Late Toilet Training
and The Concerns Involved
A Review of Possible Drawbacks with emphasis on Behavioral Aspect
Late toilet training can be referred to from two different angles: Age of the child when initiating training, or age at completion of training.
What age constitutes as “late”?
Most of the sources I have researched refer to "late" as older than 42 months of age at initiation.
In one of the articles, Barton D. Schmitt, MD (Contemporary Pediatrics 2004) considers potty training as Delayed if a child is: over 3 years of age, has normal development, and is not potty trained after a period of 3 months or more.
Looking at the length of training makes a very good point, because if training doesn’t go well and drags over months, parents may want to stop and ask “what am I doing wrong?”, “What do I need to change?” – Rather than repeating the same pattern for a few more months or longer.
Click here if you're interested in reading about the possible causes for delayed potty training.
Are there implications for late toilet training?
Certain psychologists and child development professionals have challenged the child-oriented approach to potty training (Brazelton 1962), which calls parents to wait with potty training and let the child be their guide for finding the right time. (Examples for those are - family Psychologist John Rosemond, and Dr. Linda Sonna, a professor of multicultural psychology at Yorkville University).
Personally I have adopted the parent-ing oriented training approach (or you could say, authoritative-parenting-oriented), so I believe parents’ role is to lead the training and not wait until the child shows interest or initiates potty requests.
But personal view aside, the question that this article hopes to answer is: whether late toilet training can bring negative implications – during the training period itself, and in a longer view.
Late Toilet Training and Incontinence
A recent Study found that daytime incontinence rates (resulted in daytime wetting) seem to increase in children who begin training later (Barone et al, Journal of Pediatric Urology Dec 2009).
Lead author of this Study, Dr. Joseph G. Barone pointed out some possible reasons for that, all behavioral in nature:
Daytime wetting is an “issue of control”: Older children know how to control the situation and are likely to exercise this ability.
Older children may also be quite content with wearing diapers and using them as their toilet; getting them to train and adopt new toilet habits could be challenging.
Younger children are less “set in their ways” and tend to be more willing and enthusiastic about learning new things.
It should be noted that Barone refers to functional incontinence, where there is no physiological background involved.
The conclusion reached from Dr. Barone’s study was actually opposite to previous perceptions by doctors (including Barone himself as he said), that daytime wetting was caused by training "too early".
But surprised as he was, the reasons Baron has given to explain the results of the study, are making a lot of sense to this mom.
There are also studies associating between late initiation of toilet training and situations of “bladder instability” that continue into the school years (Joinson et al, 2009: A Prospective Study of Age at Initiation of Toilet Training and Subsequent Daytime Bladder Control in School-Age Children).
Late Toilet Training and stool issues
A different Study has associated late toilet training ( > 42 months) with the occurrence of stool difficulties during the process of potty training (Taubman, Pediatrics 1997).
Such difficulties can include:
Stool toileting refusal (STR)
Hiding to defecate during toilet training
It is not conclusive that late toilet training was the only parameter causing children to develop "stool issues", as the study had also found relation to presence of younger siblings, and parents’ difficulty or inability in setting limits to the child.
So it’s possible that these two other factors had led parents to delay training, or that the combination of older age along with ineffective parenting around toilet training -– had led to those difficulties. This is just a thought of course.
To make a logical point though: if I look at the behavioral attributes Dr. Barone mentioned as possible causes for incontinence in older kids (mainly, issue of control and habit), it does make sense that the same would lead to stool withholding or refusal, ultimately resulting in constipation and further struggle.
Late Toilet Training and behavioral challenges
I find the behavioral aspect to be intriguing, because in my own trial I’ve come to learn that potty training is mainly about the education, and how I interact with my child in that context.
I wasn’t able to find a Study that directly approaches the subject of behavioral issues associated with older age, and how they appear in the context of late toilet training, although I believe the relation is clearly implied by the studies mentioned above.
Professionals who favor earlier training explain that young toddlers are easier to potty train than older children, for a number of reasons:
Older children have spent a bigger part of their lives wearing diapers, have grown to like them, and are generally less receptive of changing their habits.
Having spent years in diapers, older children are used to defecate while playing or watching TV; therefore many of them will resist taking time away from their toys, TV or any other activity -- for going to the toilet.
Sometimes it is not actual resistance but simply a matter of unawareness, or laziness. Defecating in diapers require very little attention from the child, so it’s possible that older children have become used to ignoring bladder and bowel “signals”.
Family Psychologist John Rosemond explains that habit, as oppose to language or comprehending capabilities, is the main factor in toddlers potty training: The more time spent in diapers, being used to eliminate “at will” with no regard to circumstances, the harder and longer it will be for parents to educate their child for new habits.
Older children are more likely to engage in power struggles with their parents and challenge authority. Being more mature and aware, they will easily sense how important this is for mom and dad, and realize the power they hold over them by being able to control this one major issue.
Older children are more socially aware than young toddlers and more capable of feeling guilt and shame. That makes them vulnerable to negative reactions of their human environment to incidents of daytime wetting or soiling. Those can come from the parent or other caregiver, and from other kids if the child is in daycare.
Late Toilet Training and duration of training
When late becomes long, there are additional drawbacks that go along with that:
Suppose it has been months, years even, and you are now potty training 5 year old.. I can only imagine the amount of stress, frustration, guilt and disappointment that would be part of this scenario.
At this stage, toileting probably have developed into a huge “issue” in the family, affecting everything imaginable around the parent-child relationship.
This would be bad at any age, but the older the child is, the more complicated, and harder on the child.
If the child is in daycare or Preschool, other adults are involved. What if they react inappropriately or ineffectively (like scolding) to continuous daytime wetting and soiling? (Assuming that the child is no longer in diapers)
If that happens daily, and over a long period of time, there might be little tolerance from caregivers around those incidents, or there would be pressure on the parents to put the child back in diapers during daycare hours.
If the facility doesn’t accept children who are not potty trained, then that would be another thing for parents to worry about.
Late Toilet Training: Should parents consider -- or dismiss the idea?
There is no absolute "rule" that says late toilet training would lead to difficulties and problems. Personally I think that if potty training is managed and structured well by the parents, it will be successful at any reasonable age.
Still, I would seriously consider that there are certain behavioral challenges, which children present to us as they grow from young toddlers to older toddlers, and from there to preschoolers. And, that those challenges can affect the process of potty training and require us to manage it differently, more skillfully.
For more information related to the timing of potty training, Check out this
article about the benefits of an earlier start.
Return from Late Toilet Training to
When to Start Potty Training
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Potty Training Tools Home Page
References and Sources used in this article
Resources for Late Toilet Training -- referenced by or used in this article:
Daytime wetting: Getting to the bottom of the issue; Anthony J. Casale, MD; Contemporary Pediatrics Feb 2000.
Toilet training more beneficial when started early: Incontinence rates increase in children who begin training later, data show; Scott Tennant, Urology Times Apr 2010.
Toilet training: Getting it right the first time; Barton D. Schmitt, MD; Contemporary Pediatrics Mar 2004.
Later potty training is harder on parent, child; John Rosemond, family psychologist; Knight Ridder Newspapers Jul. 27, 2005
Joseph G. Barone, Niren Jasutkar, Dona Schneider; Later toilet training is associated with urge incontinence in children; Journal of Pediatric Urology, December 2009 Vol. 5, Pages 458-461.
Bruce Taubman; Toilet Training and Toileting Refusal for Stool Only: A Prospective Study; Pediatrics, Jan 1997; 99: 54 – 58.
Blum N.J., Taubman B., Nemeth N.; Why is toilet training occurring at older ages? A study of factors associated with later training; Journal of Pediatrics 2004, 145 (1), pp. 107-111.
Bakker, E., Van Gool, J., Van Sprundel, M., Van der Auwera, C. and Wyndaele, J. (2002), Results of a questionnaire evaluating the effects of different methods of toilet training on achieving bladder control. BJU International, 90: 456–461.
Bakker, E. and Wyndaele, J. J. (2000), Changes in the toilet training of children during the last 60 years: the cause of an increase in lower urinary tract dysfunction?; BJU International, 86: 248–252
Joinson Carol PhD, Heron Jon PhD, Von Gontard Alexander MD, Butler Ursula MRCPCH, Emond Alan MD-FRCP-FRCPCH, Golding Jean PhD; A Prospective Study of Age at Initiation of Toilet Training and Subsequent Daytime Bladder Control in School-Age Children; Journal of Developmental & Behavioral Pediatrics, October 2009; Vol. 30, pp 385-393.
Children Who Hide While Defecating Before They Have Completed Toilet Training: A Prospective Study; Bruce Taubman, MD; Nathan J. Blum, MD; Nicole Nemeth, MD; Arch Pediatr Adolesc Med. 2003;157:1190-1192