Wetenschapsforum

nabob schreef:Er bestaat een methode waarmee je al op vroeg leeftijd een baby kunt leren om op een potje te leren plassen en poepen. Dit wordt de babyzindelijkheidscommunicatie (BZC) genoemd. Uitgangspunt is dat de ouder aanvoelt wanneer het kindje aandrang heeft om zijn behoefte te doen om vervolgens dit kindje boven een potje of toilet te houden. Naar verluidt krijgen baby's met deze BZC eerder controle over de sluitspier. Een kindje wordt met deze methode vaak al na anderhalve jaar zindelijk. In deze methode wordt er vanuit gegaan dat een baby al veel eerder controle over zijn/haar sluitspier kan uitoefenen. Genoemd wordt een leeftijd van tussen de 10 en 15 maanden.

De gangbare opvatting over zindelijkheid is echter dat er pas vanaf het tweede jaar met zindelijkheidstraining kan worden begonnen. Dit volgt uit de 'wetenschap' dat pas op dat moment een kindje voldoende controle heeft over zijn/haar sluitspier. Mijn vraag is nu waar deze wetenschappelijke kennis over controle over de sluitspier uit volgt. Is hier studie naar gedaan en hoe en wanneer? Waar is hier eventueel meer informatie over te vinden? Mij lijkt het zo dat er toch wel kanttekeningen te plaatsen zijn bij het feit dat een kind pas vanaf zijn tweede levensjaar in staat is om zijn behoefte op te houden.

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.

ABSTRACT

Purpose:

We describe the voiding pattern and acquisition of bladder control in healthy children up to age 6 years.

Materials and Methods:

We determined age for daytime and nighttime dryness, voiding patterns, voiding volumes and post-void residual volume per 4 hours individually and noninvasively every 3 months up to age 3 years and every 6 months up to age 6 years in 36 female and 23 male patients using 4-hour voiding observation and uroflowmetry/ultrasound.

Results:

Median age for attaining daytime and nighttime dryness was 3.5 and 4 years, respectively. No significant difference was found between girls and boys. All but 1 child attained daytime dryness an average of 10 months before attaining nighttime dryness. Bladder sensation was reported in 31%, 79% and 100% of patients at ages 2, 3 and 4 years, respectively. Median bladder capacity was 67 ml, 123 ml and 140 ml at years 1, 3 and 6, respectively. Median post-void residual volume was 5.5 ml, 0 ml and 2 ml at ages 1, 3 and 6 years, respectively.

Conclusions:

Today bladder control is acquired at a later stage despite earlier awareness of bladder function. The occurrence of bladder sensation from age 1.5 years motivates an earlier start with toilet training. Infants with small post-void residual volume at age 6 months or large bladder capacity will probably attain daytime dryness earlier than those with large post-void residual volume at age 6 months or small bladder capacity.

OBJECTIVE: To examine racial and socioeconomic differences in parental beliefs about the appropriate age at which to initiate toilet training. STUDY DESIGN: A cross-sectional survey of 779 parents visiting child health providers in 3 clinical sites in Washington, DC and the surrounding metropolitan area completed a self-report survey. The main outcome variable was parental beliefs about the appropriate age at which to initiate toilet training. Using multiple linear regression, differences in beliefs were assessed in relation to race, family income, parental education, parental age, and age of the oldest and youngest children. RESULTS: Among respondents, parents felt that the average age at which toilet training should be initiated was 20.6 months (+/-7.6 months), with a range of 6 to 48 months. Caucasian parents believed that toilet training should be initiated at a significantly later age (25.4 months) compared with both African-American parents (18.2 months) and parents of other races (19.4 months). In the multiple regression model, factors predicting belief in when to initiate toilet training were Caucasian race and higher income. CONCLUSIONS: Race and income were independent predictors of belief in age at which to initiate toilet training. More research is needed to determine what factors contribute to toilet training practices in diverse populations.