Toilet training started during the first year of life: a report on elimination signals, stool toileting refusal and completion age

Minerva Pediatr. 2008 Feb;60(1):27-35.


Aim: The aim of this study was to examine an international population of children who started toilet training in the first year of life.

Methods: Two hundred eighty-six participants completed an anonymous questionnaire. Main outcomes variables were: presence of elimination signals (ES), elimination pattern consistency (EPC), stool toileting refusal (STR), and toilet training completion age. The analysis included the differences in completion age regarding each of the following variables: start age range, presence of ES, EPC, STR and country of residency for those who completed either bowel or bladder training at the time of survey completion.

Results: Over 90% of the respondents reported that their children showed ES. STR was nearly 12%. For those who completed toilet training at the time of survey completion mean completion ages for daytime dryness and bowel control were 17.4 and 15.0 months, respectively; those who initiated toilet training during the first 6 months completed training earlier than those who started later; those who showed STR at the beginning of training completed bowel training later than those who did not (P<0.001); those who exhibited ES for voiding or bowel movements completed day-dryness and bowel training earlier than those who did not (P<0.001). Among countries of residency, those children who resided in the USA and Canada completed bowel training the earliest (P<0.001).

Conclusion: This is the first report which provides data on the current infant toilet training method, which is based mainly on ES and patterns, and practiced by motivated caregivers. Notable side effects were not observed.

Publication types

  • Multicenter Study

MeSH terms

  • Analysis of Variance
  • Canada
  • Child Behavior
  • Child Development*
  • Child, Preschool
  • China
  • Defecation*
  • Europe
  • Female
  • Health Surveys
  • Humans
  • Infant
  • Infant Behavior*
  • Male
  • Surveys and Questionnaires
  • Toilet Training*
  • United States
  • Urination*