, Tops has introduced a Washable Nappy Programme and all children are now using reusable nappies while in its settings. Parents are charged a £1 fee per day to cover the cost of the nappy and washing it in the group's eco-friendly Laundry Hub, which is powered by solar energy and uses a rainwater retrieval system. Ambient heat generated by the washing machine operation is even used to dry the nappies.
At the end of each nursery day, children are put into nappies provided by parents. This is to ensure washable nappies are circulated within the nursery and that sanitisation and laundry protocols are maintained.
Minimising the environmental impact of nappies
Nappy waste is a huge problem. Disposable nappies represent around 50 per cent of the waste that nurseries produce and contribute significantly to landfill waste. It is estimated by Pura NappiCycle that parents and carers in the UK throw away three billion disposable nappies every year, while the figure for the EU is 33 billion. In landfill, they last for up to half a millennium.6
Landfill tax is set to sharply rise by almost 22 per cent in April,7 which is likely to increase nurseries’ waste disposal bills and be another incentive for early years leaders to look for greener alternatives. Early toilet training will significantly reduce the environmental impact of nappies, but there are also other areas for settings to consider.
Moving to reusable cloth nappies is an option that environmental campaigner Elisabeth Whitebread is promoting across nurseries. She wants settings to provide resources and guidance to parents on the advantages of reusable nappies, but there are barriers, including convenience and laundering.
While Tops Day Nurseries has introduced its own on-site laundry (see Case study), other nurseries are turning to outsourced laundries, and Whitebread is working towards designing a model that would cost around the same as current nappy waste disposal rates.
Another option is to investigate how to lessen the environmental impact of disposable nappies. It is possible – nappies in Wales have been recycled for over a decade, but specialist recycling facilities are needed.
At the moment, the only nappies in England being recycled are from nurseries and families involved in a nappy recycling project led by Green Bottoms in partnership with Pura NappiCycle. Nappies from nurseries signed up to Green Bottoms in the West Midlands, the M5 corridor and Bristol, along with some Bristol homes, and being collected and taken to a specialist recycling facility in South Wales, where they go through a friction washing process and are turned into fibre pellets. The target is to recycle one million nappies in a year.
‘Around 10 per cent of all household waste collected is nappy waste,’ says Mark Smith, co-founder of Green Bottoms. ‘It's the largest single waste type that isn't recycled as a norm in England. It's bulky, dirty, multi-material with low value, so it's by no means an easy thing to recycle. We're trying to demonstrate to local authorities in England that it is possible. Recycling facilities in Wales have a lot of support from councils and the Welsh Assembly and we are starting to see interest in England. We could be doing it here too if we had the political will to make the economics work.’
In the meantime, Green Bottoms sends nappies to be turned into energy from waste, which means that they are still avoiding landfill.
FURTHER INFORMATION
- ERIC
- Green Bottoms
- Rebecca Mottrm
- Sprout Innovation
- Department for Education toilet training guidance: https://help-for-early-years-providers.education.gov.uk/health-and-wellbeing/toilet-training
