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The process of potty training depends on a number of factors that determine the ability to grasp the skills as required. Such factors include sex of a child in which Klassen et al, 2005 identified that girls were quicker to learn potty training as compared to boys. The reasons explaining this observation relate to the girls earlier maturity as compared to the boys coupled with girls’ need in pleasing their parents. Another factor is the age at which parents initiate the potty training process. This factor is relevant because, the parents may be either hasty or slow in anticipating child’s development of skill; hence, the response in learning varies. In the case of delayed potty training, there are a number of effects including risk of infection due to fecal contact, stress and discomfort. Normally, Klassen et al notes, this delay occurs due to a parent’s perception that the child is still too young to potty train or an excess reliance on diapers. Therefore, anticipating the child’s readiness to start potty training is essential. Nihal et al, 2009 investigated the effectiveness of a parent-training program on potty training. The results indicated that these skills need to be taught to parents and not left to the intuitive capabilities of a parent alone (Nihal et al, 2009, p.237-243).

Different culture approach potty training differently as indicated in the NACD journal by Chao, 2009. Some cultures encourage the use of disposable diapers delay training of their children compared to the rest. Klassen (2005) gives an example of such difference in cultural approach by comparing Israel’s Kurdish, Moroccan and Ashkenazi communities. Race also plays a cardinal role; African-Americans and the Digo community of East Africa starts potty training at an early age while Caucasian mothers initiate training as late as 39 months of age.

Kroeger and Sorensen (2010), in the journal of Intellectual Disability Research, argue that parents should not expect a challenged child to be equally capable of acquiring elimination skills with the same ease as other children. There are obstacles presented by this handicap; therefore, the Canadian Pediatric Society recommends prior pediatric check up for handicapped children. This would help identify possible challenges, which are likely to occur during potty training, and recommend appropriate approach. Acknowledging that disability might affect a child’s ability to respond to sensory stimulation, delay communication, impair motor planning among others assists in responding appropriately. Challenges such as Autism require a more attentive mode of potty training (Kroeger & Sorensen, 2010, p.556).

There are abound investigations and studies on potty training. One such study is by Klassen et al, investigates the effectiveness of different methods of toilet training for bowel and bladder control. The study investigated the effectiveness of different methods and focused on factors that modify the effectiveness such as gender, race, and culture among others. The study made an assessment of 43 children with altruism and 16 others with a Hirsch rung’s disease. The study also includes a study of 482 healthy children using a child-oriented approach. The training gears towards helping a child eliminate fear and anxiety by training the children on how to reduce straining. Klassen et al note of two evolutions of potty training methods, one being the Brazelton method developed in 1962 that proposed the child’s readiness approach to potty training. The second method named Azrin and Foxx method emerged in 1971 as a parent oriented approach.

Klassen found through observations of divided equally groups of healthy and mentally or physically challenged children that the Scope method did poorly compared to both Foxx and Azrin methods. It was also clear from the results that methods geared towards the children that are superior in performance compared to group of handicapped children. The study also indicates that training on techniques of relaxation is more efficient than the conventional standard methods. The absence of training in which the child discovers without any training fared badly compared to attempts and methods of modifying a child’s behavior. A multi disciplinary method proved better for children with exceptional conditions such as anal altruism. The conclusion from the study indicates that between Azrin and Foxx potty training methods neither can be termed as superior to another, due to lack of evidence. Hence, both programs are effective in potty training a child. The relevance of this study to the issue of potty training is pertinent. Its finding concerning challenges to handicapped children such as their cognitive abilities and difficulty in taking instructions shed a lot of light on policy needs. The study is relevant in its recommendations of policy changes. It advocates for change in definitions of toilet training, success and failure and make them identify with the cultural dimensions. This is crucial because culture shapes the approach to potty training.

However, the above study, despite its contribution towards potty training methods had it shortcomings. It failed to include empirical data that would aid in concluding the matter of adverse outcomes. Additionally, the data contain limited information on the sustainability of the two approaches.

Fonseca, 2011 in a journal of Pediatric Urology conducted a research on the relationship between the time of potty training and the development of Dysfunctional Elimination Syndrome (DES). The study method was in the form of a case study observing 160 patients. Half had DES while half were okay and healthy; both were placed in a control center and observed. For the purposes of the study, early completion time of potty training was 24 months. Study observed holding maneuvers, urgency to urinate, high and low urinary frequency and urinary tract infection (UTI). The results were such that there was no relationship between early potty training and DES as the presence of infections such as UTI predated the training. The study is relevant to this research in dispelling the myths that sometimes compel parents to initiate early potty training, as they believe it will eliminate non-existence health concerns. Conclusion from Fonceca, 2011 is that potty training should be initiated at the right time since there is no evidence of health concerns or benefits of early training (Fonseca, 2011, 332-335).

Seim (2009) in the Journal of Family Practice focuses on toilet training in first children.  This article despite being relatively ancient appears as a useful source in the above topic because of its unique approach. It approaches the topic from a parental angle and refers to previous works quoted above. The article focuses on a study by Roberts Schoellkof intended to understand how parents acquire the skill of potty training, discover the best methods, and the exact age of training. The method of the study entailed administering questionnaires to parents at a clinic-waiting bay by a nurse or a receptionist. The study examined 146 female and 120 male alongside 251 mothers, 8 fathers and 3 baby sitters in Wisconsin and Minnesota in 1985. The results are of fundamental importance in that parents learnt how to potty train from friends, intuition and least of all, health personnel. These results indicate a need for aggressive health education on this topic (Seim, 1989).

The subject of potty training still lies largely on a parental decision as evident in the lack of gusto in the legal instruments or health concern. There is a need to engrave guidelines in morally acceptable manner while retaining the autonomy of a parent. Government publications, which acknowledge the shift in parenting styles, are essential, in the modern day.

Major academicians and scientist have upheld the position that potty training should not start until 18 months. In addition, there are policy recommendations and refinement put forward. The American Academy of Pediatrics recommends placing potty chairs on a toilet sit to make it look smaller, reduce the perceived fear of falling, and encourage identification of the toilet as the end. The Canadian Pediatric Society (SPS) also recommend the same guidelines but intimates that there is no right age to start potty training. Both medical institutions recommend the use of a potty first sitting on it when clothed, and then at other times and without clothing.

There is also need to initiate a campaign on diaper usage. As noted in studies quoted above, some communities such as the Caucasian and the western world have developed huge dependence on the diaper thereby pushing forward the age of potty training. Friman et al (2008) argues that no effect of the diaper exists on continence, but it puts the parent in a comfort zone of postponing training even when the child is ready (Friman et al, 2008).

Given instances in which parents mistook late potty training as causing some health harm, coupled with the results that few parents seek counsel of medical practitioners on potty training; there isa  need for a comprehensive incorporation of this topic in the basic health framework (Seim, 1989).

There is a gap of why parents seem to have little confidence on the medical fraternity on this field which warrants a focus on research. An investigation on the blend of modern knowledge and ancient cultural practices requires research to ensure that societies uphold potty training from a medical and social setting.

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