When to Start Toilet Training
Most children achieve the physiologic, cognitive, and emotional development necessary for toilet training between 18 to 30 months of age, with the optimal window typically beginning around 24 months or later when signs of readiness are present. 1, 2
Recommended Starting Age
Begin toilet training between 18-30 months of age, with most children showing readiness markers after 24 months when developmental skills for toilet training have been mastered. 1, 2
The American Academy of Pediatrics recommends not starting before age 2 years and only when the child demonstrates clear signs of readiness. 3
Recent data shows the average age for initiating training in the United States has shifted from earlier than 18 months (four decades ago) to between 21-36 months currently. 2
Studies demonstrate no benefit of intensive training before 27 months of age, supporting a later, readiness-based approach. 2
Signs of Readiness to Look For
Before initiating training, verify the child demonstrates these specific developmental markers:
Physical capabilities: Can walk independently, put on and remove clothing without assistance, and follow simple parental instructions. 1
Communication skills: Has expressive language ability to communicate needs and can understand verbal instructions. 1
Bladder/bowel awareness: Shows awareness of a full bladder or rectum and demonstrates dissatisfaction with soiled diapers. 1
Behavioral cues: Imitates toileting behavior, expresses desire to use the toilet, and demonstrates some bladder or bowel control (stays dry through naps or overnight). 1
Anticipatory Guidance Timeline
Provide anticipatory guidance to parents beginning at the 18-24 month well-child visit, discussing readiness signs and setting realistic expectations. 1, 3
Emphasize that girls typically complete training earlier than boys, which is a normal developmental variation. 2
Important Clinical Context
A second peak of UTIs occurs between ages 2-4 years during toilet training, making proper timing and technique important for urologic health. 4
Active treatment for enuresis should not be started before age 6 years, as nighttime continence develops later than daytime control. 4
Children with medical comorbidities (Down syndrome, autism spectrum disorder, cerebral palsy) often require earlier consultation with occupational therapists or developmental pediatricians, as they have reduced likelihood of successfully attaining full toilet training within typical timeframes. 1