PART A: Over the past 100 years, recommended toilet training (TT) methods have oscillated between the two most common TT methods used in North America - rigid adult-directed programs and child-oriented ones (1). In 1962, Brazelton (2) developed the 'child readiness' approach, which focused on gradual training and is child-oriented. Current TT guidelines developed by the Canadian Paediatric Society and the American Academy of Pediatrics include a child-oriented approach, not starting before 18 to 24 months of age, and beginning when the child displays interest (3,4). The Foxx and Azrin (FA) (5) method emerged in 1971 as a parent-oriented method that emphasized structured behavioural end point training aimed at eliciting a specific chain of independent events by quickly teaching the component skills of TT. These two methods differ with respect to goal development, end points and emphasis on the child's self-esteem. Other methods include variations of operant conditioning and assisted infant TT (6,7). The goal of operant conditioning is to establish habits and proper behaviours through positive reinforcement with rewards (8). Assisted infant TT emphasizes simultaneous training of bowel and bladder control by the parent learning the infant's elimination signals (6). This can begin at two to three weeks of age (9). This method has been criticized as the 'parent training' method because the parents must be trained to recognize their infant's elimination cues.
PART B: In many cultures, including North America, successful toilet learning is perceived as a major step in a child's development and independence. It is a topic that is routinely reviewed at well-child appointments, and can create parental anxiety and frustration if independent toileting is delayed or problematic.