From the Guidelines
Children with normal urinary concentrating ability are typically fully trained for stool between 2 and 4 years of age, but for children with conditions like NDI, full continence is usually reached only in the second decade of life. When considering toilet training for stool in children, it's essential to understand that the process and timeline can vary significantly based on the child's overall health and specific conditions they may have. For children without underlying conditions affecting their urinary or bowel control, the general guidelines suggest that they usually become fully toilet trained for stool between 2 and 4 years of age, with most achieving this milestone around age 3 1. However, for children with conditions such as Nephrogenic Diabetes Insipidus (NDI), the timeline for achieving full continence can be significantly delayed, often into the second decade of life 1. Key signs of readiness for toilet training include:
- Showing interest in the toilet
- Staying dry for longer periods
- Recognizing when they need to go
- Having the physical ability to sit on and get off the toilet Parents should initiate toilet training when their child exhibits these signs of readiness, rather than strictly adhering to age guidelines. The training process involves:
- Establishing a routine
- Using positive reinforcement
- Being patient with accidents
- Avoiding punishment It's also important to note that some children may take longer to train, especially at night, which can be influenced by factors such as large urine volumes in conditions like NDI, leading to a higher incidence of night incontinence 1. If a child is still experiencing regular accidents beyond age 4, it may be beneficial to consult with a pediatrician to rule out any underlying issues that could be affecting their ability to achieve full continence.
From the Research
Toilet Training Readiness
- Most U.S. children achieve the physiologic, cognitive, and emotional development necessary for toilet training by 18 to 30 months of age 2
- Markers of readiness for toilet training include being able to walk, put on and remove clothing, and follow parental instruction; expressive language; awareness of a full bladder or rectum; and demonstrated dissatisfaction with a soiled diaper 2
Stool Toileting Refusal and Withholding
- Complications of toilet training include stool toileting refusal, stool withholding, encopresis, hiding to defecate, and enuresis 2
- These problems typically resolve with time, although some may require further investigation and treatment 2
- Functional constipation is a common problem encountered in the pediatric setting, and for many children, it is functional in nature, potentially stemming from a pattern of stool output that is infrequent or not fully productive 3
Treatment and Management
- The most effective medication for functional constipation, when used in parallel with toilet training, is osmotic laxatives 4
- Non-pharmacological management, including adequate fiber and fluid intake, physiotherapy, or neuromodulators, can also be effective 4
- In children, the approach focuses on the behavioural nature of the disorder and the initial therapeutic steps involve toilet training and laxatives 5
- Treatment of adult functional constipation involves lifestyle interventions, pelvic floor interventions, and pharmacological therapy 5