Parenting Heretic

Have you noticed I'm not so much down with the parenting experts? You might have. I try to reign it in but I know that sometimes it leaks through, a little. Experts! Bah! Oops, there I go again.

But, well, I have reason. When have they ever been right about anything? And you, in the back row, with the kid who always developed exactly according to the books? Shut up. I don't want to hear about it. Among my acquaintance I do not know of a single child who developed exactly according to Expert Advice, once you factor in milestones, temperament, response to discipline, acquisition of literacy and other abstract skills, and so on. Gods know Frances hasn't. She was early with the rolling and then didn't bother to walk until she was 19 months (a fact which all the books assured me was certainly disastrous, because all babies walk by then, you know); we've fed her a variety of foods from four and a half months on and she was breastfed but she is still a stickler for texture (a trait she gets from me, I am convinced), her brain is obviously working since she's learned her letters etc. you're-bored-of-hearing-me-brag-about-this but her drawing skills are a bit behind, and standard disciplinary measures such as time-outs and natural consequences do dick all, because she's so freaking easy-going that most of the time she simply doesn't care. 'Sit in a chair for two minutes? I can't play with that toy anymore? Oh well. I'll just sit here and laugh and sing myself a song and everything will be a-ok!'

So, the advice of the Experts carries a weight of exactly zero with me, and I mean that in the most scientific way possible. If you took the advice of the Experts into a Room of Andrea and let go of it, it would float in the air.

And this applies too to the subject of toilet training, a subject I've noticed on which diverse Experts have diverse Opinions, and each Expert is morally and scientifically certain that his or her Opinion is the correct one, and the other Experts are therefore advocating child abuse or are ignorant of children's bodily functions. In fact, it reminds me a great deal of the Attachment Parenting vs. CIO debates, and I've come to a similar conclusion.

Each of the books and articles I've consulted has a different age for bladder control, from 32.5 months to five years. Each talks about the acquisition of social and physical milestones such as the desire to please and the ability to pull down one's own pants and recognize when one is about to pee. Yet each still comes to drastically different conclusions. I have concluded that none of them know what they are talking about.

And we all know that we were toilet trained at much younger ages, though the consensus today seems to be that it was "too early" and it probably wasn't really training. I'm not convinced of this, considering that all of the information I've found to support it has been subjective and anecdotal. By and large the attitude seems to be that since we do it differently now, and since everyone knows that time has marched on and this means progress so that whatever we do know must be better than what other people did before, then this later training must be better.

Of course, each of the Experts uses the magic word in their writings: "research." "We have research that indicates," they say, and the continue on to write whatever it is that I've just quoted above. I'm sure they do have research. I'm also sure that research can be slanted, misrepresented, or poorly conducted so that the results are not useful. I prefer to read the research myself. So that's what I did:

J Pediatr. 2004 Jul;145(1):107-11.

Why is toilet training occurring at older ages? A study of factors associated with later training.

Blum NJ, Taubman B, Nemeth N.

Division of Child Development and Rehabilitation, Children's Hospital of Philadelphia, University of Pennsylvania, School of Medicine, Philadelphia, 19104, USA. blum@email.chop.edu

Recent studies suggest that children are completing toilet training much later than the preceding generation. Our objective was to identify factors associated with later toilet training. Children between 17 and 19 months of age (n=406) were enrolled in the study. At enrollment, parents completed the Parenting Stress Index and the Receptive-Expressive Emergent Language Scale. Follow-up parent interviews were conducted every 2 to 3 months until children completed daytime toilet training. Information obtained at follow-up interviews included steps parents were taking to toilet train their child, child toilet training behaviors, presence and frequency of constipation, birth of a sibling, and child care arrangements. In a stepwise linear regression model predicting age at completion of toilet training, 3 factors were consistently associated with later training: initiation of toilet training at an older age, presence of stool toileting refusal, and presence of frequent constipation. Models including these variables explained 25% to 39% of the variance in age at completion of toilet training. In conclusion, a later age at initiation of toilet training, stool toileting refusal, and constipation may explain some of the trend toward completion of toilet training at later ages.

BJU Int. 2002 Sep;90(4):456-61.

Results of a questionnaire evaluating the effects of different methods of toilet training on achieving bladder control.

Bakker E, Van Gool JD, Van Sprundel M, Van Der Auwera C, Wyndaele JJ.

Department Urology, University of Antwerp, Edegem, Belgium.

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.

So here we have two recent studies that seem to fly in the face of all the advice we currently receive: not only might later training result simply in later control, but it might also have a higher risk of later bladder control and uti problems (note: as with every study that finds a "higher risk," do remember that it might be an increase of 1% or 100%, and so this is not meant as a judgement of any kind; and I only have the abstracts so who knows if the studies were any good). More interestingly, I found a few articles from the Journal of Pediatrics, also recent, on this question:

This one, from 2002, discusses the skills necessary for children to learn in sequence from the beginning of the process to mastery. I'm going to quote from it liberally because I found it very interesting:

"A critical review of the literature reveals 2 broad categories of readiness skills: global readiness skills, which include achievement of motor milestones (eg, sitting, walking), understanding and use of words for elimination, positive relationships with caregivers and the desire to please, identification with and imitation of parents and significant others, and the desire to be autonomous and master primitive impulses; and specific toileting readiness skills, which include bladder control (eg, staying dry for 2 hours), physical awareness (eg, appearing uncomfortable in soiled diapers), and instructional readiness (eg, indicating a need to urinate). Several authors have stated that these skills are present by 18 to 24 months in normally developing children, yet normative data are lacking.

"The broad sequence of achieving toileting "milestones" has also varied across studies. For example, Brazelton studied upper-middle-class children in Cambridge, Massachusetts, and found that approximately 80% of children attained daytime control of bowel and bladder function simultaneously at an average of 28 months, with no difference between the genders. In 12% of children, daytime bowel training occurred first; in 8%, bladder control was achieved first. Stein and Susser noted that children who attended day nurseries in Lancashire, United Kingdom, typically acquired nighttime bowel control before daytime control and daytime bladder control before nighttime control."

Consider: first of all, non of the literature agrees. Secondly, the research the literature is based on doesn't agree. Thirdly, Brazelton found that children can achieve daytime control by the age of 28 monnths, and what was he, a raving fascist lunatic?

Further on: "The median age when parents rated their girls as "stays dry during the day" was 32.5 months (95% CI: 30.9–33.7). The median age when girls could independently enter the bathroom and urinate by themselves was 33.0 months (95% CI: 31.2–34.4). The interquartile ranges varied from 6.9 to 11.4 months for girls for the age at acquiring each skill."

Frances will be thirty months in a few days; she will be adjusted-thirty months (which might count for potty training, I don't know) near the end of July. I don't expect her to adhere to the schedule--she never has for anything else up to this point, why would the potty be any different?--but I do expect, given her temperament and personality, that without some coordinated action on the part of her parents that Frances is one of those children who would otherwise become old enough and smart enough to decide that she would rather wear diapers--because it's easier, she can keep playing, and she enjoys having us care for her. These are traits of hers I have seen time and time again and, while in many instances they make her a sweet child and a joy to parent, they can also delay the acquisition of needed skills. Erik and I have learned that when anything presents itself to Frances that might be difficult to learn, that might involve embarassment or falling down or a concentrated effort, that we need to actively prevent ourselves from rescuing her and we need to encourage her to do it by herself. Even now, when she has been walking for almost a full year and when we have witnessed her walking and running for hours at a stretch when it's fun, she will beg us and cry and plead with us to carry her if we go to a mall or to a park (the kind with flowers, not the kind with slides). Oh, she's absolutely adorable when she begs ("Can I give you a lift?" she asks, with tears in her eyes and her arms stretched high), but the fact is that we know she can do it and she simply would rather not because she prefers to have other people do things for her.

All of which adds up to: I am eager not to miss the window of opportunity if I can possibly help it. Frances will not let us know when she is ready. We have to encourage her to be ready. Not with threats or punishments or consequences, which would be bizarre, abusive and completely non-productive, but with lots and lots of potty time and as much inducement as we can manage.

That she is as small as she is makes me feel that this is even more important. She is discouraged enough by ordinary, every-day barriers like falling down while she is running. Extraordinary barriers present themselves to her like Himilayas: at a staircase, she simply rebels. But she must learn how to climb them by herself because Erik and I are not always there to help her. Erik and I are both saps who frequently do give in, depending on the situation (if she is very tired, or not feeling well, or already upset), but if Frances had her way she would climb a stair by herself once in a week.

And I can't help but compare this to my family of origin: I was always self-motivated, and it made me a helion in my parents' eyes. A straight-A extra-curricular clarinet-playing volunteering kind of helion, but we all have our cross to bear. My brother, on the other hand, was not a helion. He was the Easy Child. He was also supremely unmotivated to do anything for himself. He would only get a B in school if my parents paid him for it; he demanded and got drives from my parents to whatever he wanted to do until his late teens, and was only induced to get his license when my parents paid for it in full and gave him a car. It was a combination of factors, where my brother's easy temperament and willingness to have others do for him what he could do for himself matched with my parents willingness to do things for him whenever he asked because at least he wasn't difficult, to the point where my parents discovered only when my brother entered his twenties that they were effectively stuck with a son who would, by his own devices, never get a job, never graduate from school. At 28 he's still in university, by the way, and refuses employment that is not intellectually stimulating enough. He is currently getting a Masters in Psychology because that is what his wife is doing, and because he can set his own hours as a shrink. For god's sake, they co-signed on his mortgage! They're still paying for his car repairs! When he talked to me about how he would support kids if he had them, he asked to borrow Frances's crib--the one she is still sleeping in--and assumed that we would be happy to lend him anything we have because of course we would not be so inconsiderate as to have another child of our own when it might conflict with his schedule.

And, god help me, that's not going to be Frances. Potty training may seem like an odd place to start (though it's been a conscious part of my parenting her since this aspect of her temperament became obvious), but I want her to learn from an early age that when she can manage something for herself, I expect her to do so at least a statistical majority of the time. Undoubtedly sometimes I will really fuck up. That's part of parenting. But as much as I don't want to end up in my parents' position, with a son who would absolutely move back home and live in their basement if they let him, I really, really don't want Frances to end up in my brother's position (as enviable as it sometimes strikes me because he definitely has had much of his comfort handed to him on a silver platter).

OK, back to the article:

"Contemporary literature has maintained that toileting readiness skills typically develop between 18 and 24 months of age. Our data challenge this conventional wisdom. In only 2 of the 11 readiness skills were the median ages for girls less than 24 months of age: "stays BM free overnight" (22.1 months) and "understands potty words" (22.8 months). The median ages for boys were over 24 months in all 11 readiness criteria. Although some boys and girls acquire readiness skills before their second birthday, most do not. As practitioners advocating that parents wait until their children are ready to start toilet training, we should now revise our ages upward to 22 to 30 months when children are typically ready for toilet training."

And Frances is? Thirty months, almost, or at the tail end of what this research indicates is an average age range for readiness for toilet training. Not that the age ranges mean squat when your girl only learns to walk at nineteen months, but this is different. I can see the readiness signs are almost entirely in place, and when I look at the chart (for which you will have to click through to the article) I can see she is learning the skills in sequence and at appropriate ages, with the exception of hand-washing and that's because she can't reach the sink even on a stepstool. And I'm not starting now in the expectation that she will be out of diapers in a month or two (since anyway what would I put her in? I still haven't found any underwear in her size) but simply so that when everything clicks in her little head the potty is there, she knows what to do with it, and Erik and I are already practiced at encouraging her to use it--it's a part of our routine, in other words.

This article explored the relationship between the age when training was initiated, the age when intensive training (defined as parents asking the child to use the potty more than three times per day) was initiated, and the age of successful potty training completion. A quote: "We found that the age at initiation of intensive toilet training correlates strongly with the age at completion of toilet training. However, this correlation is not present when the group that began intensive training between 17 and 27 months is evaluated alone. Other studies have also found that age of initiation of toilet training is an important predictor of age at attainment of bladder control or completion of daytime training but have not reported data on this relationship at different ages of initiation or on the relationship between age at initiation and duration of toilet training. A study that examined the relationship between parental pressure to train and age at completion of training in a sample that often began training before 18 months found no relationship between parental pressure to train and age of completion of toilet training. Our study suggests that there is little benefit to beginning intensive training before 27 months of age, although we could not find any toilet training problems, other than a longer duration of training, that were associated with earlier initiation of intensive training."

Or in other words, starting before 27 months was associated with a very long potty training process and no earlier achievement of the desired result, but after 27 months, the earlier the parents started, the earlier the kids were done. On average. Kids, being individuals, delight in bucking these statistics with a casual smear of one poop-stained hand; so there will always be kids who train very quickly before 27 months and kids who train very slowly after 27 months no matter what the parents do. But sitting here with a thirty-month-old daughter, I can find little reason to wait. According to the handy charts, a child begun between 27 and 33 months will be completed sometime between 36 and 40 months, whereas a child who begins at 33-36 months will be completed sometime between 38 and 41 months and a child begun after 36 months of age will be 43 to 47 months by the time they're done (on average).

Could Frances defy these experts as readily as the other ones? Absolutely. But at least I know how these experts came to their conclusions, what their sources were, what research they undertook and how, and I can take that and apply their statistics to my own situation to come up with a solution that seems to make sense for my family. I'm not expecting it to be a magic bullet, I'm not expecting it to be easy or convenient, I'm expecting it to be the probable best option of a field of options for how to potty train my particular little girl. If it takes eight months or ten months, it takes eight months or ten months. I just want the potty to be there, and I want Frances to know what it's for, and I want her to have some experience in using it, and I want her to know that her father and I expect her to use it when she can. That is the sum total of my current goals.

All of our kids insist on being individuals. It's part of what makes parenting such a challenge--from day one, they're determined to be themselves, not the more predictable creatures we've read about in the books. For some kids this means that no matter what their parents do, they simply will not use a potty until after a certain age. For others this means their parents can't keep them off of a potty from the age of twenty months or so. I am certain that everyone reading this has done whatever research they feel is necessary and has come to a reasoned and compassionate solution that works for their own particular family and their own idiosyncratic child with his or her own inclinations and preferences, and I'm sure also that those solutions are as varied as any other trait one might expect in such a large group. Please understand that I don't think that it is bad to postpone potty training in general; but I also don't think that it is bad not to. There's no one way to do this.

But I do want you to understand that my own choices have also been thoroughly researched and made with the best interests of my family at heart. This doesn't mean I can't be wrong, gods know that happens often enough. And if I am, well, you can all organize an Internet Laugh at Andrea Party, and I'll buy the balloons. I want you to understand that we are starting now because I think it is best for Frances.

~~~~~

This morning after breakfast I enticed her on to the potty by saying that she could bring her newest toys, the Calico Critters twin baby kittens, with her. We bought them yesterday morning when we went shopping because we went into the Mastermind store where they had a whole Calico Critters house set up with a set of the kittens out, and she wouldn't leave them alone. She hasn't left them alone since we got home yesterday, either, and keeps putting them down for a nap and then getting them up again. It's adorable. So of course, there would be no pottying without the little baby kittens, and they came along.

Frances sat there and demanded that I "talk to the boy kitten," which means pretend to be his voice so that he and Frances can have a conversation, which they did. At one point, Frances looked at me with complete pride and happiness on her face and said, "I'm going to make a pee!" And then she did. When she decided she was done, we got up and got dressed.

Frances is ready, and so am I.

Posted by Andrea at June 20, 2006 9:02 AM under Mothers and Anti-Mothers

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