Health Promotion and Maintenance Q 103
A mother complains to the clinic nurse that her 2 ½-year-old son is not yet toilet trained. She is particularly concerned that, although he reliably uses the potty seat for bowel movements, he isn’t able to hold his urine for long periods. Which of the following statements by the nurse is correct?
A. The child should have been trained by age 2 and may have a psychological problem that is responsible for his "accidents."
B. Bladder control is usually achieved before bowel control, and the child should be required to sit on the potty seat until he passes urine.
C. Bowel control is usually achieved before bladder control, and the average age for completion of toilet training varies widely from 24 to 36 months.
D. The child should be told "no" each time he wets so that he learns the behavior is unacceptable.
Correct Answer: C. Bowel control is usually achieved before bladder control, and the average age for completion of toilet training varies widely from 24 to 36 months.
Toddlers typically learn bowel control before bladder control, with boys often taking longer to complete toilet training than girls. Readiness to begin toilet training depends on the individual child. In general, starting before age 2 (24 months) is not recommended. The readiness skills and physical development the child needs occur between age 18 months and 2.5 years.
Option A: Many children are not trained until 36 months and this should not cause concern. Later training is rarely caused by psychological factors and is much more commonly related to individual developmental maturity. Timing is important. Toilet training should not be started when the child is feeling ill or when the child is experiencing any major life changes such as moving, new siblings, new school, or new child-care situation.
Option B: Bowel control is first achieved before bladder control. Start a routine with regular reminders beginning with one time a day—after breakfast or maybe at bath time when the child is already undressed. Watch for behavior, grimaces, or poses that may signal the need for a bowel movement, and ask the child if he or she needs to go.
Option D: Reprimanding the child will not speed the process and may be confusing. Accidents are common and should be expected in the training process. Praise the child whenever he or she tells you that he/she needs to go and when the child tells you without being reminded.