7.7: Elimination Development
- Page ID
- 228357
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)Infants urinate as often as every 1 to 3 hours or as infrequently as every 4 to 6 hours. In case of sickness or if the weather is very hot, urine output might drop by half and still be normal. If an infant shows any signs of distress while urinating or if any blood is found in a wet diaper medical care should be sought.
Toilet Training
Toilet training typically occurs after the second birthday. Mota and Barros (2008) did a meta analytic review and found that the age at which toilet training is initiated has been increasing the world over. However, in most developing countries (as seen in deVries and deVries, 1977; and anecdotal personal experience) toilet training starts and is completed much earlier than in the US. However, most experts suggest that to prevent frustration, encourage healthy parent child relationships and to prevent disorders associated with elimination, it is better to watch for signs from the child (Mota & Barros, 2008, Kiddoo, 2012). Some children show interest by age 2, but others may not be ready until months later. The average age for girls to be toilet trained is 29 months and for boys it is 31 months, and 98% of children are trained by 36 months in the Western world (Boyse & Fitzgerald, 2010). The child’s age is not as important as his/her physical and emotional readiness. If started too early, it might take longer to train a child.
According to The Mayo Clinic (2016b) the following questions can help parents determine if a child is ready for toilet training:
- Does your child seem interested in the potty chair or toilet, or in wearing underwear?
- Can your child understand and follow basic directions?
- Does your child tell you through words, facial expressions or posture when he or she needs to go?
- Does your child stay dry for periods of two hours or longer during the day?
- Does your child complain about wet or dirty diapers?
- Can your child pull down his or her pants and pull them up again?
- Can your child sit on and rise from a potty chair?
If a child resists being trained or it is not successful after a few weeks, it is best to take a break and try again when they show more significant interest in the process. Most children master daytime bladder control first, typically within two to three months of consistent toilet training. However, nap and nighttime training might take months or even years.
Elimination Disorders
Some children experience elimination disorders that may require intervention by the child’s pediatrician or a trained mental health practitioner. Elimination disorders include enuresis, or the repeated voiding of urine into bed or clothes (involuntary or intentional) and encopresis, the repeated passage of feces into inappropriate places (involuntary or intentional) (DSM5) The prevalence of enuresis is 5%-10% for 5 year-olds, 3%-5% for 10 year-olds, and approximately 1% for those 15 years of age or older. Around 1% of 5 year- olds have encopresis, and it is more common in males than females.
Some children experience elimination disorders including:
- enuresis - the repeated voiding of urine into bed or clothes (involuntary or intentional) after age 5
- encopresis - the repeated passage of feces into inappropriate places (involuntary or intentional).
The prevalence of enuresis is 5%-10% for 5 year-olds, 3%-5% for 10 year-olds and approximately 1% for those 15 years of age or older. Around 1% of 5 year- olds have encopresis, and it is more common in males than females. These are diagnosed by a medical professional and may require treatment.[2]
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th edition (DSM-V). Washington, DC: Author.
deVries, M.W. & deVries, M.R. (1977). Cultural Relativity of Toilet Training Readiness: A Perspective From East Africa. Pediatrics, 60(2), 170-177. https://doi.org/10.1542/peds.60.2.170
Kiddoo D. A. (2012). Toilet training children: when to start and how to train. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 184(5), 511–512. https://doi.org/10.1503/cmaj.110830
Mota, D.M. & Barros, A. J. D. (2008). Toilet training: methods, parental expectations and associated dysfunctions. Jornal de Pediatria, 84(1), 9-17. doi: 0021-7557/08/84-01/9
Attributions:
Child Growth and Development by Jennifer Paris, Antoinette Ricardo, and Dawn Rymond, 2019, is licensed under CC BY 4.0
Parenting and Family Diversity Issues by Diana Lang, 2020, published by Iowa State University is licensed under CC BY-NC-SA 4.0
[1] Image by Manish Bansal is licensed under CC-BY-2.0
[2] Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0