Toilet Training

Definition

Toilet training is the process of teaching a young child to control the bowel and bladder and use the bathroom for elimination. A child is considered to be toilet trained when he or she initiates going to the bathroom and can adjust clothing necessary to urinate or have a bowel movement. Toilet training is sometimes called toilet learning or potty training.

Description

The average age at which children complete toilet training in the United States is approximately three years old. In some cases children learn bladder control first; others learn bowel control before bladder control. Control is generally first achieved during the daytime, well before a child is able to stay dry at night.

Some children achieve some control over bladder and/or bowel movements as early as nine months of age and are able to cooperate in controlling themselves to some degree by the age of 12 to 15 months. Most experts agree, however, that toilet training should only be initiated when a child exhibits certain signs of readiness that usually appear between the ages of two and three years of age. Unlike infants, toddlers know when they are urinating or defecating and may assume certain postures or become quiet when they are about to move their bowels. They have also learned the vocabulary their family uses for elimination. Another sign is a sense of fastidiousness and desire for order that appears at this stage of development. Children are likely to ask parents to change their dirty diapers right away, and they show a general interest in orderliness that can be harnessed for purposes of toilet training. A child this age also has a pronounced desire to imitate the parent of the same sex, a trait that can be used to advantage in enticing her to use the toilet. Lastly, the child will begin to show signs of being able to delay urination or bowel movements such as waking from sleep still dry or refraining from urinating or defecating for longer periods of time while not wearing a diaper.

Strategies

Child care experts generally recommend a strategy that uses praise as a motivator, has little pressure from the parents, and is fun for the child. It has been found that when parents wait until their toddler has attained the greatest possible degree of readiness, the process is easier, faster, and accompanied by fewer lapses. The emphasis is on letting the child proceed at his own pace, motivated by the desire to be a "big boy" or "big girl" and imitate his parents. Measures that may cause pressure and anxiety need to be avoided.

The first step in toilet training is to purchase a potty. There are different versions of potties, including ones that sit on the floor and are emptied after each use, ones that have cups to protect against splatters, and ones that sit on top of an adult toilet with or without a step stool for the child to climb up to it. The floor-level model is most often recommended for the first stages of toilet training. Some recommend taking the child to the store to help pick out his or her own potty, then helping to personalize it with a name, stickers, paint, etc., with the general idea of making the potty a prized possession of the child's, not something to be feared.

The child should first spend some time sitting on the potty, first while clothed and then with clothes removed, so that he or she is comfortable sitting on it. The connection between what she is doing on her small potty and what the adults and siblings do on the big potty should be emphasized. One suggestion is to bring the child to the potty with a dirty diaper and the contents placed in it so he or she can see that this is where they belong. Parents should watch for cues from the child that he or she may be about to urinate or have a bowel movement, such as a concentrated look, yanking at his or her diaper, squatting, or grunting. Often this behavior will happen first thing in the morning, right after a nap, or approximately 20 minutes after a meal. The child should be taken to the potty, his or her diaper should be removed, and the child encouraged to sit for at least one minute. Some children may enjoy reading a book or singing a song while waiting. Special read-aloud books about toilet training are popular. Parents should never strap a child into a potty or force him or her to sit on it. If the child has not used the potty after five minutes or so, he or he should be encouraged to get dressed and try again soon.

The general consensus from experts is that much encouragement and praise should be used when a child cooperates with toilet training and when he or she begins to urinate or defecate in the potty. Rewards such as hugs and kisses, verbal praise, stickers, stars, or favorite treats can be used when the child uses the potty or tells a parent he or she has to use it. Pull-up diapers or plastic training pants can be purchased so that the child can remove them him or herself. For many children, simply progressing from diapers to training pants and then to regular underpants is an incentive in itself. When accidents occur, they should be treated casually; punishment, teasing, or chastising should be avoided.

Nighttime training usually begins when a child can stay dry all day, for at least four to six hours. Girls usually reach this point before boys; some girls begin to stay dry at naptime and even occasionally at night before the age of two. After the age of two, dry nights become more frequent: 45 percent of girls and 35 percent of boys stay dry at night at the ages of two to three. With many children, nighttime training is not done until the age of three and, in many cases, not complete until four or five. The signal from the child's bladder has to be strong enough to wake him from sleep and get him to the bathroom at least once or twice a night. As many as 25 percent of children have relapses after they have been dry at night for six months or longer, usually due to a temporary stressor. In a minority of children, nighttime bladder control does not develop until after the age of five; this situation often occurs in families where there is a history of enuresis (bedwetting).

Common problems

In some cases a child may resist all toilet training efforts from the parents, some going so far as to resist sitting on the potty or even holding back bowel movements. Toilet training resistance may be the result of a parent over-admonishing the child when accidents are made or the child does not use the potty when directed. In some cases the child is simply not ready for toilet learning. More rarely, resistance can be caused by a condition that causes the child pain when he or she uses the potty, such as painful urination associated with a urinary tract infection. If a child is uncooperative during the toilet training process, parents can try letting the child initiate the process when he or she is ready, using rewards and positive feedback each time the child is successful in using the potty or goes a whole day without soiling his or her pants, replacing the child's diaper or training pants with regular underwear or having the child change his or her own clothes when accidents occur.

One potential negative effect of resistance is that the child can hold back bowel movements, resulting in constipation. This in turn makes elimination uncomfortable and even painful, creating even greater reluctance and resistance on the part of the child. Severe cases of constipation can cause painful anal fissures, fecal soiling (encopresis), or rectal enlargement. Unusual delays in toilet training normal children or regressions to soiling generally indicate family stress and/or underlying emotional problems and may require counseling to be effectively resolved.

Parental concerns

Toilet training is often a dreaded and frustrating task for parents. The process can go more smoothly for parent and child if parents are educated on training techniques that emphasize waiting until a child shows signs of readiness before initiating training and taking a child-oriented approach.

When to call the doctor

Parents should contact a healthcare provider if their child exhibits any of the following behaviors:

• holding back bowel movements or constipation
• evidence of painful urination or defecation
• extended toilet training resistance (i.e. lasts several months)

Resources

BOOKS

Morgan, Richard. Zoo Poo: A First Toilet Training Book. New York: Barron's Educational Resources, 2004.

Warner, Penny, et al. Toilet Training without Tears or Trauma. Minnetonka, MN: Meadowbrook Press, 2003.

PERIODICALS

"Toilet Training." Pediatrics for Parents 20, no. 8 (August 2003): 2.

Schmitt, Barton D. "Toilet Training Basics." Clinical Reference Systems (2002): 3263–7.

——. "Toilet Training Problems: Underachievers, Refusers, and Stool Holders." Contemporary Pediatrics 21, no. 4 (April 2004): 71–82.

Schonwald, Alison, et al. "Factors Associated with Difficult Toilet Training." Pediatrics 113, no. 6 (June 2004): 1753–7.

ORGANIZATIONS

American Academy of Pediatrics (AAP). 141 Northwest Point Boulevard, Elk Grove Village, IL 60007. Web site: <www.aap.org>.

WEB SITES

McKinney, Merritt. "Late Start May Delay Toilet Training: Study." MedlinePlus, August 19, 2004. <www.nlm.nih.gov/medlineplus/news/fullstory_19622.html> (accessed September 10, 2004.)

Stephanie Dionne Sherk

The Gale Encyclopedia of Children's Health: Infancy Through Adolescence
Copyright © 1999 by The Gale Group.
Published by The Gale Group. All rights reserved, including the right of reproduction in whole or in part in any form.

Training and Development

The field of training and development has changed significantly during the past several years, reflecting both its role and importance in achieving higher employee performance and meeting organizational goals. Today, this field has become more important because employees need to learn new skills, advance their knowledge, and meet the challenges of technology in achieving high performance.

BACKGROUND

Training has traditionally been defined as the process by which individuals change their skills, knowledge, attitudes, and/or behavior (Robbins and DeCenzo, 1998). In this context, training involves designing and supporting learning activities that result in a desired level of performance. In contrast, development typically refers to long-term growth and learning, directing attention more on what an individual may need to know or do at some future time. While training focuses more on current job duties or responsibilities, development points to future job responsibilities. However, sometimes these terms have been used interchangeably or have been denoted by the single term performance consulting, which emphasizes either the product of training and development or how individuals perform as a result of what they have learned (Robinson and Robinson, 1995).

To be effective, training and development must meet a number of goals. First, they must be focused on individual training needs but still reflect organizational goals in terms of desired or expected performance. Second, training and development must reflect learning goals or outcomes, outlining what will be accomplished by this process. Third, they must be based on sound learning principles, be perceived as important by trainees, and be conducted in a manner that maximizes learning. Last, they must be evaluated to determine effectiveness and to help guide change and improvement.

TRENDS IN TRAINING AND DEVELOPMENT

A number of trends have occurred that reflect the common theme of making training more effective. Some of the most significant trends include the following:

• A greater emphasis on customized training reflects the needs of trainees, both in terms of the skills and knowledge they currently have and those that they need, along with identifying the unique learning style of each individual. By having this focus, training can better match each individual's learning goals and needs, and thus be perceived as more relevant and appropriate by the trainee.
• An increased development of personalized learning objectives relates to present or future job requirements and reflects past performance appraisal information. This information can be gained, in part, by conducting a needs assessment for each trainee and can help in designing learning activities that encompass the critical skills and content areas needed for future performance.
• A greater use of instructional technologies, such as distance learning, allows individuals to customize learning to their job situation—such as location, time, access to technology, and so forth. The use of current training technologies can greatly assist individuals in their learning, since training content and delivery can be standardized, quickly updated, and constructed so as to require learners to demonstrate the desired competencies as they engage in learning activities.
• A greater integration of training and development into the workplace links learning to job performance. Training outcomes and learning activities are linked to each individual's job requirements so that what trainees learn will be reflected in their job performance. For example, individuals who have participated in a training program on developing teamwork skills would be expected to demonstrate these skills in their future job performance.
• A greater use of action or performance plans requires trainees to develop a plan outlining how they will implement what they have learned and how they will determine whether this plan will, in fact, improve performance. The use of this process further links training to job performance; it can also be integrated with the performance appraisal process to measure changes or improvements in an individual's performance.

A MODEL FOR CREATING TRAINING EFFECTIVENESS

With training and development becoming more systematic, models describing the process and activities required to achieve successful training are being used more frequently to explain how training should be designed, delivered, and evaluated. One such model, as shown in Figure 1, outlines the steps that should be completed during the pre-training, training, and post-training stages. This model also presents a brief summary of each of these stages, explaining why each step should be performed carefully and accurately.

During the pre-training stage, information is gathered to help determine the need for training. An assessment is made regarding what improvements or changes an organization needs to make, along with an assessment of what trainees need to meet their performance expectations. From this information, a decision can be made regarding the training gap, for example, the difference between the performance that is desired and the performance that currently exists.

After this assessment is complete, a number of training activities can be completed, including developing training goals or outcomes, determining the appropriate learning activities and strategies, and achieving an understanding and commitment from the trainees for the program or activities. When these activities are performed effectively, the likelihood that the training will be successful is greatly enhanced.

During the final stage, post-training, a number of activities are required to follow up on the training, ensure that it is integrated into the workplace, and measure performance changes and the effectiveness of the training. Although training can be measured through several techniques, the most important and relevant measurement is one that focuses on changes in performance rather than other factors, such as trainees' satisfaction with the training or what they have learned.

IMPACT OF TRAINING AND DEVELOPMENT ON PERFORMANCE AND ORGANIZATIONAL EFFECTIVENESS

One current method of evaluating the impact and importance of training is to examine the potential—or real—benefits to be achieved through training and development. Although not all benefits can be measured on a strict cost-benefit analysis basis, most benefits can be at least informally measured and used to determine effectiveness. The most significant direct benefits of training are the following:

• It clarifies job duties and responsibilities
• It increases an individual's job competence
• It provides the foundation for further development
• It assists in conducting an accurate performance appraisal
• It produces higher levels of performance

In addition, training may also be evaluated in terms of indirect benefits that can add additional value. These indirect benefits could include the following:

• Enhancing teamwork and team building
• Producing a strong sense of commitment to the organization
• Achieving higher levels of employee motivation
• Assisting in cross-training/job rotation

Although the impact of training can be measured in terms of individual learning and performance, another way to determine its impact is in relation to organizational growth, development, or effectiveness. As organizations have changed in recent times, there has emerged a need to study the critical elements that make organizations prosper and relate these to training and development. It is common today to view organizations in a dynamic sense, noting that they are constantly changing, renewing themselves, and in need of being reflective of current business practices. One current prospective is to view an organization as a "learning culture," reflecting its need to be constantly involved with learning how to become better and to provide significant training opportunities for employees (Senge, 1990). Accordingly, when organizations adopt this learning culture, they create a variety of training opportunities for all employees and develop performance expectations that instill in all employees the need for and value of training and development on a continual basis.

SUMMARY

Training and development have achieved a high degree of recognition for their importance in helping individuals become better performers and assisting organizations in achieving their goals. The field has become more visible, training processes more clearly defined, and the need for training more evident as societal and technological changes have occurred.

Through designing training and development activities as described in the model presented in Figure 1, the benefits outlined in this article—both direct and indirect—can be achieved. Further, when employees learn new skills and acquire new knowledge, they increase their career potential and add extra value to their employers and others whose work is impacted by their performance.

Following a well-structured plan for designing, implementing, and evaluating training and development programs is helpful in ensuring the effectiveness of the program and achieving a return on investment. To be effective, training should reflect the following guidelines:

• It should be tied to the organization's culture and goals. The current mission and goals should guide the development of all training and development activities. Each potential training activity should be reviewed by asking: How will this help achieve the organization's mission or goals?
• It should be perceived as important by trainee. Training should be viewed as important and relevant for achieving personal success and high performance levels.
• It should be relevant to the needs of the trainees. Some form of assessing the needs of the trainees should be completed prior to training to ensure that the program and learning activities are relevant to what the trainees need to learn or do.
• It should be linked to the workplace. Once training is completed, a plan should be completed by all trainees outlining how they will integrate the training results into their job. Some type of action plan—defining what activities will be completed, how they will be done, and when they will be implemented— should be used.
• It should be applied but based on sound learning principles. Current learning and training theories and principles should be used as the foundation for developing and delivering training programs, but the learning activities should stress how these theories and principles can be used in daily job duties.
• It should be supported and reinforced. If training is to be implemented effectively, support should be given by the trainees' supervisor and others who have an impact on the performance of trainees. In addition, policies and performance reward systems should help to support the training efforts and recognize when performance has improved as a result of training.

BIBLIOGRAPHY

DeCenzo, D. A., and Robbins, S. P. (1998). Supervision Today Upper Saddle River, NJ: Prentice-Hall, Inc.

Robinson, D. G., and Robinson, J. C. (1995). Performance Consulting: Moving Beyond Training San Francisco: Berrett-Koehler Publishers.

Senge, P. M. (1990, Fall). "The Leader's New Work: Building Learning Organizations." Sloan Management Review vol. 32(1): 1-17.

DAVID HYSLOP

The Gale Encyclopedia of Busine$$ and Finance
Copyright © 1999 by The Gale Group.
Published by The Gale Group. All rights reserved, including the right of reproduction in whole or in part in any form.

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