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Why Toilet Training Can Trip Up Parents and Doctors

When it comes to potty training advice, pediatricians don't have much science to look to.
When it comes to potty training advice, pediatricians don't have much science to look to.

Science has failed parents, at least when it comes to determining how to toilet-train their children. There's scant data on whether it's better to potty train early or late, or whether it's OK to go diaper-free with "elimination communication," which involves whisking tiny babies off to the potty whenever they pee, which can be two or three times an hour.

The sorry state of potty training science is the subject of an article published today in the Canadian Medical Association Journal. Darcie Kiddoo, a pediatric urologist at the University of Alberta, reviewed the research on potty training and found that "very little scientific information is available."

What got her going was a concern about pediatricians who don't know what to tell parents. But that same worry could be extended to parents barraged by advice from friends and relatives on the merits of Brazelton vs. Azrin-Foxx vs. Gross-Loh. Choose the wrong method of potty training, those well-meaning advisors intimate, and your offspring will be scarred for life.

The debate has been raging since 1962, when pediatrician T. Berry Brazelton published the first standardized method. His " child oriented approach" starts kids on the john at 18 months, but urges to wait until they're psychologically ready and show interest.

By contrast, psychologists Nathan Azrin and R.M. Foxx, authors of the 1974 book " Toilet Training in Less than a Day," offer a "parent-centered" approach that involves scheduled potty stops and positive reinforcement. Two small studies showed that for children who were physiologically and psychologically ready, they could indeed be potty trained in 4.5 hours.

More recent, and also more ancient, are the diaper-free methods such as elimination communication and infant potty training. Their advocates urge parents to learn when their baby needs to eliminate, and then hold the child over the toilet. "This practice makes conventional potty training unnecessary," says the website for the group . Proponents also say that the practice encourages parent-child bonding, and creates less waste.

But as Kiddoo, the pediatric urologist, points out, no research has been done on benefits or drawbacks of diaper-free potty training. It's also possible the benefits of bonding and savings on diapers are offset by the need for parents and child to spend much of the day within hail of a bathroom.

A 2006 review of potty training by the Agency for Healthcare Research and Quality (with Kiddo as one of the authors) didn't find any studies that directly compared the two most popular two methods, Brazelton and Azrin and Foxx. There also were no evaluations of whether the different methods of toilet training can cause problems like bedwetting, constipation, or urinary tract infections.

Despite that, both the American Academy of Pediatrics and the Canadian Paediatric society recommend the Brazelton approach, starting at 18 months.

Parents will make their own way, of course. Given the state of the science on toilet training, that sounds like the best advice yet.

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