Changes in the toilet training of children during the last 60 years: the cause of an increase in lower urinary tract dysfunction?

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 significantly postponed. One reason for starting training, i.e. bladder control during the afternoon nap (which can probably be considered as an indication of sufficient 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.