# Situation: At the well-child clinic of a Rural Health Unit (RHU), the nurse sees toddlers aged 12 to 36 months with their parents. Four parents ask whether their toddlers are ready to begin toilet training. Which toddler is MOST ready to begin now?

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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: At the well-child clinic of a Rural Health Unit (RHU), the nurse sees toddlers aged 12 to 36 months with their parents.

Four parents ask whether their toddlers are ready to begin toilet training. Which toddler is MOST ready to begin now?

## 보기

1. A 30-month-old who walks well but cries and hides when put on the potty chair
2. A 22-month-old who stays dry for 2 hours and says when he must pass stool **✔ 정답**
3. A 26-month-old who shows readiness signs but whose baby sister was born last week
4. A 15-month-old who wakes dry from naps and watches her parents use the toilet

**정답: 2**

## 해설

Toilet training begins when the child shows physical and cognitive readiness, usually not before 18 to 24 months, when sphincter control develops. The 22-month-old stays dry for about 2 hours and communicates the urge. Readiness also means a calm period: a new sibling causes stress and regression, and a child who fears the potty is not emotionally ready.

## 심화 해설

Core readiness criteria

Toilet training is not a race, and readiness depends on a combination of physical, cognitive, and emotional signs. The child needs enough sphincter control to hold urine and stool, the awareness to recognize the urge, and the language or gesture to communicate that urge. Readiness also requires a stable, low-stress environment, because emotional distress can delay or reverse progress. A child who stays dry for about 2 hours and can signal when stool is coming is showing the physiologic and cognitive readiness needed to begin training. [1][3]

Why the 22-month-old is most ready

The 22-month-old in option 2 demonstrates two key readiness signs simultaneously. Staying dry for 2 hours indicates that the bladder can store urine for a meaningful interval, which reflects developing sphincter control. Saying when he must pass stool shows awareness of the urge and the ability to communicate it before elimination occurs. These are the same readiness indicators that predict a smoother transition and higher probability of success. [1][3] Although age alone is not a strict criterion, this child is within the expected window when sphincter control typically emerges, around 18 to 24 months. [1]

Why the other toddlers are not ready yet

Option 1 describes a 30-month-old who walks well but cries and hides when placed on the potty chair. Walking well is a motor skill, not a toilet-training readiness sign. Crying and hiding indicate fear of the toilet, which is a form of emotional resistance. Watch out! A child who fears the potty is not emotionally ready, and forcing training can lead to stool toileting refusal and prolonged setbacks. [3]

Option 3 presents a 26-month-old who shows readiness signs, but a new baby sister was born last week. The arrival of a sibling is a major life stressor for a toddler. Even if the child previously showed readiness, Key point! stress and regression are common during this period, and starting toilet training during a family transition increases the risk of failure and frustration. [1][3] The timing is wrong even though the child may have the underlying skills.

Option 4 describes a 15-month-old who wakes dry from naps and watches her parents use the toilet. Waking dry from a nap is a positive sign, and imitation is a normal developmental behavior, but these are not sufficient by themselves. At 15 months, sphincter control is typically not yet mature enough for voluntary bladder and bowel control. Watch out! Readiness before 18 months is uncommon, and starting too early often results in a longer, more frustrating process for both child and parent. [1]

Readiness signs versus non-predictive skills

Research on toddlers in different stages of toilet training shows that some developmental skills are present in nearly all children and therefore do not help predict readiness. Skills such as sitting stably, picking up small objects, and spontaneously placing objects into containers are universal at this age and have no predictive value for toilet training success. [1] This is why walking well in option 1 or watching parents use the toilet in option 4 are not strong indicators of readiness. The meaningful signs are those related to bladder and bowel awareness, such as staying dry for intervals, showing discomfort when wet or soiled, and communicating the need to eliminate. [1][3]

| Toddler | Readiness signs present | Barrier to starting now | Decision |
| --- | --- | --- | --- |
| 30-month-old who walks well but cries on potty | Motor skill only | Fear of toilet, emotional resistance | Not ready |
| 22-month-old dry for 2 hours and signals stool | Bladder control, urge awareness, communication | None identified | Most ready |
| 26-month-old with readiness signs but new sibling | Readiness signs present | Stressful life event, regression risk | Delay training |
| 15-month-old dry after naps and imitates toileting | Partial dryness, imitation | Immature sphincter control, age below typical window | Not ready |

Clinical application for well-child visits

When parents ask about toilet training readiness, the nurse should assess for a cluster of signs rather than any single behavior. The most useful indicators are staying dry for 2 hours or more, showing awareness of the urge to void or defecate, communicating that urge through words or gestures, and showing interest in the toilet without fear. [1][3] Equally important is evaluating the family context. A recent move, a new sibling, or parental stress can all interfere with a child's ability to cooperate with training. [3] The goal is to match the start of toilet training to a period when the child is both developmentally capable and emotionally settled. [1][3]References (research sources)

- [1]Development Signs in Healthy Toddlers in Different Stages of Toilet Training: Can They Help Define Readiness and Probability of Success?Research articleWyndaele JJ, Kaerts N, Wyndaele M, Vermandel A (2020) · DOI: 10.1177/2333794X20951086

- [3]The Perils and Pitfalls of Potty Training.Research articleKimball V (2016) · DOI: 10.3928/00904481-20160512-01

## 임상 시나리오

Toilet Training Readiness in ToddlersAssessing physical, cognitive, and emotional signs
Begin toilet training when the child shows sphincter control, awareness of the urge, and ability to communicate it. Staying dry for about 2 hours and signaling before stooling are strong readiness indicators.

Readiness typically emerges between 18 and 24 months. Age alone is not a criterion; assess the combination of physical readiness, cognitive awareness, and emotional stability.

CautionDelay training during stressful life events such as the birth of a sibling, which can cause regression. A child who cries or hides from the potty chair is not emotionally ready, regardless of age.

## 핵심 개념

- **Sphincter control** — The ability to voluntarily hold and release urine and stool, typically developing around 18 to 24 months of age.
- **Toilet training readiness** — A combination of physical, cognitive, and emotional signs indicating a child can begin learning to use the toilet.
- **Regression** — Loss of previously acquired skills or behaviors, often triggered by stress such as the birth of a sibling.
- **Bladder capacity** — The ability of the bladder to store urine for a meaningful interval, reflected by staying dry for about 2 hours.
- **Emotional readiness** — A child's willingness and lack of fear toward the toilet or potty chair, necessary for successful toilet training.

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