Parents' and child care professionals' toilet training attitudes and practices: A comparative analysis.
U.S. Census data released in October 2000 indicated that 30% of children under age 5 spent time in organized care, with another 19% being cared for by other non-relatives (Smith, 2000). This compares with the 13% of children in organized care in 1977 (U.S. Bureau of Census Data, 1998). With the increase of women in the labor force and the need to balance career and family, it is no surprise that the rate of children in out-of-home placements is on the rise. Preschoolers whose parents work or were in school spend an average of 35 hours per week in child care.
The current convergence of care by parents and child care providers has resulted in a "sharing" of responsibility for many of the developmental milestones that were formerly an exclusive parental responsibility. The process of toilet learning is one such responsibility that has crossed the home-school divide. Parents and child care professionals are negotiating how best to approach this often complicated and time consuming task. The joint nature of this effort raises a number of questions about the congruence of toilet training attitudes and practices among parents and child care professionals. For example, is there agreement on start times and what constitutes readiness? Are both groups using the same toilet training methods and responding similarly to accidents? Answers to such questions offer insight into whether parents' and professionals' toilet training philosophies are synchronous.
The purpose of this study was to compare how parents and child care professionals perceive the toilet training process, and to determine where the two groups seek information about toileting when difficulties arise. Although Schum et al, (2001) found that maternal employment and child care use were not statistically significant factors in the overall time it takes to complete toilet training, information about congruence between parent and professional belief systems has tremendous descriptive value, and can lead to recommendations to facilitate cooperation between the two groups. Moreover, parent and caregiver congruence is viewed as an important research inquiry; as congruence has been shown to positively affect children's outcomes. Specifically, Victor, Halverson, and Wampler (1988) report that parent-teacher agreement on child temperament correlates with preschool children's social adaptability, confidence, academic skill, and being viewed as a "nonproblem."
The impetus behind this investigation came from personal experiences and stories from friends and colleagues about disparities between parents' and child care professionals' wishes regarding toilet training. One colleague who sought child care for her 2-1/2-year-old at a respected child care center was told that her son could not join the program unless he was toilet trained. Needing out-of-home placement, and desperate for quality care, she pushed her son to get out of diapers. The result was exhausting power struggles, high levels of stress, and a strained relationship. Making little progress, the mother decided that placement in the program was not worth the cost of forcing her child to use the toilet, and she delayed her return to work. Many parents, of course, do not have the option to stay home, and ultimately may need to settle for- some unsatisfactory solution.
The opposite scenario, in which parents pressure child care professionals to initiate toilet training, also occurs. Whether parents are busy at home, defer to child care providers for guidance, or because their cultural practices support a particular style of training, parents may ask providers to play an active role in toilet learning. At one center, the staff of the infant program worked to reach a compromise with the parents of a 16-month-old girl who wanted their daughter to be taken to the toilet at 15minute intervals. In this family, early training was the norm. The infant room was not equipped with a toilet, however, and the center's philosophy was to follow the child's lead in terms of readiness.
Recurrent discrepancies such as these led to the hypothesis that child care professionals and parents would have significantly different ideas about the timing of toilet training, what constitutes readiness, toilet-training practices, and response to accidents. The authors predicted that child care professionals' responses to these four core toilet training topics would more closely resemble a child-centered approach to toilet learning, the dominant approach espoused in the early childhood literature, than would the parents' responses.
In general, societal attitudes towards toilet training have changed considerably during the last century. In the early 1900s, permissive toilet learning was encouraged. It was believed that, like other developmental accomplishments, the ability to use the toilet would emerge naturally (Martin, King, Maccoby, & Jacklin, 1984). Others took heed of Freud's warnings and cautiously initiated training. They feared that complications during the toilet training process could create psychosexual tensions and inner conflict, which ultimately would influence lifelong personality traits (Freud, 1908).
In the 1920s and 1930s, however, behaviorism gained acceptance and American parents were encouraged to adhere to strict training schedules with early start dates (Martinet al., 1984). Toilet use was considered a behavior that could be controlled by systematic stimulus and response management.
A shift occurred during the Post World War II era, when a maturational approach again took center stage. Spock (1946) was one of the first to advocate a move back to a gradual-passive approach to toilet training, believing that bowel and bladder control would develop predictably. Washing machines and disposable diapers made the practical application of such advice more feasible (Seim, 1989). Brazelton (1962) built on Spock's ideas and advanced a "child-oriented" approach to toilet learning. He emphasized both the physiological and psychological tasks that predict readiness, and encouraged parents to follow their child's lead when initiating training. This relaxed approach gained widespread acceptance (Luxem & Christophersen, 1994), and continues to be the most commonly cited approach in the popular literature (e.g., Bainer & Hale, 2000; Brazelton, 1992; Brazelton et al., 1999; Honig, 1993; Robson & Leung, 1991).
Timing of initiation
Those who use a child-oriented approach usually agree that there is no "magic age" at which toilet training should be initiated. Training is considered an individualized process dependent upon a child's developmental level and signs of readiness. In fact, the American Academy of Pediatrics (1998) strongly discourages pushing a child into training before she is motivated and has reached an appropriate level of maturity. While some children may be ready as early as 18 months, most are not ready until they are at least 24 months of age (Stadtler, Gorski, & Brazelton, 1999). In a 1993 study of 1,192 American children, Bloom, Seeley, Ritchey, and McGuire found that the mean age of achieving bladder and bowel control was 24 years. These findings are similar to Brazelton's 1951-1961 survey of 1,170 children, which showed that 26% of children achieved success by 24 months of age, 52% by 27 months, 84% by 30 months, 96% by 36 months, and 98.7% by 37 months. In a study of toilet training in first-born children, Seim (1 989) found that more parents (42.6%) initiated training when their children were 24 to 29 months of age than during any other period, with the second most initiating training between 18 and 23 months of age (30.5%).
Toilet readiness is often discussed as a "window of opportunity," because initiation too early or too late can make the process more difficult. When training is initiated before all developmental criteria are met, the pressure on the child to perform may be immense. The stress and power struggles that ensue could lead to decreased self-esteem, strained parent-child relationships, and physical complications (for example, enuresis or encopresis) (Stadtler et al., 1999). Initiating training too early can extend the total time needed for training (Gorski, 1999). Not recognizing and responding to a child's readiness signs, on the other hand, can cause a child's interest in the toilet to wane, also leading to prolonged training. In addition, initiation should not begin when a child is ill or when a life change or stressor exists. For example, if parents are divorcing or moving, if the child is entering a new school, or a new sibling enters the family, toilet training should be postponed. These life events are likel y to exacerbate tensions during toilet learning.
Brazelton's (1962) model of toilet-readiness describes three physiological/maturational criteria that should precede the initiation of training: 1) voluntary control over bladder and bowel reflex actions, emerging at approximately 9 months of age; 2) the ability to cooperate with training, at approximately 12-15 months; and 3) myelinization of the pyramidal tracts of the central nervous system, at approximately 18 months. Brazelton's recent writing, however, extends the second criterion (the ability to cooperate) to 18-24 months of age, accounting for not only the ability to follow instructions, but also internal feedback factors such as self-determination, the desire to imitate and identify with mentors, and selfesteem (Stadtler et al., 1999).
Gorski (1999) outlined the overt signs that a child may be developmentally ready to begin toilet training. Included are a child's ability to imitate behavior, put objects where they belong, express independence (such as saying "no"), walk and sit down, take clothes on and off, express an interest in the toilet, and indicate when she is "going" to the bathroom or when she needs to "go." The Fundamentals of Toilet Training Study (Schum et al., 2001) indicated that most parents (72%) look for signs of children's readiness before they initiate training.
Because toilet training involves adult participation, parent readiness is also a key component in initiating training. Parent readiness includes an understanding of toilet training literature and theories, an awareness of their child's developmental level, a plan for the gradual exposure to toileting, realistic expectations about the time it takes to train a child, an understanding of temperament, and patience (Stadtler et al., 1999). Parents' misperceptions about the toilet training process can lead to inaccurate assumptions; for example, they may believe a child's lack of cooperation is a deliberate act of defiance or laziness. If toileting is not progressing as expected, misperceptions also can lead to feelings of parental inadequacy. In extreme cases, parents' unrealistic expectations and frustration can lead to child abuse (Krugman, 1985; Schmitt, 1987).
Numerous lay publications outline steps for child-oriented toilet training (e.g., Bainer & Hale, 2000; Brazelton, 1992; Honig, 1993; & Israeloff, 1992). Common methods include introducing a potty chair, allowing a child to explore the chair without pressure, reading children's books about using the toilet, talking about how others use the toilet and allowing the child to observe parents and siblings if she is interested, talking about how the body feels before using the toilet, introducing what is involved in toilet use (taking clothes off, sitting on the toilet, flushing, washing hands, etc.), and buying regular underwear. Based on a child's bowel and bladder rhythms, parents can provide reminders when appropriate (such as in the morning or after a meal). Reminders are also useful when noticeable cues that a child may need to use the toilet are evident (grimaces, crouched body positions, etc.).
Adults are encouraged to use a low-pressure approach of praising successes and patiently accepting accidents. If problems exist, it is generally recommended that training be put off for several months. Brazelton (1992, p. 417) suggests using a supportive statement in these situations such as, 'We'll stay out of it. You're just great, and you'll do it when you are ready."
The child-oriented methodological approach is not based on empirical research about tactics that predict success. In fact, there are no empirical studies that analyze child-oriented approaches. Rather, the recommendations derive from theories that emphasize children's social-emotional development and how they learn. Bandura's social learning theory (1986) predicts that individuals learn by modeling the behaviors of those around them. Children are more likely to model a behavior if they identify with the model, and if they repeatedly observe the behavior being modeled. In the case of toilet learning, children's observations of parents, siblings, and peers using the toilet serve as motivation for initiating the behavior themselves. Bandura stipulated, however, that if a child is not yet developmentally capable of the behavior, imitation will not occur.
Relational theories buttress the idea that children are more likely to be motivated toward a behavior if they have a relationship with the person initiating the behavior. 'We learn from those we love" is an applicable credo. Honig (1993) believes that success in toilet training is inextricably tied to a trusting and nurturing relationship. If children feel loved and supported by the adult initiating training, they will learn.
Erikson's (1963) second stage of psychosocial development, autonomy versus shame and doubt, coincides with the toilet training years. Successful resolution of the stage comes when adults provide reasonable guidance and choices that foster a sense of self-efficacy in the newly "independent" toddler. Accordingly, adults who set safe guidelines around toileting tasks, while supporting autonomous efforts, help children develop pride and a positive sense of competency.
Finally, child development texts reiterate the importance of predictability and explanation in guiding children (Gonzalez-Mena & Eyer, 1997). Children are more likely to comply when they know what is expected of them and when it should occur. Thus, chances for success are enhanced by familiarizing children with a potty chair, what is involved in toilet use, and how the body feels before using the bathroom, and by providing reminders.
Responding to Accidents
Child-oriented approaches strongly discourage punishing children for accidents. Punishment can foster shame, which is counterproductive to instilling children with a sense of self-worth and sell-efficacy. Honig (1993) warns that shaming children involved in the toileting process can lead them to think that the reproductive area of their bodies is dirty or bad, and can affect adult intimacy. Furthermore, the use of punishment is associated with negative emotional reactions, avoidance of the punisher, and aggression (Kazdin, 2001). Aversive treatment is more likely to discourage, rather than encourage, attainment.
Instead, accidents should be treated with empathy, support, and patience (Robson & Leung, 1991). Because accidents are an inevitable part of toilet learning, they should not be treated as catastrophic events. Cleaning up with the child after the accident, reminding her to remember next time, and talking about how the body feels are all child-oriented responses. Gorski (1999) reminds parents to be nonthreatening and encouraging when training.
Participants in this study were 89 parents and 97 child care professionals from San Diego County. Both groups were convenience samples. Parents were recruited from publicly funded child care centers, private for-profit preschools, and three Head Start programs throughout the county. An emphasis was placed on procuring a sample that represented the diverse socio-economic and cultural make-up of San Diego County. In order to qualify for participation, parents must have gone through the process of toilet training a child.
Of the 89 parents queried, 14 were male and 75 were female. Twenty-two parents were between 19 and 29 years of age, 30 were 30-39 years, 33 were 40-49 years, and 1 was 49+ years, with three not reporting. Twenty-five parents had one child, 40 had two children, and 23 had three or more children (with one not reporting). Relational status was 67 married and 21 non-married (with one not reporting). Ethnic self-identification was 57 Caucasian, 14 African American, 7 Hispanic, 2 Asian, 4 "other," and 5 non-reported.
The sample of 97 child care professionals consisted of 54 preschool teachers, 23 teacher's aides, 6 program directors, 2 family child care providers, and 12 child development students working at the San Diego State University (SDSU) child care center. The sample was composed of a mixture of Head Start staff, SDSU child care center employees, and professionals from private, church-affiliated, in-home, and corporate preschools in San Diego County. Preschools were defined as schools serving children ages 3 to 5. Five respondents were male and 92 were female. Fifty individuals were between 19-29 years of age, 22 between 3039 years, 14 between 40-49 years, and 11 were 49+ years. Ethnic classifications were not collected for this group.
Directors from target child care centers were contacted by phone, informed about the investigation, and solicited for participation. With director approval, a student researcher visited the site and informed staff of the voluntary nature of participation and their rights as participants. If parents and professionals consented, they were given a questionnaire to fill out onsite. The questionnaires took approximately 15 minutes to complete, and no compensation was offered for participation. Questionnaires were similar, although not identical, for both groups.
The toilet training questionnaire was developed specifically for the current investigation. Questions were designed based on a review of the relevant literature and discussions with child care professionals and parents. A pilot questionnaire with open-ended responses was field tested with a sample of 15 parents and teachers. Based on responses, investigators restructured the questionnaire, using fixed-response questions. Slightly different versions of the questionnaires were created for the parent and professional sample in order to collect detailed demographic information on families, such as the number of children, as well as information on the mothers and fathers themselves. The professional questionnaire was made up of 16 questions, while the parent questionnaire contained 23 questions.
Both questionnaires sought demographic information and opinions about toilet training beliefs and practices. The majority of questions required participants to answer "yes" or "no" to fixed-response statements concerning the four core toilet training topics, although some statements, such as age of initiation, required making a categorical response: Age of initiation, "What age is a child ready to start toilet training?" Readiness, How do you know a child is ready?" Practices, "How should toilet training be conducted?" and Response to accidents, "Should children be punished for accidents?" and "What do you do if a child has an accident?" With the exception of age of initiation, participants could respond affirmatively to more than one choice.
With the aim of determining where parents and professionals turn for toileting assistance, both groups were asked to respond categorically to the question, "Where do you seek help with difficulties in toilet training?" Exclusive to the parent questionnaire were questions relating to how they trained their children, whether they believed it was necessary to self-prepare, and whether they trained their children differently than they themselves were trained.
Descriptive statistics were performed for both groups, and a between-group analysis was used to compare the four core investigative inquiries. Within-group statistics were performed to determine demographic correlates of toilet training beliefs and attitudes.
Child care professionals' and parents' positive responses to the four core toilet training topics-timing of initiation, readiness, methodology, and accidents--are graphically illustrated in Figures 1 to 4. Prescribed answers are listed on the vertical axis, with the percentage of "yes" responses on the horizontal axis. The figures clearly demonstrate divergent thinking between the two groups. Chi-square tests show statistically significant differences at the p < .05 level for all analyses.
Timing of initiation: In terms of the age a child is ready to be toilet trained, between-group analyses between parents and child care professionals resulted in statistically significant findings, [X.sup.2] (5, N = 171) = 14.98, p < .01. Figure 1 shows the comparative percentages of each response for the two groups. Strikingly, 67.9% of professionals believed children should be trained at 25 months of age and later, with only 40.2% of parents sharing the same viewpoint.
Readiness: When asked how one knows a child is ready to begin toilet training, analyses showed significant differences between professionals and parents for each of the following fixed responses (see Figure 2): developmentally and emotionally ready, [X.sup.2] (1, N= 164) = 32.14, p < .001; shows interest in the potty, [X.sup.2] (1, N = 169) 48.45, p < .001; child asks to go, [X.sup.2] (1, N = 166) = 38.96, p < .001; and child shows interest in regular underwear, [X.sup.2] (1, N = 158) = 59.83, p < .001. The agreement among professionals on these readiness factors ranged between 90.4-100%, while agreement among parents ranged from 29 .4-58.8%.
Practices: Figure 3 graphically illustrates the significant differences found between professionals' and parents' toilet training practices. When asked "How should training be conducted?," fixed response answers showed dramatic differences: introduce what is expected, [X.sup.2] (1, N = 170) = 32.5, p < .001; have a potty chair available, [X.sup.2] (1, N = 172) = 34.47, p < .001; with praise, [X.sup.2] (1, N = 174) = 38.36, p < .001; with patience, [X.sup.2] (1, N = 180) 50.90, p < .001; and read children's books about toilet training, 2? (1, N= 109) = 39.48, p < .001. The majority of professionals responded positively to utilizing the above practices (92.9-100%), while parents presented mixed results (31.3-61.6%).
Response to accidents: Regarding accidents, professionals' and parents' answers to the question "Should children be punished for toileting accidents?" varied considerably, [X.sup.2] (1, N= 158) = 29.52, p < .001. The preponderance of professionals (94.8%) believed that children never should be punished for accidents, while 5.2% believed it depends on the circumstances or motivation. The vast majority of parents (87.1%) also believed that children should not be punished, while 2.4% said they should be punished, and 10.6% believed it depends on the circumstances. When asked how to respond to toileting accidents, chi-square analyses showed significant differences at p < .05 level. Answers to fixed-response questions are outlined in Figure 4 as follows: change or bathe child, [X.sup.2] (1, N = 173) = 22.14, p < .001; take child to potty chair, [X.sup.2] (1, N = 158) = 23.76, p < .001; ask child to remember next time, [X.sup.2] (1, N = 161) = 6.49, p < .01; talk about how the body feels before having to use the to ilet, [X.sup.2] (1, N = 158) = 29.57, p < .001; and ignore accidents, [X.sup.2] (1, N = 154) = 17.05, p < .001.
Parents and professionals had two identical fixed-response options to the question, "Where do you seek help when difficulties in toilet training arise?" For these two alternatives, Chi-square tests were performed. The results for read books were (1, N = 135) = 57.19, p < .001; for ask a person in the medical profession, [X.sup.2](1, N = 129) = 13.58, p < .001. Eighty-four percent of professionals used books for help, and 53% sought the advice of medical professionals. This result compares with 18% of parents reporting they used books and 21% reporting they used medical personnel. Parents were asked independently whether they sought guidance from friends (24%), family members (48%), or child care providers (15%). Child care professionals looked to other staff members (90%) and to parents (97%) for assistance.
Within-group analyses were performed to determine whether any demographic factors were correlated with questionnaire responses. When the professional sample was analyzed according to gender and age categories, no significant differences were found in fixed responses to the four core toilet training focal areas, or for questions pertaining to procuring assistance in training.
Parent surveys contained three questions not asked of the professional sample: 1) How did you train your children? 2) Do parents need to prepare themselves?, and 3) Are you training your children differently than you were trained? Seventy-five percent of parents trained their children using encouragement, 71% had a potty chair available when their children were ready, 66% took their children to the bathroom periodically, and 37% used rewards. Interestingly, these figures are higher than those given for similar choices to the question: How should toilet training be conducted? Seventy percent of parents believed it was important that they prepare themselves before training their children, and 17% responded that they were training their children differently than they were trained. Twenty-nine percent said they were training their children the same, while 54% replied that they did not remember.
The parent sample, from which more demographic data were collected, was analyzed according to gender, age, ethnicity, marital status, number of children, and the age of the mother and father at the birth of the first child. Significant findings were found for only a handful of responses. Age of parents, ethnicity, and marital status significantly affected the response to the statement, "I knew my child was ready to be toilet trained when he wanted to wear regular underwear," [X.sup.2] (3, N = 83) = 13.01, p < .01; and [X.sup.2] (5, N = 81) = 21.39, p < .01, and [X.sup.2] (1, N = 84) = 7.78, p < .01, respectively. Younger parents (19-29 years of age) were more likely to use underwear as a signal for toilet readiness, as were Hispanic, African American, and non-married parents. Age of parents and marital status also significantly affected using books as a resource when difficulties arose: [X.sup.2] (3, N = 82) = 12.11, p < .01 (age) and [X.sup.2] (1,N = 83) = 7.61, p < .01 (marital status). Parents in the 30-39 age bracket and non-married parents were most likely to refer to books on toilet training.
Finally, being non-married was linked to paying attention to a child's developmental and emotional cues when assessing readiness, [X.sup.2] (1, N 84) = 4.59, p < .03, sitting a child on the toilet when she asks to do it, [X.sup.2] (1, N = 66) = 6.02, p < .01, and seeking advice from medical professionals, [X.sup.2] (1, N = 83) = 4.46, p < .04. Being married, on the other hand, was significantly related to reading children's books about toilet training to familiarize children with the process, [X.sup.2] (1, N = 66) 4.89, p < .03. Gender, number of children, and age at birth of first child did not significantly affect the responses.
Parents' and child care professionals' toilet training attitudes and practices differed significantly in the present study. For each of the four core toilet training topics examined (age of initiation, readiness, practices, and response to accidents), child care professionals' responses were markedly more child-oriented in nature. While the authors expected discrepancies between the two groups' beliefs, they did not anticipate finding such a large gap.
In the age of initiation category, for example, the majority of professionals (68%) believed that children's toilet training should be initiated after 24 months of age, while the majority of parents (53%) believed training should begin before 24 months. This finding is dissimilar to Seim's 1989 research, which placed most parents initiation efforts between 24-29 months. This parental practice is of concern in light of Stadtler et al.'s conviction that most children do not fall within the readiness parameters until 24 months of age. The parents in this sample did exhibit a range of beliefs about the age of initiation (from 0-12 months to 37-41 months), however, indicating that no widespread consensus about timing existed. The professional group also gave a range of responses as to the proper age of initiation, lending support to the idea that there is no "magic age" for training. Nevertheless, children's developmental maturity and the "window of opportunity" for toilet initiation should not be ignored.
In terms of readiness factors, the parent sample had significantly different views when compared to the professional sample. Only between 29.4-58.8% of parents, compared with 90.4-100% of professionals, said that they based children's readiness for training on whether they were developmentally and emotionally ready, showed interest in the potty, asked to go to the toilet, and showed interest in regular underwear. For the parent group, these numbers are considerably lower than Schum et al.'s (2001) finding that 72% of parents are looking for signs of readiness before initiating training. This finding that 49.4% of parents and 8.9% of professionals are not using developmental and emotional readiness as a marker for toileting initiation is of particular interest. It suggests that some parents and professionals may not be waiting for children to achieve a sufficient level of maturity before training. Toilet training practices were largely agreed upon by the professional sample. Between 90-100% of professionals be lieved that when conducting training, adults should introduce to children what behavior is expected, have a potty chair available, use praise, be patient, and read children books about toileting; these are techniques that concur with Western child-oriented tradition (Bainer & Hale, 2000; Brazelton, 1992; Honig, 1993; Israeloff, 1992; Stadtler et al., 1999). On average, between 50-60% of the parent sample supported similar toilet training practices.
When it came to responding to accidents, 74-94% of professionals were in agreement that children should be bathed/changed, taken to a potty chair, asked to remember next time, and participate in a discussion about how the body feels; parents agreed with such tactics 31-65% of the time. Interestingly, 5.8% of professionals and 32.9% of parents reported ignoring accidents. This may suggest that some children are not given enough information about toileting expectations. Moreover, they may not be given empathic support when an accident does occur. A pressing question that arises from these data is how are accidents being responded to, if not by the techniques offered in the fixed-response choices. Punishment may be one alternative. Five percent of professionals and 13% of parents believed punishment could be warranted in certain toileting accidents. Punishment, according to Kazdin (2001), is associated with a range of negative consequences. Future research could uncover other possible responses to accidents.
Initially, the large discrepancy between parent and professional beliefs seemed alarming. Yet, some evidence suggests that the gap between actual parent and professional practices may not be as great. When parents were asked how they trained their children, their responses were more similar to the professionals'. A majority reported providing encouragement, a potty chair, taking their child to the bathroom periodically, and preparing the children for the process. We hypothesize that parents may not feel as confident as child care professionals in approaching toilet training authoritatively. However, when asked for personal experiences, their responses better reflect their beliefs.
This realization, however, accounts for only a fraction of the differences between parents' and professionals' toilet training responses. One possible explanation for parents' lack of consensus about child-oriented approaches is that many may be using a behaviorally based approach to training, as indicated by the fact that 37% of parents reported using rewards when training. A second possibility is that parents' toilet training beliefs and practices may reflect their diverse cultural backgrounds. The child-oriented approach is dominant in Western cultures, but may not reflect best practice in other cultures. Another possibility is that parents are not finding access to current information about toilet training strategies. Fewer than 50% of parents reported asking for help with training. When they did, they were most likely to ask family members (48%) and friends (24%), two groups they likely feel an affiliation towards. Medical professionals, books, and child care providers were sought for advice by only 15-2 1% of parents, an indication that parents might not feel comfortable consulting with professionals. Alternatively, some parents may not be seeking current information because they follow the same practices as their parents used for them. Only 29% of parents responded affirmatively to the question, "Are you training your child different fly] than your parents trained you?"
Communication between parents and professionals deserves further exploration since only 15% of parents sought a professional's advice. This prompts questions about whether supportive parent-provider relationships exist, whether professionals are offering toileting information to parents, and whether professionals are practicing what they preach. The latter scenario is suggested because a number of child care centers do not accept children who are not toilet trained. In an informal survey of 20 San Diego County child care centers (Obegi, 2001), nearly half did not accept children over 3 years old who were in diapers. Others would charge parents an extra fee for children over 2 years of age who were not trained, or they would keep untrained children in the toddler group until they achieved toileting success. With the majority of professionals (68%) in this sample advocating a 24-month-old or later training start date, it seems probable that some professionals, because of staff constraints and the necessity to k eep prices low, may not be following their own advice about developmentally appropriate practice.
Because these sample sizes were small, within-group analyses provided little information about demographic factors that may have influenced professionals' or parents' responses. For parents, some evidence suggests that age of the parent, ethnicity, and, particularly, marital status, may influence toileting beliefs. Certainly, a follow-up investigation with a larger and demographically more diverse sample may help clarify parental attitudes and practices regarding toilet training. Schum et al. (2001) allude to future research that may begin to address some of these questions.
The dramatic results found in the between-group analyses of this investigation must be viewed with caution. First, the sample sizes of both the parent and professional groups were moderate (N = 89 and N = 97, respectively), requiring caution in generalizing findings. As aforementioned, the limited numbers of participants also make it difficult to make correlations between parent/professional responses and demographic factors. Furthermore, the demographic questionnaire did not include the ethnicity of the professional sample, nor the exact amount of early childhood education both groups had.
The results also should be tempered by the fact that participants were a convenience sample. By not systematically recruiting participants based on their family variables, socio-economic levels, or cultural background, it is difficult to control for the influence of these factors. The convenience sample also makes it difficult to generalize findings to a larger population.
Another serious limitation of the study was that the pool of parents and professionals were not drawn from the same child care centers. This precludes questions that relate to bi-directional influences in joint toileting efforts. An investigation that queried parents and professionals about joint home/school toilet training would offer tremendous insight about the flow of toileting information, agreement about practices, and overall levels of cooperation and satisfaction.
Finally, additional fixed responses could have been added to the four core toilet training topics, to allow for alternative and culturally varied approaches to training. This change might have provided more information about how some parents and professionals conceptualize the toileting process, and made the generalization of single-report responses more pragmatic.
Despite these limitations, the dramatic between-group findings contribute to our understanding of how parents and professionals view the toilet training process. In light of this understanding, the authors have outlined a series of recommendations that advocate for greater information sharing between professionals and parents so that children can best be supported developmentally and socio-culturally in their toilet learning. These recommendations may help bridge the gap between parent and professional beliefs and practices.
The first step in facilitating successful toilet training is for parents and professionals to form a partnership. At the time of enrollment, sit down together to discuss child-rearing practices and beliefs, including toilet training philosophies. The professional's role in this meeting should be as "the learner"--someone who listens, understands, and appreciates the parent's culturally based perspective. Putting the parent in a parallel power position facilitates partnership building. Parents who trust their child care providers are more likely to work cooperatively with them, which increases the likelihood that children will feel supported in their toilet training both at home and at school. Parents are also more likely to ask professionals for assistance if they believe that their input is valued.
Second, directors of child care centers should ensure that staff is educated about developmentally appropriate and culturally sensitive approaches to toilet training by providing readings, staff meetings, and ongoing discussions about situation-specific topics. Third, it is crucial to maintain an ongoing dialogue between staff and parents, since successful toilet training requires collaboration between parents and professionals. These exchanges of information can occur in both formal and informal settings such as parent-teacher conferences, parent nights, or daily updates in the classroom. Professionals also should post information on bulletin boards, distribute information in parents' cubbies, and be available to parents.
Child care professionals and parents should have a unified plan about toilet training so that children will benefit from a consistent approach at school and at home. Such a plan should be both developmentally appropriate and tailored to the individual child. It should not be age-driven; children who are not trained by a certain age should not be prevented from moving on with their peers.
Before the implementation of toilet training, professionals and parents should add children to their partnership, as children are motivated to model and work with individuals who support them (Bandura, 1986). Both professionals and parents should prepare children for the toileting process by outlining expectations, reading books about toilet training, and reassuring them that accidents are normal and should not be cause for shame. Professionals should not immediately begin toilet training with newly enrolled children. They should establish a trusting and nurturing relationship with children first. Many children feel motivated to practice their toileting skills at child care centers because a large number of children are participating. However, if they don't feel safe or supported, even the opportunity to model a peer will not get them on the potty chair! Parents should focus on their child's readiness and not compare him/her to other same-age children. Toilet training strategies affect a child's sense of self and her or his beliefs about the responsivity and sensitivity of others.
In conclusion, the authors found that parents and child care professionals had significantly different ideas about the timing of initiation, readiness, toileting practices, and response to accidents. When difficulties arose, parents were much more prone to turn to family members and friends for guidance, while professionals looked to literature, other staff members, and parents for clarification. These findings suggest that more needs to be done to unite parents and child care professionals in the toilet training process. The authors hope that the awareness of incongruity in toilet training practices, combined with the earnest desire to support children through their developmental milestones, will prompt parents and child care professionals to work in synchrony toward children's toilet framing success.
Figure 1 Timing of Initiation Comparison Between Parents; and Professionals' Attitudes Age in months Professionals Parents Percentage 0-12 3.6 3.4 13-24 26.2 49.4 25-30 51.2 26.4 31-36 14.3 11.5 37-41 2.4 2.3 no idea 2.4 6.9 Note: Table made from bar graph Figure 2 Readiness--Comparison Between Parents' and Professionals' Attitudes Readiness Professionals Parents Percentage Developmentally & emotionally ready 91.1 50.6 Shows interest in potty 100 55.3 Asks to go to the toilet 98.8 58.8 Shows interest in regular underwear 90.4 29.4 Note: Table made from bar graph Figure 3 Practices--Comparison Between Parents' and Professionals' Attitudes Conducting Training Professionals Parents Percentage Introduce what is expected 95.2 58.1 Have a potty chair available 97.7 61.6 With praise 97.7 59.3 With patience 100 57 Read children's books about toileting 92.9 31.3 Note: Table made from bar graph Figure 4 Accidents--Comparison Between Parents' and Professionals' Attitudes Responding to Accidents Professionals Parents Percentage Change/bathe 94.3 65.9 Take to potty chair 79.5 41.2 Ask to remember next time 81.6 63.5 Talk about how body feels 74 30.6 Ignore 5.8 32.9 Note: Table made from bar graph
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The authors thank Terry A. Cronan and William A. Hillix for reading the manuscript and providing very helpful feedback. Correspondence and requests for reprints should be sent to Dr. Shulamit Ritblatt, Department of Child and Family Development, San Diego State University, San Diego, CA 92182-4502; Telephone: 619594-6501; Fax: 619-594-5921; E-mail: firstname.lastname@example.org