Tips for Successful Potty Training

Abstract

Toilet training, a pivotal developmental milestone, signifies a child’s increasing autonomy and competence. This paper provides an evidence-based overview of successful toilet training, integrating global perspectives with a particular focus on African contexts. It examines the multifaceted indicators of child readiness—physiological, cognitive, emotional, and social—and discusses various training methodologies, including child-oriented, parent-led, accelerated, and traditional infant communication approaches. The report also addresses common challenges such such as regression and resistance, offering practical, empathetic solutions. A significant portion is dedicated to exploring the profound influence of parental attitudes, family dynamics, and external environments, including childcare settings and socioeconomic factors. Furthermore, it delves into the unique cultural beliefs, traditional practices, and infrastructural realities prevalent across Africa, highlighting their impact on toilet training outcomes. The paper concludes with actionable recommendations for parents, caregivers, and healthcare professionals, advocating for culturally sensitive, consistent, and supportive strategies to foster positive toilet mastery and promote child well-being globally.

Introduction

The Significance of Potty Training as a Developmental Milestone

Toilet training, often referred to as potty training or toilet learning, represents a fundamental developmental milestone in early childhood. This transition from diaper dependency to independent toileting is more than a mere acquisition of a new skill; it is a complex process reflecting a child’s holistic maturation across multiple domains.¹ The process integrates physiological control, cognitive understanding, emotional regulation, and behavioral adaptation, marking a significant step towards a child’s autonomy and self-sufficiency.¹

The emphasis on physiological, cognitive, and emotional development underscores that successful toilet training is not simply about teaching a child to use a toilet, but rather a profound indicator of their overall developmental readiness. This means that a successful approach must consider the child’s readiness holistically, rather than attempting to impose a training regimen prematurely. For both children and their families, achieving toilet mastery fosters a sense of accomplishment, boosts a child’s confidence, and can significantly reduce the practical and financial burden associated with diaper use.⁶ Recognizing this milestone as a comprehensive developmental achievement, rather than a singular behavioral task, is crucial for effective and supportive parenting.

Purpose and Scope of This Research Paper

This paper aims to provide a comprehensive, evidence-based guide to successful toilet training for a diverse audience, encompassing parents, caregivers, and healthcare professionals. It synthesizes international research and integrates unique perspectives from African contexts to offer globally relevant and culturally sensitive recommendations. The report seeks to demystify the toilet training process by outlining key readiness indicators, exploring various training methodologies, and addressing common challenges. It will analyze the critical role of parental attitudes, consistency among caregivers, and the influence of external environments. A significant focus will be placed on understanding traditional African practices, the evolving impact of modernization, and the unique environmental and infrastructural challenges prevalent in many African settings. By examining these multifaceted influences, this paper endeavors to provide nuanced insights and practical strategies that promote positive toilet mastery, ultimately contributing to child well-being and public health outcomes worldwide.

Understanding Child Readiness for Potty Training

Successful toilet training is contingent upon a child demonstrating readiness across several developmental domains. Recognizing these cues is paramount to fostering a positive and efficient learning experience.

Physiological Foundations and Milestones

Physiological readiness forms the bedrock of successful toilet training, primarily involving a child’s ability to control their bladder and bowel sphincters. This crucial muscular control typically develops between 12 and 18 months of age.⁹ Key physiological indicators include the capacity to remain dry for at least two hours during the day or after naps, which signifies sufficient bladder capacity and control.¹ Additionally, having predictable bowel movements is a strong indicator, as regularity makes it easier to anticipate and plan for toileting.¹

An early and critical step in this process is the development of body awareness, or interoception—the ability to associate internal sensations of fullness with the impending need to urinate or defecate.² This awareness often emerges around 12 to 18 months. As a child’s physical state awareness expands, they may begin to demonstrate discomfort with a wet or soiled diaper, attempting to remove it or resisting diaper changes.¹ This internal perception and recognition of bodily signals are foundational, as without it, a child cannot consciously initiate or hold elimination, regardless of their physical capability. Therefore, parental efforts should focus on helping children identify and interpret these internal cues, rather than solely enforcing scheduled potty breaks.

Cognitive and Language Development Cues

Cognitive readiness for toilet training involves a child’s developing understanding and problem-solving abilities. This includes the capacity to follow simple one- or two-step instructions, which is essential for understanding and executing the steps involved in using the toilet.¹ A child should also grasp the fundamental purpose of the toilet or potty chair.²

Language development plays a pivotal role, enabling children to communicate their needs effectively using words or agreed-upon gestures.¹ Children may express interest in “big kid” underwear or begin asking questions about their body parts, particularly the “private” ones used for elimination.⁹ The ability to mentally picture what they want to do (use the potty), create a plan to get there, and remain in place long enough to finish, all require developing cognitive skills such as memory and planning.⁹ Acquiring simple words to describe their body and its functions helps a child think more fully about the process of elimination, setting the stage for learning through experience.⁹ This suggests that language serves as a bridge to independence and problem-solving, directly supporting the child’s ability to internalize and manage the complex sequence of toileting, transitioning from external prompting to internal self-direction.

Emotional and Social Indicators of Readiness

Emotional and social readiness are equally vital for a successful toilet training journey. A child’s intrinsic motivation and comfort with the process are key indicators. This may manifest as a direct interest in using the toilet, an explicit request to start, or imitating the toileting behaviors of parents or older siblings.¹ A child might also begin to seek privacy or hide when soiling their diaper, indicating a nascent awareness of social norms surrounding elimination.² Crucially, the child should not exhibit fear of the toilet, which can be a significant barrier to progress.¹² While a desire to please parents can serve as an initial motivator ¹, it is important to navigate this delicate balance.

The core of successful toilet training hinges on the child feeling in control of their own body and the process.² If parents are overly emotional or attempt to force the child, it can lead to frustrating power struggles, where the child may resist by withholding urine or stool as a means of asserting control.¹⁰ This highlights a paradox: while social motivation can initiate interest, excessive parental pressure can undermine the child’s burgeoning autonomy, leading to resistance or regression. Therefore, fostering a sense of agency in the child is paramount.

Individual Variation and Age Considerations

It is widely acknowledged that there is no single “right” age to commence toilet training, as it is a gradual process that children typically initiate at their own pace.¹ Most children in the United States demonstrate the necessary physiological, cognitive, and emotional readiness between 18 and 30 months of age.¹ Girls often show signs of readiness slightly earlier than boys, typically between 24 and 26 months compared to 29 months for boys.¹ The average age for initiating training in the U.S. falls between 2 and 3 years, with most children achieving daytime bowel and bladder control by age 4.² Nighttime dryness, a separate developmental milestone, generally takes longer to achieve, often occurring between ages 5 and 7 years.¹³

The emphasis on “no one right age” and the importance of waiting for “readiness signs” directly contrasts with parental tendencies to initiate training based purely on chronological age.⁶ This divergence between parental expectations and actual child development can have significant consequences. Rushing the process due to age-based expectations, rather than observing genuine readiness, can lead to frustration and delays for both the child and parents.⁷ Such premature attempts may prolong the overall training process ⁶ and potentially contribute to psychological stress, anxiety, and other physical or social problems for the child.²⁰ Prioritizing developmental readiness over arbitrary age targets is therefore crucial for a smoother, more positive, and ultimately more successful toilet training experience.

Table 1 provides a consolidated overview of key readiness signs for toilet training across various developmental domains.

Table 1

Key Readiness Signs for Potty Training

Category	Specific Signs	Typical Age Range (where available)
Physiological	Body awareness (associating fullness with elimination)	12-18 months 2
	Dry for at least 2 hours during the day or after naps	2-5 years (daytime dryness) 1
	Predictable bowel movements	1
	Discomfort with soiled diapers	1
	Sphincter control	12-18 months 9
Cognitive/Language	Follows simple (one- and two-step) directions	1
	Communicates needs (words/gestures)	1
	Asks to be changed or for underwear	12
	Shows interest in underwear/body parts	9
	Knows basic bathroom words (e.g., “pee,” “poop,” “potty”)	2
	Can plan to get to potty and remain there	9
Emotional/Social	Shows interest in toilet use or imitates others	1
	Seeks privacy or hides for elimination	2
	Not afraid of the toilet	12
	Desire to please parents	1
	Asks to start using the toilet	12
Overall Readiness		18-30 months 1
	Girls often earlier	24-26 months 1
	Boys often later	29 months 1
Nighttime Dryness		5-7 years 13

Effective Potty Training Approaches and Strategies

Various approaches to toilet training exist, each with its own philosophy and methodology. The most effective strategy often depends on the individual child’s temperament, the family’s lifestyle, and cultural context.

Child-Oriented (Brazelton) Methods

The child-oriented approach, notably popularized by T. Berry Brazelton, is a widely endorsed method by leading pediatric organizations such as the American Academy of Pediatrics (AAP) and the Canadian Paediatric Society.¹ This method advocates for a gradual, stepwise process, where parents patiently observe and respond to the child’s cues, allowing the child to dictate the pace of learning and avoiding any undue pressure to advance.¹

Typically, this approach begins around 18 months of age, with the introduction of a potty chair as the child’s “own chair”.⁴ Initial steps involve encouraging the child to sit on the potty while fully clothed, often when a parent is also using the toilet, to familiarize them with the concept and location.⁴ Progress is then made to sitting without a diaper, and eventually, to using the potty for elimination. A core principle of this method is to prevent problems by allowing for periods of disinterest or negativity from the child.⁴ If significant resistance or breakdowns occur, parents are advised to temporarily halt training and reassure the child, emphasizing that learning will happen when they are ready.⁴ This approach, by prioritizing the child’s pace and cues, aims to prevent power struggles and foster a sense of control over their own body.¹⁰ The gradual introduction and acceptance of a child’s occasional disinterest are designed to build intrinsic motivation and self-efficacy, promoting a positive association with toileting rather than relying on external rewards or coercion.

Parent-Led and Accelerated Training Approaches

In contrast to child-oriented methods, parent-led approaches involve a more structured initiation of toilet use by caregivers. This often entails establishing a routine where children are encouraged to use the toilet at specific, regular intervals throughout the day, such as every two to three hours, after meals, or before naps and bedtime.²² This systematic scheduling aims to habituate the child to the routine of toileting.

Accelerated training methods, such as the “Fast Track Method” or “Potty Train in a Day” (also known as the Azrin and Foxx method), are characterized by their intensive, rapid approach.⁴ These methods often involve concentrated practice drills, extensive positive reinforcement (e.g., praise, small snacks, stickers), and sometimes the use of pretend play with dolls to demonstrate the toileting process.¹ While some studies suggest these methods can be remarkably quick and effective for certain children, with some reportedly achieving training in an average of 3.9 hours ²⁵, their success is often observed in more compliant children, typically those under two years of age.²⁵

Another accelerated approach is the “Bare Bottom Method,” where the child spends initial training days without pants or underwear. This strategy allows the child to immediately perceive when they are eliminating, thereby fostering a direct connection between bodily sensations and the act of voiding.²⁵ While these methods promise rapid results, they are often described as intense ⁴ and may not be suitable for every child’s temperament, particularly those who are strong-willed or highly independent.⁴ This highlights a critical trade-off: accelerated methods might offer efficiency for certain child personalities or family needs, but they carry a higher risk of resistance or frustrating power struggles if the child is not receptive.¹³ Parental assessment of a child’s temperament is therefore as crucial as assessing readiness signs when selecting a training method, as a mismatch can prolong the process or create negative associations with toileting.

Infant Potty Training and Elimination Communication

Infant potty training, often referred to as Elimination Communication (EC), represents a distinct approach to toileting that diverges significantly from Western child-led or parent-led methods. This practice involves caregivers observing a baby’s subtle cues for elimination and then holding them over a toilet, potty, or designated outdoor spot, often from a very young age—sometimes as early as a few weeks or months of life.³ Rather than formal training, EC is more akin to a conditioning process, leveraging infants’ natural reflexes and the caregiver’s close physical proximity and responsiveness to the baby’s signals.²⁵

This method is prevalent in many non-Western cultures, including numerous communities across Africa, where disposable diapers may be scarce, costly, or simply not part of traditional child-rearing practices.³⁶ The primary drivers for this early training are often practical considerations such as cleanliness and convenience, as well as deeply ingrained cultural norms.³⁶ The widespread adoption of EC in these contexts underscores that toilet training methods are not solely determined by developmental psychology but are profoundly shaped by environmental and socioeconomic realities. This approach, therefore, serves as a practical adaptation to resource scarcity, where early training becomes a necessity for hygiene and convenience, rather than a philosophical choice. This perspective challenges the Western-centric view that “readiness” is the sole determinant of optimal training age, suggesting that diverse contexts necessitate different, yet equally valid, approaches to achieving toileting independence.

Universal Principles for Success: Consistency, Positive Reinforcement, and Hygiene

Regardless of the specific method chosen, several universal principles are consistently associated with successful toilet training outcomes. These principles emphasize creating a supportive and predictable learning environment for the child.

Consistency is paramount across all aspects of the training process. This includes maintaining a consistent routine for bathroom breaks, using consistent language and cues, and ensuring that all caregivers—parents, grandparents, babysitters, and daycare providers—follow the same approach and expectations.⁷ This unified approach is not merely about avoiding confusion; it creates a predictable and structured environment that significantly reduces a child’s anxiety and resistance.²⁶ When a child knows what to expect, they feel more secure and confident in the transition.²⁶ This consistent framework acts as a multiplier effect, accelerating learning and solidifying new habits by minimizing cognitive load and emotional uncertainty for the child.

Positive reinforcement is another critical component. Praise, encouragement, and small, immediate rewards (such as stickers or favorite activities) effectively motivate children and build their confidence.¹ Focusing on effort and progress, rather than just perfect outcomes, reinforces positive behavior and encourages persistence.

Finally, proper hygiene practices must be integrated from the very beginning. This includes teaching children how to wipe effectively (emphasizing front-to-back for girls to prevent germ transfer) and ensuring thorough handwashing with soap and water after every toilet use.¹³ These practices are fundamental not only for personal cleanliness but also for public health.

Table 2 offers a comparative overview of the various potty training methods, highlighting their key principles, typical initiation ages, and associated advantages and challenges.

Table 2

Comparison of Potty Training Methods

Method Name	Key Principles/Approach	Typical Age of Initiation	Pros	Cons/Challenges
Child-Oriented (Brazelton)	Child-led pace; gradual introduction; observation of child’s readiness cues; gentle encouragement; no pressure.	18+ months 4	Fosters child empowerment and autonomy; reduces power struggles; positive association with toileting. 4	May take longer to achieve full training; requires significant parental patience. 4
Parent-Led (Gradual/Scheduled)	Parents initiate toilet use at specific, regular time intervals (e.g., every 2-3 hours, after meals, before naps/bedtime).	Varies, often after readiness signs emerge (e.g., 18-24 months) 22	Establishes routine and predictability; can be effective for habit formation. 26	May feel less child-driven; requires consistent parental prompting. 22
Accelerated (Fast Track/3-Day/Bare Bottom)	Intensive, rapid training (e.g., 1-3 days); repetition of behaviors; positive reinforcement (praise, rewards); bare bottom time for immediate feedback.	Often 20-30 months, but can be earlier for compliant children. 25	Can achieve quick results for some children; direct feedback from bare bottom. 25	Intense and demanding for parents; may not suit all child temperaments (e.g., strong-willed children); can lead to frustration if child resists. 4
Infant Potty Training (Elimination Communication)	Caregivers observe subtle infant cues for elimination; hold baby over appropriate receptacle; often uses sound prompts.	Weeks/months of age (infancy) 3	Reduces diaper use and waste; promotes early body awareness; driven by cleanliness/convenience in low-resource settings. 36	Requires constant caregiver attention and responsiveness; may not align with Western developmental readiness concepts. 34

Common Challenges and Navigating Setbacks

Despite careful planning and consistent effort, toilet training can present various challenges and setbacks. Understanding these common issues and how to address them empathetically is crucial for successful outcomes.

Understanding and Addressing Potty Training Regression and Accidents

Accidents are an entirely normal and expected part of the toilet training journey.¹ Equally common is regression, a phenomenon where a child who has seemingly mastered toileting skills begins to have accidents again. This affects approximately one-third of families.⁷

Regression is frequently triggered by significant life changes or emotionally stressful situations. Such events can include the arrival of a new sibling, moving to a new home, family conflicts, or periods of illness.² In these instances, accidents should be understood not as defiance or a lack of effort, but as an outward manifestation of a child’s internal stress or overwhelm. Young children often lack the verbal skills to express their confusion, anxiety, or fear, and regression becomes a form of communication.⁵² This reframing of regression from a behavioral problem to a developmental coping mechanism necessitates a response characterized by empathy and support, rather than criticism or punishment.¹³ Parents are advised to respond calmly, avoid anger or shaming, and involve the child in the cleanup process in a gentle, supportive manner.¹

Managing Resistance, Fear, and Emotional Issues

Children may exhibit resistance to toilet training for a variety of reasons rooted in their emotional and psychological development. Common fears include the loud noise of flushing toilets or discomfort with the size and perceived instability of adult-sized toilets.⁸ Some children may seek increased parental attention, inadvertently using accidents as a means to engage caregivers in emotional interaction.⁵²

As children develop a sense of self and autonomy, they may also begin to experience feelings of discomfort or shame after an accident, even if parents are generally accepting.⁵² This can lead to behaviors such as hiding wet underwear or claiming to have used the bathroom when an accident occurred.⁵² Critically, toilet training can become a battleground for control. If parents exert too much pressure or become overly emotional about the process, children may engage in power struggles, sometimes by withholding urine or stool as a powerful way to assert their independence.¹⁰ For a young child, controlling their bodily functions is one of the few areas where they have absolute power. When parents try to control this, the child may use it to resist, highlighting the importance of respecting the child’s agency and fostering a collaborative, rather than coercive, approach.

Addressing Physical Challenges: Focus on Constipation

Beyond emotional and developmental factors, physical challenges can significantly impede toilet training progress. Constipation is a particularly common issue, often leading to painful bowel movements, which in turn can cause a child to withhold stool or refuse to use the toilet altogether.¹ This creates a vicious cycle: painful experiences lead to fear of pooping, which results in further withholding, exacerbating the constipation and making subsequent eliminations even more painful. This cycle can cause significant psychological distress for the child and prolong the training process.

Therefore, addressing any underlying constipation is crucial, ideally before or during the initiation of toilet training.¹¹ Strategies to prevent and manage constipation include ensuring adequate hydration through plenty of water-based drinks and incorporating a high-fiber diet.²⁹ Managing constipation is not merely a physical intervention but a critical psychological one, as it helps break the cycle of fear and discomfort associated with bowel movements.

Table 3 outlines common potty training challenges and provides practical solutions for parents and caregivers.

Table 3

Common Potty Training Challenges and Practical Solutions

Challenge	Underlying Reasons (if applicable)	Practical Solutions/Tips
Child doesn’t want to use potty/resists	Power struggle; fear of toilet; desire for attention; not ready.	Pause training for a month, then try again calmly. 51 Make potty time fun with special books/toys. 7 Avoid forcing. 10
Child won’t stay sitting on potty	Boredom; discomfort; fear.	Limit time on potty (2-5 minutes). 13 Keep special books/toys in bathroom. 7 Praise for trying, even if nothing happens. 13
Frequent wetting/accidents	Not fully ready; inconsistent routine; distraction; underlying medical issue.	Go back to diapers for a while or continue without, being prepared for changes. 51 Stay calm, don’t show frustration. 13 Ensure consistency in routine and cues. 26
Potty training regression	Major life changes (new sibling, move, illness, family conflict); inner stress.	Be understanding and sympathetic. 8 Avoid anger/punishment. 52 Gently involve child in cleanup. 52 Reassure and offer support. 52
Fear of flushing/toilet	Active imagination; magical thinking; loud noises.	Allow child to flush toilet to gain control. 18 Make it a fun game (e.g., waving goodbye to poop). 11 Avoid flushing while child is on potty. 13
Hiding accidents/shame	Developing sense of right/wrong; embarrassment; seeking approval.	Do not criticize or punish. 52 Gently acknowledge accident, reassure it’s okay. 52 Help them clean up and discuss getting back on track. 52
Constipation / Stool withholding	Painful bowel movements; fear of pooping; power struggle.	Consult pediatrician to rule out medical causes. 5 Ensure adequate hydration and high-fiber diet. 29 Avoid pressure around pooping. 10

Contextual Influences on Potty Training Outcomes

Toilet training is not an isolated developmental event; it is deeply embedded within a child’s social, familial, and environmental context. Various external factors can significantly shape the process and its outcomes.

The Impact of Parental Attitudes and Expectations

Parental attitudes and expectations exert a profound influence on the trajectory of toilet training.⁶ A common challenge arises from parents holding “unrealistic expectations” regarding the appropriate age for training. Many parents, even those well-informed, may prefer to initiate training before 24 months, often based solely on chronological age rather than observing the child’s developmental readiness.⁶ This disconnect between parental desires and a child’s actual developmental stage can lead to a cascade of negative consequences.

When expectations are unrealistic, parents may experience frustration, which can manifest as increased pressure, punishment, or even neglect during the training process.⁶ This creates a “expectation-frustration-conflict” cascade: unrealistic expectations lead to premature training attempts, which are often met with child resistance or accidents. This, in turn, fuels parental frustration, potentially escalating into negative interactions that prolong the training duration and may result in adverse physical or psychological outcomes for the child.⁶ Conversely, realistic and appropriate expectations are associated with more positive parent-child interactions, which facilitate smoother child development.⁶ This highlights the critical need for anticipatory guidance for parents to foster realistic expectations about the individualized nature of toilet training.

Ensuring Consistency Across Caregivers and Family Dynamics

Consistency in rules, routines, and language across all individuals involved in a child’s care is a cornerstone of successful toilet training. This includes parents, grandparents, babysitters, and daycare providers.¹⁴ When a child receives conflicting messages or experiences different approaches in various settings, it can cause confusion and significantly impede learning.¹⁹

Conflicting approaches are particularly problematic in situations such as split households due to parental separation or divorce, or when multiple adults share caregiving responsibilities.¹ Such inconsistencies can lead to difficulties and even regression in toilet training.¹ Children thrive on routine and predictability, which fosters a sense of security and confidence.²⁶ Inconsistency undermines this foundational security, potentially leading to anxiety, resistance, or regression as the child struggles to understand shifting expectations. Open communication and a concerted effort to agree upon and maintain a unified approach among all adults are therefore vital.²⁶ A “unified front” not only streamlines the learning process but also reinforces the child’s emotional stability, making it a critical factor for successful and stress-free training.

The Role of Daycare and External Environments

Daycare centers and other external environments play a significant role in a child’s toilet training journey. These settings can provide structured environments and guidance from experienced caregivers, which can be highly beneficial.¹ Effective collaboration and clear communication between parents and daycare providers are essential to ensure consistency in routines and strategies, reinforcing the learning that occurs both at home and in childcare.²⁶

However, external factors can also present considerable challenges. Longer hours spent in childcare, a lack of adequate training for early years workers, and the absence of clear potty training policies in some settings can inadvertently create inconsistencies or less effective practices.⁵³ This constitutes a “hidden curriculum” where informal practices or a lack of formal training can undermine parental efforts, leading to confusion for the child and prolonged training. This highlights a systemic issue that requires better training and policy development within childcare sectors. Additionally, external factors like travel can disrupt established routines, causing anxiety for the child and potentially leading to accidents or constipation.¹⁴

Socioeconomic Factors: Income, Education, and Access to Resources

Socioeconomic status, encompassing factors such as parental education level and household income, can significantly influence the age at which toilet training is initiated and completed.¹ Research indicates a correlation where higher maternal education levels and family income are often associated with a later initiation of toilet training.⁵⁴ This trend may be linked to differing parental beliefs about optimal timing and greater access to resources, including disposable diapers.³⁷

Conversely, households with lower socioeconomic status may initiate training earlier, often driven by the financial burden associated with purchasing disposable diapers.⁸ This suggests that the “choice” of when to potty train is not always a purely developmental or philosophical one but is heavily influenced by economic realities. The cost of diapers can act as a strong practical motivator for earlier training, even if the child has not yet reached the developmental “readiness” typically recommended by Western pediatric guidelines. This highlights a critical socioeconomic determinant of health practices, where resource availability directly shapes parenting decisions and, consequently, child development outcomes.

Potty Training in African Contexts: Unique Perspectives and Challenges

Toilet training practices in African contexts present a rich tapestry of traditional approaches, evolving influences from modernization, and significant challenges related to environmental infrastructure and public health. Understanding these unique dynamics is crucial for developing relevant and effective support systems.

Traditional Practices and Cultural Beliefs Regarding Early Training and Waste Disposal

Many African cultures have historically practiced and continue to employ very early toilet training methods, often initiating the process in the first weeks or months of a child’s life.³ This approach, often referred to as assisted infant toilet training or elimination communication (EC), is deeply ingrained and passed down through generations.³² Caregivers, typically mothers or other female family members, develop a keen awareness of their baby’s subtle cues for elimination and then hold the infant over a designated spot, such as a patch of ground or a small pot.³² This early training is primarily driven by practical needs for cleanliness and convenience in environments where disposable diapers are absent or economically unfeasible.³⁶

Cultural beliefs also profoundly influence waste disposal practices. For instance, in some communities, the feces of very young infants (typically under six months or before the introduction of solid foods) are considered pure or harmless.⁵⁸ This belief can lead to the disposal of infant stool in areas immediately surrounding the home rather than in latrines, which, while culturally acceptable, poses significant public health risks.⁵⁸ Furthermore, various taboos and superstitions may surround toilet use, such as beliefs that disposing of infant feces in latrines could prevent developmental milestones or cause other perceived harms to the child.⁵⁸ This highlights a complex interplay of cultural norms, practicality, and health outcomes. Public health interventions related to sanitation and child waste disposal in Africa must be culturally appropriate and understand these deeply ingrained beliefs to be effective, rather than simply imposing Western norms.

The Evolving Landscape: Impact of Modernization and Disposable Diapers

The increasing availability and adoption of disposable diapers, alongside evolving parenting philosophies influenced by Western recommendations (such as more child-led approaches), are gradually reshaping traditional toilet training practices in some African urban areas.³² While disposable diapers offer convenience and reduce the immediate labor of cleaning, their super-absorbent nature can inadvertently hinder a child’s body awareness by wicking away moisture, making it harder for them to feel wet and recognize the need to eliminate.⁴² This can contribute to a later average age of toilet training compared to traditional practices.³⁷

This shift presents a “modernization paradox”: a product designed to ease parental burden inadvertently prolongs the period of dependency on diapers and significantly increases environmental waste.⁶² This environmental impact is particularly pronounced in regions with inadequate waste management infrastructure, where disposable diapers contribute to growing mountains of plastic waste and pose public health challenges.⁶² This illustrates how technological and cultural shifts, while seemingly beneficial, can have unforeseen and complex consequences for child development and broader public health.

Environmental and Infrastructure Realities: Pit Latrines and Water/Sanitation Challenges

In many rural and informal urban settlements across Africa, the prevailing environmental and infrastructural realities pose profound challenges to effective and hygienic toilet training. Inadequate sanitation infrastructure, characterized by the widespread use of unsafe pit latrines, is a major concern.⁶⁶ These latrines can be extremely dangerous, especially for small children, with documented fatal accidents occurring due to falls into pits.⁶⁷ Consequently, young children may develop a fear of these facilities, preferring safer, child-sized potties.⁶⁷

Furthermore, a pervasive lack of access to clean water and soap severely impedes proper hygiene practices, contributing significantly to the prevalence of diarrheal diseases—a leading cause of child mortality in the region.⁶⁶ Open defecation remains a widespread practice, influenced by cultural norms, a lack of gender-sensitive latrines, and low literacy levels regarding hygiene and disease transmission.⁵⁹ These challenging conditions make consistent, hygienic toilet training exceptionally difficult to implement and sustain.

The prevalence of unsafe pit latrines and open defecation, coupled with water scarcity and inadequate hygiene facilities, creates a dire public health crisis that directly impacts toilet training. Children’s fear of latrines and the high risk of water-borne diseases mean that successful, hygienic toilet training is not merely a developmental milestone but a matter of survival and dignity. This underscores that effective toilet training strategies in these contexts must be integrated with broader Water, Sanitation, and Hygiene (WASH) initiatives and infrastructure development, as individual efforts are insufficient without a supportive and safe environment.

Table 4 provides a summary of the cultural and environmental factors influencing potty training in African contexts.

Table 4

Cultural and Environmental Factors in African Potty Training

Factor Category	Specific Factor	Impact on Potty Training
Traditional Practices	Early initiation / Elimination Communication (EC)	Early dryness; driven by cleanliness/convenience; passed down through generations. 32
	Cultural beliefs about infant waste (e.g., “harmless” feces)	Disposal around the house; public health risks due to lack of safe disposal. 58
	Taboos/superstitions about toilet use	Resistance to latrines; preference for open defecation. 58
Modernization Influences	Increased use of disposable diapers	Delayed body awareness due to moisture wicking; later toilet training age. 37
	Changing parenting styles (e.g., Western child-led)	Shift from early, practical training to later, readiness-based approaches. 37
Environmental/Infrastructure Realities	Unsafe pit latrines in rural/school settings	Safety concerns (fatal accidents); children’s fear of toilets; preference for potties. 67
	Lack of access to clean water and soap	Major barrier to hygiene; increased risk of diarrheal diseases. 66
	Open defecation (prevalence)	Public health hazard; children learn to eliminate in unsafe environments. 59
Socioeconomic Factors	Financial burden of diapers	Motivates earlier training in poorer households. 8
	Low literacy levels among caregivers	Limited understanding of hygiene risks; impacts waste disposal practices. 59

Recommendations for Parents, Caregivers, and Healthcare Professionals

Achieving successful toilet training requires a collaborative and informed approach from all stakeholders involved in a child’s care. Recommendations should be tailored to individual needs while upholding universal principles of child development and public health.

Evidence-Based Guidance for Diverse Family Structures

Healthcare professionals play a pivotal role in guiding families through the toilet training process. It is recommended that physicians provide anticipatory guidance to parents starting around 18 to 24 months of age, focusing on identifying signs of readiness rather than adhering to rigid age-based timelines.¹ This proactive approach positions the pediatrician as a navigator of diverse potty training journeys, helping parents assess readiness and understand their own perceptions and goals.¹ Professionals should counsel parents that no single training method is universally superior; instead, the most effective approach is one that is well-suited to the individual child’s temperament and the family’s unique circumstances, consistently employing positive reinforcement.¹

For children with developmental delays, disabilities, or chronic illnesses, early consultation with specialists such as occupational therapists or developmental pediatricians is highly recommended.¹ Specialized support services, including those offered by organizations like “The Potty School,” can provide tailored assistance and expert guidance for these unique needs.⁷⁷ This highlights a shift from a reactive, problem-solving role to a proactive, preventative one, acknowledging the emotional and contextual complexities parents face. The pediatrician’s role is to help families navigate the individualized journey, rather than prescribing a one-size-fits-all solution.

Fostering a Positive and Supportive Potty Training Environment

Creating a positive and supportive learning environment is fundamental to successful toilet training. Parents and caregivers should empower the child by recognizing their control over their own body and allowing them to decide whether to use the potty or a diaper.² Positive language should be consistently used, avoiding negative or shaming words such as “dirty” or “yucky” when discussing bodily functions.²

To make potty time enjoyable and engaging, incorporating books, toys, or songs specifically reserved for bathroom breaks can be highly effective.² The active involvement of fathers is also crucial, as their participation strengthens bonds, models gender-specific behavior, and promotes a child’s sense of independence.⁸⁰ Furthermore, maintaining consistency in daily routines, such as scheduling regular bathroom breaks (e.g., after meals, before naps and bedtime), reinforces the habit and provides predictability for the child.¹¹ The strategies learned during potty training, such as patience, positive reinforcement, and respecting a child’s agency, can serve as a foundation for effective parenting in other developmental domains, demonstrating that this milestone is a vehicle for broader parenting skills.

When and How to Seek Professional Support

Parents and caregivers should not hesitate to seek professional guidance if they encounter persistent difficulties or concerns during toilet training. Consultation with a healthcare professional is advisable if a child is older than 2.5 years and shows no interest in toilet training, is older than 3 years and is not daytime trained, consistently refuses to sit on the potty, or exhibits stool withholding behavior.¹³ It is important to rule out any underlying medical concerns, such as constipation or bladder infections, which can significantly impede progress.¹¹

Healthcare professionals can offer tailored advice, conduct assessments to identify any underlying health conditions, or provide referrals to specialists like occupational therapists or developmental pediatricians, particularly for children with special needs.¹ Early intervention in these cases is crucial not only for immediate problem-solving but also as a preventative measure against chronic physical or psychological issues related to toileting. This underscores the long-term health implications of successful toilet training and the value of timely professional support.

Conclusion

Toilet training is a complex and highly individualized developmental journey, shaped by a dynamic interplay of physiological, cognitive, emotional, social, cultural, and environmental factors. While universal principles of patience, consistency, and positive reinforcement are consistently paramount for success, effective outcomes are achieved by deeply understanding each child’s unique readiness and adapting strategies to the specific contextual realities of their family and community.

In African contexts, this understanding is particularly critical. Traditional practices of early infant toilet training, driven by practical needs for cleanliness and convenience, offer valuable lessons in responsiveness and cue recognition. However, the evolving landscape, influenced by the increasing availability of disposable diapers and the adoption of Western parenting styles, presents a “modernization paradox” where convenience may inadvertently prolong the training period and exacerbate environmental waste challenges. Concurrently, persistent environmental and infrastructural realities, such as unsafe pit latrines and limited access to clean water and sanitation, pose significant public health risks, highlighting that successful, hygienic toilet training is intrinsically linked to broader sanitation and dignity issues.

Ultimately, fostering positive toilet mastery requires a holistic and integrated approach. Parents, caregivers, and healthcare professionals must work collaboratively, integrating evidence-based strategies with culturally sensitive practices. This includes providing anticipatory guidance, setting realistic expectations, ensuring consistency across all care environments, and recognizing the profound influence of socioeconomic factors. By addressing individual developmental needs within their unique cultural and environmental contexts, and by advocating for improved sanitation infrastructure, communities can empower children to achieve this vital milestone, thereby promoting not only individual well-being but also advancing broader public health objectives across Africa and globally.

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References

American Academy of Pediatrics. (n.d.). Cognitive and Verbal Skills Needed for Toilet Training. HealthyChildren.org. Retrieved from https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/Cognitive-and-Verbal-Skills-Needed-for-Toilet-Training.aspx ⁹

American Academy of Pediatrics. (n.d.). Emotional Issues and Bathroom Problems. HealthyChildren.org. Retrieved from https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/Emotional-Issues-and-Bathroom-Problems.aspx ⁵²

American Academy of Pediatrics. (n.d.). Praise and Reward Your Child’s Success. HealthyChildren.org. Retrieved from https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/Praise-and-Reward-Your-Childs-Success.aspx ¹⁸

American Academy of Pediatrics. (n.d.). Social and Environmental Obstacles During Toilet Training. HealthyChildren.org. Retrieved from https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/Social-and-Environmental-Obstacles-During-Toilet-Training.aspx ⁴³

American Academy of Pediatrics. (n.d.). The Right Age to Toilet Train. HealthyChildren.org. Retrieved from https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/the-right-age-to-toilet-train.aspx ²

Baird, D. C. (2019). Toilet training: Common questions and answers. American Family Physician, 100(8). Retrieved from https://www.aafp.org/pubs/afp/issues/2019/1015/p468.html ¹

Children’s Hospital of Philadelphia. (n.d.). Toilet Training Children and Adolescents with Down Syndrome. Retrieved from https://www.chop.edu/news/toilet-training-children-and-adolescents-down-syndrome ⁴⁹

Crane, Ohio State University. (n.d.). Potty Training With Young Children. Retrieved from https://crane.osu.edu/our-work/potty-training-with-young-children/ ⁸¹

ERIC. (2023, September). Potty Training. Retrieved from https://eric.org.uk/potty-training/ ⁴²

ERIC. (n.d.). Why are children potty training later?. Retrieved from https://eric.org.uk/why-are-children-potty-training-later/ ⁵³

Go Diaper Free. (n.d.). Infant Potty Training in Indigenous Africa: How People Potty Their Babies in Countries Without Diapers (Part 1). Retrieved from https://godiaperfree.com/infant-potty-training-in-indigenous-africa-how-people-potty-their-babies-in-countries-without-diapers-part-1/ ³⁶

Go Potty Now. (n.d.). Why a Father Figure Is Important During Potty Training. Retrieved from https://gopottynow.com/why-a-father-figure-is-important-during-potty-training/ ⁸⁰

Huckleberry Care. (n.d.). Which potty training method is best to use for my child. Retrieved from https://huckleberrycare.com/blog/potty-training-methods-which-is-best-for-your-child ²⁸

Joizi. (n.d.). Potty Training Insights From Around The World. Retrieved from https://joizi.co.uk/blogs/home/potty-training-insights-from-around-the-world ³²

Konga. (n.d.). Potty Training. Retrieved from https://www.konga.com/category/potty-training-2875 ⁸²

La Petite Academy. (2022, October 3). Identifying Readiness for Toilet Learning. Retrieved from https://www.lapetite.com/blog/2022/10/identifying-readiness-for-toilet-learning/ ¹²

Laitacare Kenya. (2022, October). Potty Training. Retrieved from https://lactacarekenya.co.ke/wp-content/uploads/2022/10/TT-Potty-Training.pdf ⁴⁷

Mayo Clinic. (2024, November 7). Potty training: How to get the job done. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/potty-training/art-20045230 ¹³

MDPI. (2022, May 1). A scale assessing children’s readiness for toilet training (Toilet Training Readiness Scale-TTRS) was developed and content validated. Retrieved from https://www.mdpi.com/2227-9067/11/9/1149 ⁸³

MDPI. (2020, May 1). Cultural and Behavioral Barriers to Safe Disposal of Child Feces in Rural Tanzania. Retrieved from https://www.mdpi.com/1660-4601/17/9/3084 ⁵⁸

Mom.com. (n.d.). 7 Potty Training Practices Around the World. Retrieved from https://mom.com/toddler/7365-potty-training-practices-around-world ³³

Motherhood101. (n.d.). Popular Methods of Potty Training. Retrieved from https://motherhood101.co.ke/popular-methods-potty-training-2/ ⁸⁴

National Diaper Bank Network. (n.d.). When to Start Potty Training. Retrieved from https://nationaldiaperbanknetwork.org/when-to-start-potty-training/ ¹⁷

Nationwide Children’s Hospital. (n.d.). Toilet Training. Retrieved from https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/toilet-training ¹⁴

NHS. (n.d.). How to potty train. Retrieved from https://www.nhs.uk/baby/babys-development/potty-training-and-bedwetting/how-to-potty-train/ ¹⁹

NHS. (2022, June 17). Potty training problems. Retrieved from https://www.nhs.uk/baby/babys-development/potty-training-and-bedwetting/potty-training-problems/ ⁵¹

One Proud Toddler. (n.d.). Making Sense of Different Potty Training Methods. Retrieved from https://oneproudtoddler.com/blogs/potty-training-explained/making-sense-of-different-potty-training-methods ²⁵

Parent Data. (n.d.). Potty Training: Best Advice. Retrieved from https://parentdata.org/potty-training-best-advice/ ³¹

PLOS Sustainability and Transformation. (2023, September 21). Disposable diaper consumption in sub-Saharan Africa: Estimating the risks of associated unsafe waste. Retrieved from https://journals.plos.org/sustainabilitytransformation/article?id=10.1371/journal.pstr.0000106 ⁶²

Positive Solutions Behavior Group. (n.d.). The Importance of Consistency in Toilet Training. Retrieved from https://positivesolutionsbehaviorgroup.com/the-importance-of-consistency-in-toilet-training/ ⁴⁴

PubMed. (1996, October). Cultural relativity of toilet training readiness: A perspective from East Africa. Retrieved from https://pubmed.ncbi.nlm.nih.gov/887331/ ⁵⁷

PubMed Central. (2023, February 1). Challenges of sanitation in developing counties – Evidenced from a study of fourteen towns, Ethiopia. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC9898597/ ⁶⁹

PubMed Central. (2020, April 20). Developmental signs for toilet training in healthy toddlers: An observational study. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC7450290/ ²⁰

PubMed Central. (2023, July 1). Factors associated with toilet training in urban informal settlements in Kampala, Uganda: A mixed-methods study. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10298274/ ⁷⁵

PubMed Central. (2008, September). Toilet training: An update on the role of the pediatric health care provider. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC2529421/ ⁴

PubMed Central. (2023, August 1). Toilet Training Intervention for Parents of Children with Developmental Delays: A Feasibility Study of a Telehealth-Based Occupational Therapy Program. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10333974/ ⁸⁵

Quora. (n.d.). How did primitive African tribes potty train their children?. Retrieved from https://www.quora.com/How-did-primitive-African-tribes-potty-train-their-children ³⁴

ResearchGate. (n.d.). Beliefs about the appropriate age for initiating toilet training: Are there racial and socioeconomic differences?. Retrieved from https://www.researchgate.net/publication/6900249_Beliefs_about_the_appropriate_age_for_initiating_toilet_training_Are_there_racial_and_socioeconomic_differences ⁵⁴

ResearchGate. (n.d.). Socio-Cultural Factors Influencing Child Faecal Matter Disposal among Caregivers in Wadajir District in Mogadishu-Somalia. Retrieved from https://www.researchgate.net/publication/350966029_Socio-Cultural_Factors_Influencing_Child_Faecal_Matter_Disposal_among_Caregivers_in_Wadajir_District_in_Mogadishu-Somalia ⁵⁹

Rivertowns Pediatrics. (2024, July 15). Consistency and Routine: Key Factors in Successful Potty Training. Retrieved from https://rivertownspeds.com/consistency-and-routine-key-factors-in-successful-potty-training/ ²⁶

Scribbr. (2024, September 5). APA in-text citation guide. Retrieved from https://www.scribbr.com/apa-style/in-text-citation/ ⁸⁶

Seattle Children’s Hospital. (n.d.). Potty Training Your Child. Retrieved from https://www.seattlechildrens.org/health-safety/parenting/toliet-potty-training/ ¹⁶

SciELO. (n.d.). Toilet training in the 2004 Pelotas Birth Cohort: Prevalence and associated factors. Retrieved from https://www.scielo.br/j/jped/a/kgbgVbNsdLJxS7BNQyMDyMH/?format=pdf&lang=en ⁶

South African Journal of Child Health. (2017). Toilet training practices in Nigerian children. Retrieved from https://journals.co.za/doi/pdf/10.7196/SAJCH.2017.v11i3.1287 ³

Ten Little. (n.d.). Which potty training method is best to use for my child?. Retrieved from https://tenlittle.com/blogs/potty-training/which-potty-training-method-is-best-to-use-for-my-child ²²

The Potty School. (n.d.). Potty Training for Special Needs. Retrieved from https://www.thepottyschool.com/services/special-needs ⁷⁷

Turkish Journal of Pediatrics. (n.d.). A study of toilet training practices in children in Ankara, Turkey. Retrieved from https://turkjpediatr.org/article/download/1214/1207/1207 ⁵⁶

UC Davis Health. (n.d.). Do’s and don’ts of potty training your toddler. Retrieved from https://health.ucdavis.edu/children/patient-education/potty-training-children ¹¹

UCL News. (2025, March 4). Toilet training research bids to reduce nappy waste. Retrieved from https://www.ucl.ac.uk/news/2025/mar/toilet-training-research-bids-reduce-nappy-waste ⁶⁵

UNICEF. (n.d.). Early childhood development | UNICEF Parenting. Retrieved from https://www.unicef.org/parenting/topics/early-childhood-development?page=1%2C%2C%2C%2C0 ⁸⁷

UNICEF. (n.d.). UNICEF Parenting. Retrieved from https://www.unicef.org/parenting/topics/parenting?page=10%2C%2C%2C%2C0 ⁸⁸

UNICEF. (2023, March 20). A triple threat of water-related crises is endangering the lives of 190 million children. Retrieved from https://www.unicef.org/press-releases/triple-threat-water-related-crises-endangering-lives-190-million-children-unicef ⁷¹

UNICEF. (n.d.). Water, Sanitation and Hygiene (WASH) in West and Central Africa. Retrieved from https://www.unicef.org/wca/what-we-do/wash ⁷⁰

What to Expect. (n.d.). 3-Day Potty Training. Retrieved from https://www.whattoexpect.com/toddler/potty-training/3-day-potty-training ²⁹

WHO Regional Office for Africa. (n.d.). Water. Retrieved from https://www.afro.who.int/health-topics/water ⁶⁸

Wikipedia. (n.d.). Elimination communication. Retrieved from https://en.wikipedia.org/wiki/Elimination_communication ³⁸

Wikipedia. (n.d.). Toilet training. Retrieved from https://en.wikipedia.org/wiki/Toilet_training ³⁹

Zero to Three. (n.d.). Potty Training: Learning to Use the Toilet. Retrieved from https://www.zerotothree.org/resource/potty-training-learning-to-the-use-the-toilet/ ¹⁰

Works cited

1. Toilet Training: Common Questions and Answers – AAFP, accessed August 5, 2025, https://www.aafp.org/pubs/afp/issues/2019/1015/p468.html
2. The Right Age to Potty Train – HealthyChildren.org, accessed August 5, 2025, https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/the-right-age-to-toilet-train.aspx
3. Toilet training practices in Nigerian children – Sabinet African Journals, accessed August 5, 2025, https://journals.co.za/doi/pdf/10.7196/SAJCH.2017.v11i3.1287
4. Among healthy children, what toilet-training strategy is most effective and prevents fewer adverse events (stool withholding and dysfunctional voiding)? Part B: Clinical commentary – PMC, accessed August 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC2529421/
5. Toilet Training Research – The Toileting Teacher, accessed August 5, 2025, https://www.thetoiletingteacher.com/blog/toilet-training-research
6. Toilet training: methods, parental expectations and … – SciELO, accessed August 5, 2025, https://www.scielo.br/j/jped/a/kgbgVbNsdLJxS7BNQyMDyMH/?format=pdf&lang=en
7. Study: Potty training challenges common, with anxiety and setbacks affecting many families, accessed August 5, 2025, https://www.contemporarypediatrics.com/view/study-potty-training-challenges-common-with-anxiety-and-setbacks-affecting-many-families
8. Potty training often brings setbacks and surprises for families – News-Medical.net, accessed August 5, 2025, https://www.news-medical.net/news/20250721/Potty-training-often-brings-setbacks-and-surprises-for-families.aspx
9. Cognitive and Verbal Skills Needed for Toilet Training …, accessed August 5, 2025, https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/Cognitive-and-Verbal-Skills-Needed-for-Toilet-Training.aspx
10. Potty Training: Learning to the Use the Toilet | ZERO TO THREE, accessed August 5, 2025, https://www.zerotothree.org/resource/potty-training-learning-to-the-use-the-toilet/
11. Do’s and don’ts of potty training your toddler | Patient Education – UC Davis Health, accessed August 5, 2025, https://health.ucdavis.edu/children/patient-education/potty-training-children
12. Identifying Readiness for Toilet Learning – La Petite Academy, accessed August 5, 2025, https://www.lapetite.com/blog/2022/10/identifying-readiness-for-toilet-learning/
13. Potty training: How to get the job done – Mayo Clinic, accessed August 5, 2025, https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/potty-training/art-20045230
14. Toilet Training – Nationwide Children’s Hospital, accessed August 5, 2025, https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/toilet-training
15. Bright Futures Information for Parents: 2 Year Visit – AAP, accessed August 5, 2025, https://www.aap.org/en/practice-management/bright-futures/bright-futures-family-centered-care/well-child-visits-parent-and-patient-education/bright-futures-information-for-parents-2-year-visit/
16. Potty Training Your Child – Seattle Children’s Hospital, accessed August 5, 2025, https://www.seattlechildrens.org/health-safety/parenting/toliet-potty-training/
17. When Is Your Child Ready To Start Potty Training – National Diaper Bank Network, accessed August 5, 2025, https://nationaldiaperbanknetwork.org/when-to-start-potty-training/
18. Toilet Training: 12 Tips to Keep the Process Positive – HealthyChildren.org, accessed August 5, 2025, https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/Praise-and-Reward-Your-Childs-Success.aspx
19. How to potty train – NHS, accessed August 5, 2025, https://www.nhs.uk/baby/babys-development/potty-training-and-bedwetting/how-to-potty-train/
20. Development Signs in Healthy Toddlers in Different Stages of Toilet Training: Can They Help Define Readiness and Probability of Success?, accessed August 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC7450290/
21. Potty Training – People’s Community Clinic, accessed August 5, 2025, https://www.austinpcc.org/early-childhood-resources/potty-training/
22. Which potty training method is best to use for my child? – Ten Little, accessed August 5, 2025, https://tenlittle.com/blogs/potty-training/which-potty-training-method-is-best-to-use-for-my-child
23. Brazelton Child-Oriented Toilet Training Method – FPnotebook, accessed August 5, 2025, https://mobile.fpnotebook.com/Peds/Behavior/BrzltnChldOrntdTltTrngMthd.htm
24. nationalautismresources.com, accessed August 5, 2025, https://nationalautismresources.com/child-oriented-toilet-training-method/
25. Making Sense of Different Potty Training Methods – One Proud …, accessed August 5, 2025, https://oneproudtoddler.com/blogs/potty-training-explained/making-sense-of-different-potty-training-methods
26. Key Factors in Successful Potty Training | Rivertowns Pediatrics, accessed August 5, 2025, https://rivertownspeds.com/consistency-and-routine-key-factors-in-successful-potty-training/
27. How to potty train your child & 3 proven methods that work – Dr Maraschin, accessed August 5, 2025, https://www.drmaraschin.co.za/how-to-potty-train-your-child-3-proven-methods-that-work/
28. Potty training methods: Which is best for your child? – Huckleberry, accessed August 5, 2025, https://huckleberrycare.com/blog/potty-training-methods-which-is-best-for-your-child
29. Three-Day Potty Training: How It Works and Tips for Success – What to Expect, accessed August 5, 2025, https://www.whattoexpect.com/toddler/potty-training/3-day-potty-training
30. Writing in APA Style 7th Edition Example Paper | Antioch University, accessed August 5, 2025, https://www.antioch.edu/wp-content/uploads/2019/12/APA-7-Writing-in-APA-7th-Ed-Example-Paper.pdf
31. What to Know About Potty Training | ParentData by Emily Oster, accessed August 5, 2025, https://parentdata.org/potty-training-best-advice/
32. Potty Training: Insights from Around the World – JOIZI, accessed August 5, 2025, https://joizi.co.uk/blogs/home/potty-training-insights-from-around-the-world
33. Potty-Training Practices Around the World – Mom.com, accessed August 5, 2025, https://mom.com/toddler/7365-potty-training-practices-around-world
34. How did primitive African tribes potty train their children? – Quora, accessed August 5, 2025, https://www.quora.com/How-did-primitive-African-tribes-potty-train-their-children
35. Potty training in third world (kind of elimination communication) : r/pottytraining – Reddit, accessed August 5, 2025, https://www.reddit.com/r/pottytraining/comments/12k9a0w/potty_training_in_third_world_kind_of_elimination/
36. What Would an Indigenous Person Say About Pottying Their Baby …, accessed August 5, 2025, https://godiaperfree.com/what-would-an-indigenous-person-say-about-pottying-their-baby/
37. Toilet Training Around the World – Potty Genius, accessed August 5, 2025, https://pottygenius.com/blogs/blog/toilet-training-in-other-times-and-in-other-countries
38. Elimination communication – Wikipedia, accessed August 5, 2025, https://en.wikipedia.org/wiki/Elimination_communication
39. Toilet training – Wikipedia, accessed August 5, 2025, https://en.wikipedia.org/wiki/Toilet_training
40. Infant Potty Training in Indigenous Africa: How people potty their babies in countries without diapers (Part 1), accessed August 5, 2025, https://godiaperfree.com/infant-potty-training-in-indigenous-africa-how-people-potty-their-babies-in-countries-without-diapers-part-1/
41. Potty Training Around the World, accessed August 5, 2025, https://pottytime.com/potty-training-around-the-world/
42. Potty training: how to start & best age to potty train – ERIC, accessed August 5, 2025, https://eric.org.uk/potty-training/
43. Social and Environmental Obstacles During Toilet Training …, accessed August 5, 2025, https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/Social-and-Environmental-Obstacles-During-Toilet-Training.aspx
44. The Importance of Consistency in Toilet Training – Positive Solutions Behavior Group, accessed August 5, 2025, https://positivesolutionsbehaviorgroup.com/the-importance-of-consistency-in-toilet-training/
45. Potty training at daycare – Naitre et grandir, accessed August 5, 2025, https://naitreetgrandir.com/en/step/1-3-years/daycare/potty-training-at-daycare/
46. Potty Training Support in Daycare Centers, accessed August 5, 2025, https://playto.com/blog/potty-training-support-in-daycare-centers
47. Untitled – Lactacare Kenya Limited, accessed August 5, 2025, https://lactacarekenya.co.ke/wp-content/uploads/2022/10/TT-Potty-Training.pdf
48. Toilet learning: Anticipatory guidance with a child-oriented approach – PMC, accessed August 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC2819951/
49. Toilet Training Children and Adolescents with Down Syndrome, accessed August 5, 2025, https://www.chop.edu/news/toilet-training-children-and-adolescents-down-syndrome
50. How To Potty Train Your Little One – Baby Soft, accessed August 5, 2025, https://www.babysoft.co.za/tips-and-advice/potty-training/how-to-start-potty-training
51. Potty training problems – NHS, accessed August 5, 2025, https://www.nhs.uk/baby/babys-development/potty-training-and-bedwetting/potty-training-problems/
52. Emotional Issues and Potty Training Problems – HealthyChildren.org, accessed August 5, 2025, https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/Emotional-Issues-and-Bathroom-Problems.aspx
53. Why are children potty training later? – ERIC, accessed August 5, 2025, https://eric.org.uk/why-are-children-potty-training-later/
54. Beliefs about the appropriate age for initiating toilet training: Are …, accessed August 5, 2025, https://www.researchgate.net/publication/6900249_Beliefs_about_the_appropriate_age_for_initiating_toilet_training_Are_there_racial_and_socioeconomic_differences
55. Beliefs about the appropriate age for initiating toilet training: are there racial and socioeconomic differences? – PubMed, accessed August 5, 2025, https://pubmed.ncbi.nlm.nih.gov/16887427/
56. Toilet training age and influencing factors: a multicenter study, accessed August 5, 2025, https://turkjpediatr.org/article/download/1214/1207/1207
57. Cultural relativity of toilet training readiness: a perspective from East Africa – PubMed, accessed August 5, 2025, https://pubmed.ncbi.nlm.nih.gov/887331/
58. Local Perceptions, Cultural Beliefs, Practices and Changing Perspectives of Handling Infant Feces: A Case Study in a Rural Geita District, North-Western Tanzania – MDPI, accessed August 5, 2025, https://www.mdpi.com/1660-4601/17/9/3084
59. Socio-Cultural Factors Influencing Child Faecal Matter Disposal among Caregivers in Wadajir District in Mogadishu-Somalia – ResearchGate, accessed August 5, 2025, https://www.researchgate.net/publication/350966029_Socio-Cultural_Factors_Influencing_Child_Faecal_Matter_Disposal_among_Caregivers_in_Wadajir_District_in_Mogadishu-Somalia
60. The influence of culture on open defaecation in some basic schools in selected districts in Ghana: A preliminary study – PMC, accessed August 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC7537866/
61. (PDF) Toilet training practices in Nigerian children – ResearchGate, accessed August 5, 2025, https://www.researchgate.net/publication/321004732_Toilet_training_practices_in_Nigerian_children
62. Disposable diaper consumption in sub-Saharan Africa: Estimating the risks of associated unsafe waste | PLOS Sustainability and Transformation, accessed August 5, 2025, https://journals.plos.org/sustainabilitytransformation/article?id=10.1371/journal.pstr.0000106
63. TIL that before the introduction of disposable diapers, 90% of American children were potty trained by age two – Reddit, accessed August 5, 2025, https://www.reddit.com/r/todayilearned/comments/a4uv23/til_that_before_the_introduction_of_disposable/
64. Disposable diaper consumption in sub-Saharan Africa: Estimating the risks of associated unsafe waste – ResearchGate, accessed August 5, 2025, https://www.researchgate.net/publication/379877136_Disposable_diaper_consumption_in_sub-Saharan_Africa_Estimating_the_risks_of_associated_unsafe_waste
65. Toilet training research bids to reduce nappy waste | UCL News, accessed August 5, 2025, https://www.ucl.ac.uk/news/2025/mar/toilet-training-research-bids-reduce-nappy-waste
66. Urbanization in sub-Saharan Africa: Declining rates of chronic and recurrent infection and their possible role in the origins of non-communicable diseases, accessed August 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC5935558/
67. South Africa under pressure to eradicate pit latrines at rural schools …, accessed August 5, 2025, https://www.africanews.com/2023/05/14/south-africa-under-pressure-to-eradicate-pit-latrines-at-rural-schools/
68. Water | WHO | Regional Office for Africa, accessed August 5, 2025, https://www.afro.who.int/health-topics/water
69. Challenges of sanitation in developing counties – Evidenced from a study of fourteen towns, Ethiopia – PubMed Central, accessed August 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9898597/
70. Water, Sanitation and Hygiene | UNICEF West and Central Africa, accessed August 5, 2025, https://www.unicef.org/wca/what-we-do/wash
71. A triple threat of water-related crises is endangering the lives of 190 million children – Unicef, accessed August 5, 2025, https://www.unicef.org/press-releases/triple-threat-water-related-crises-endangering-lives-190-million-children-unicef
72. Informal settlements and the care of children 0–3 years of age: a qualitative study – PMC, accessed August 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10482249/
73. The Impact of Water and Sanitation Challenges on Education – DBSA, accessed August 5, 2025, https://www.dbsa.org/article/impact-water-and-sanitation-challenges-education
74. Sanitation services for the urban poor: A social capital approach to sanitation challenges in informal settlements | PLOS Water – Research journals, accessed August 5, 2025, https://journals.plos.org/water/article?id=10.1371/journal.pwat.0000086
75. Water, Sanitation, and Hygiene Challenges in Informal Settlements in Kampala, Uganda: A Qualitative Study – PubMed Central, accessed August 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10298274/
76. socio-cultural barriers and triggers to total sanitation in West Africa – WASH Matters, accessed August 5, 2025, https://washmatters.wateraid.org/publications/towards-total-sanitation-socio-cultural-barriers-and-triggers-to-total-sanitation-in
77. Potty Training for Special Needs, accessed August 5, 2025, https://www.thepottyschool.com/services/special-needs
78. The Potty School: Child Potty Training Services and Consultants, accessed August 5, 2025, https://www.thepottyschool.com/
79. The Ultimate Guide to Potty Training Your Toddler – Moms on Call, accessed August 5, 2025, https://momsoncall.com/blogs/blog/the-ultimate-guide-to-potty-training-your-toddler
80. Why a Father Figure Is Important During Potty Training – Go Potty, accessed August 5, 2025, https://gopottynow.com/why-a-father-figure-is-important-during-potty-training/
81. Potty Training With Young Children – Crane Center for Early Childhood, accessed August 5, 2025, https://crane.osu.edu/our-work/potty-training-with-young-children/
82. Baby Potty & Pant Inserts | Buy Online – Konga, accessed August 5, 2025, https://www.konga.com/category/potty-training-2875
83. Toilet Training Readiness Scale for 0–5-Year-Old Children: A New Measurement Tool Based on a Child-Centred Approach – MDPI, accessed August 5, 2025, https://www.mdpi.com/2227-9067/11/9/1149
84. Popular methods of potty training – Motherhood101, accessed August 5, 2025, https://motherhood101.co.ke/popular-methods-potty-training-2/
85. A Telehealth Delivered Toilet Training Intervention for Children with Autism – PMC, accessed August 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10333974/
86. APA In-Text Citations (7th Ed.) | Multiple Authors & Missing Info, accessed August 5, 2025, https://www.scribbr.com/apa-style/in-text-citation/
87. Early childhood development | UNICEF Parenting, accessed August 5, 2025, https://www.unicef.org/parenting/topics/early-childhood-development?page=1%2C%2C%2C%2C0
88. UNICEF Parenting, accessed August 5, 2025, https://www.unicef.org/parenting/topics/parenting?page=10%2C%2C%2C%2C0