Going potty

Toilet training is one of those hot topics where advice to parents has changed radically over the years. 'Regular bowel action is of the greatest importance,' wrote Mary Truby King at the turn of the last century in her popular book, Mothercraft. 'If training is begun on the third day, baby will very soon learn to pass a motion at the same time every day. The nurse or mother should place a little chamber on her knees. Let the baby feel the cold edge of the chamber at his back.'

As you might imagine, this is far from the advice being given today.

Parents and carers are now advised to wait until children are physically and psychologically ready for toilet training, which means that there is a wide variation in age. Anything between 18 months and three years is now considered to be within normal development.

So how can you tell whether a child is ready to leave nappies? First, it is important to consider the child's physical development. In order to achieve physical control of bladder and bowel movements, the child's nervous system must be sufficiently developed so that the child can hear the body's 'alarm system'. Pulling at nappies, or signalling to carers that they have wet or soiled themselves, is one indicator of this, along with periods of time when the nappy is dry.

Words and feelings

Children also need to be able to communicate effectively. Having and using words for bowel and bladder movements is essential if they are to be able to signal their needs. Finally, children need to be emotionally and cognitively ready. At a simple level, children need to understand that 'poo' and 'pee', so to speak, come from them. The development of 'ultra'

nappies that leave children feeling dry is thought by some people to be contributing to children seeming indifferent to starting the process. This is important, as the desire to leave nappies is also a factor in stress-free toilet training. This is the reason carers are often advised to allow children some time to roam without a nappy on, which is probably best done in the child's own home for hygiene reasons.

Avoid 'PRP'

Once a child is ready to leave nappies, it is important to avoid pressuring them - there should be no 'performance-related poos'! The extent to which children are praised needs to be carefully thought out. Wild applause and treats at the first 'tinkle' can send out a hidden message to a child that going to the potty is about pleasing adults, and so can set up a fear of failure. This in turn can mean that the child fails to relax and thus cannot release any urine.

For the same reasons, star charts, like those used for an older child who wets the bed, are not always a good idea. Jennie Lindon, author of Childcare and Early Education and child psychologist, says, 'I definitely would not use star charts in connection with toilet training or at all with any child of this age. They can create a lot of pressure, and the child does not always understand the symbolic nature of the stars, as they're just too young.' A low-key approach to toilet training is therefore often more appropriate. When the potty is put out and little said about it, many children, if they are ready, will 'go' of their own accord providing they can manage their clothes.

Working with parents

Years ago, mothers were often solely responsible for toilet training. This is no longer the case with so many children in daycare, and the process of training may be shared between nursery and home. Working carefully with parents is essential so that children do not get confused messages, or they may actually refuse to go near a potty and everyone ends up feeling frustrated. Debra Smith, UK operations manager of Kinderquest, part of the US group Bright Horizons Family Solutions, says, 'We tend to work with the parents, although if staff notice that a child appears to be ready, we will discuss it with the parents and take the lead from them. We also ensure that we follow the approach that is being taken at home to provide consistency which we feel is essential.'

Finally, a look across the Channel offers an interesting perspective on toilet training. In France there is a belief that a child's ability to walk upstairs using alternate feet is a key physical indicator of the child's readiness to leave nappies.

Student links

* This article links to element C2.2 of the NVQ 3 in Early Years Childcare and Education.

Evidence collector:If you are a student, you may wish to complete the following assignment to show your knowledge of toilet training and personal hygiene routines.

Assignment:Using a question and answer format, design a leaflet for parents which explains how best to approach toilet training with their child.

Bedwetting

* Bedwetting, or to use its medical term, enuresis, is extremely common in very young children. Most four-year-olds have frequent accidents at night even though they may well be dry during the day. As children get older, an estimated 15 per cent of five-and six-year-olds continue to wet the bed, especially those whose parents or close family members also used to wet the bed as children. Current advice to parents of older children is to remain calm, and to avoid putting children back into nappies. The reasoning behind this is that this subconsciously prevents the child from taking control, and it can also lower a child's feelings of self-worth. Advice should be sought from a GP or health visitor, who may refer the child to an enuresis clinic.