Objective To analyse the changes in toilet training of children in Belgium in the last three generations and to seek a possible cause for the apparent increase in lower urinary tract dysfunction over that period. Patients and methods A questionnaire (25 questions) was developed and completed by 321 people who had toilet-trained 812 children. The population was divided into three groups according to the age of those who trained the children. Results There has been a major change in toilet training in the last 60 years; the age at which toilet training began has been signi®cantly postponed. One reason for starting training, i.e. bladder control during the afternoon nap (which can probably be considered as an indication of suf®cient bladder capacity) has become less important. Season (summer) has become a more important factor, as has starting school. Training by bladder drill, formerly widely used, was progressively abandoned and a more liberal attitude adopted by the youngest parents. Conclusion There seems to be good concordance between the programmes currently proposed for treating bladder dysfunction in children and the traditional bladder-training methods used by parents 60 years ago. To start bladder training when the child stays dry during the afternoon nap and using bladder drill might help to avoid permanent bladder dysfunction. The lack of formal bladder training may be responsible for an increase in lower urinary tract dysfunction.
Children with daytime wetting with/without night-time wetting have very often bladder-sphincter dysfunctions, which is in turn correlated with recurrent urinary tract infections. Eight percent of the 10 to 12 year old schoolchildren report daytime wetting with/without night-time wetting with some frequency. Surprisingly few parents, especially in the daytime wetting group, searched for medical help. Physicians and paediatricians should be encouraged to be more attentive to wetting in children and initiate discussion about urinary en faecal problems with parents and children.
Objective To analyse if family situation, personal habits and toilet training methods can influence the achievement of bladder control. Subjects and methods A questionnaire with 41 questions was distributed to 4332 parents of children completing the last 2 years of normal primary school. The questionnaire had been tested for reproducibility of the answers in a random subgroup of 80 parents. The aims of the investigation were explained in an accompanying letter and the response rate was 76.7%. The result were analysed using the chi-square test (Yates corrected). Results Two groups of children were identified, one with no lower urinary tract symptoms (3404) and one with complaints of daytime and night-time wetting, and urinary tract infections (928). The groups were termed the 'control' and 'symptom' groups, respectively. There were no differences in the family situation between the groups. The symptom group reported more 'below average' school results and less independence in homework and hygiene. The age at which toilet training started was significantly higher in the symptom group and scheduled voiding was used significantly less. The reaction of the parents when the attempt at voiding was unsuccessful was significantly different; in the control group most parents just postponed the effort and had the child try again later, whereas in the symptom group more parents asked the child to push, made special noises or opened the water tap. Conclusions These data show significant differences in toilet training between children with and with no lasting problems of bladder control. Postponing the onset of the training after 18 months of age and using certain methods to provoke voiding (asking to push, opening the water tap) probably increases the risk of later problems with bladder control.
Daytime with/without night-time wetting, more than 10 voidings a day and nocturia are indicators of recurrent urinary tract infections. If they are simultaneously present, the relative risk for recurrent urinary tract infections is 60%. Consequently, paediatricians should take urinary symptoms very seriously into account, and as incontinence is still a hidden condition, question the child on this topic.
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