Toilet training and bowel habits in children up to 4 years: Insights from a population-based prospective cohort study.

OBJECTIVES

Recognizing bowel dysfunction and toilet training issues can be challenging due to conflicting information about what is normal. This study aims to provide an overview of toilet training practices and bowel habits in healthy children up to 4 years.

METHODS

This study among 6850 parent-child pairs was part of the Generation R Study-a population-based prospective cohort study-and used questionnaires regarding toilet training and bowel habits. Logistic regression was used to analyze associations of demographic factors with toilet training start and completion, presented as odds ratios [95% confidence interval].

RESULTS

At 24 months, 60.1% of children had started toilet training, and at 36 months, 60.0% had completed it. Sex, maternal education level, and the child's ethnic background were associated with having started toilet training by 24 months (girls: 1.48 [1.31-1.67], high compared to low educational level: 0.65 [0.47-0.91], and Turkish, Surinamese, Antillean, and other (outside Europe), compared to Dutch: 1.71 [1.26-2.32], 1.73 [1.29-2.31], 3.79 [2.04-7.05], and 1.53 [1.23-1.91], respectively). Only sex and ethnic background showed associations with having completed toilet training by 36 months. Reported defecation frequency varied widely in early life but stabilized to 1-2 times daily for 81.3% of children by 24 months. Infrequent bowel movements and predominantly hard feces were present in up to 6.3% and 14.3%, respectively.

CONCLUSION

This study demonstrates that 60% of children are toilet-trained by 36 months. Additionally, it provides insights into healthy children's bowel habits and toilet training milestones, highlighting variations by sex, socioeconomic status, and ethnicity, which can help identify abnormal patterns.