toilet training, the process of teaching a child to control the functions of the bladder and bowel. Training programs vary, but all emphasize a positive, consistent, nonpunitive, nonpressured approach. Each program is individualized, depending on the mental and physical age and state of the child, the parent-child relationship, and readiness of the child to learn. Training often begins around 24 months of age, when voluntary control of the anal and urethral sphincters is achieved by most children. When the child has mastered some motor skills, is aware of his or her ability to control the body, and can communicate adequately, training is likely to be easy. Resistance occurs if the parents try to train the child before the child is physiologically and psychologically ready. Bowel training is usually accomplished before bladder training because the urge to evacuate the bowel is stronger than the urge to empty the bladder, and the need is less frequent and more regular. Nighttime bladder control may not be achieved until the child is 4 or 5 years of age or older. Behavior modification, using a system of rewards for each of the various phases of the training, is usually successful. A major function of health care providers working with children is to identify the readiness of the child to learn and to work with the parents, advising them in a nonauthoritarian way of the various techniques.
