1962;29;121-128 Pediatrics T. Berry Brazelton A CHILD-ORIENTED ...

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third of these, were started to be trained before 18 months. One hundred and eight (9.2%) were untrained by 4 years. Of these 70 or two-thirds had started training be fore 18 months. Of the 16 problem chil dren only two had started early, and the time of training them seemed to have little influence in creating their more severe dif ficubties. Of these 16 children, 12 were enuretic after 5 years of age, 4 soiled in stress situa tions, and 8 had chronic constipation. There were environmental problems in all of these cases, and it was obvious that in each of these children the above symptoms reflected deeper disturbances of a psycho genic nature. But of the other 1,154 in the group, there were often similar environ mental stresses present, and it is encourag ing that these did not produce problems in the training area. This suggests that by allowing the child more freedom to develop his controls at his own speed, problems in such an area may be prevented, provided parental anxiety in this area can be averted also. It is not possible in this paper to present the details of techniques available to pediatricians which can facilitate the handling of incipient problems, but these results bead one to believe that such a child-oriented approach does divert en vironment tension from this area and may reduce the incidence of subsequent diffi culties. SUMMARY Results of toilet training obtained from the records of 1,170 children in pediatric practice over a 10-year period are sum marized. The suggested method stressed the child's interest and compliance in de veloping autonomous control. This was in stituted at about 2 years of age and de pended on his physiologic and psychobogic readiness. Initial success was achieved simubtane ously in both bowel and urinary control in 79.5% of the cases, 12.3% in bowel control alone, and 8.2% in urinary control. This first accomplishment was reached at an average ARTICLES 127 age of 27.7 months. Daytime training was completed between 2 and 2% years of age in 80.7% of this group. The average age for day training was 28.5 months; males and females showed no significant difference; first children were 1.2 months slower than their siblings. Night training was accom plished by 3 years in 80.3% of cases. The average age for completion of all training was 33.3 months. Males took 2.46 months longer for complete training. First children were delayed 1.7 months in complete train ing in relation to their siblings. Of the children who had chronic diffi culties in this area, 76 (6.5%)were untrained at 4 years, and 16 (1.4%) were failures by the age of 5 years. The value of such a child-oriented program in preventing resid ual symptoms is stressed. REFERENCES 1. Bell, A. I., and Levine, M. I. : The psychologic aspects of pediatric practice : I. Causes and treatment of chronic constipation. Pzm ATRICS, 14:259, 1954. 2. Bodian, M., Stephens, F. D., and Ward, B. C. H. : Hirschsprung's disease and idiopathic megacolon. Lancet, 1 :6, 1949. 3. Davidson,M.: Constipationand fecal incon tinence. Pediat. Clin. N. Amer., 5:749, 1958. 4. Garrard, S. D., and Richmond, J. B. : Psycho genic megacolon manifested by fecal soiling. Pznwrmcs, 10:474, 1954. 5. Glicklich, L. B.: An historical account of enuresis. PEDIATRICS, 8 :859, 1951. 6. Greenacre,P.: Urinationand weeping.Amer. J. Orthopsychiat., 15:1, 1945. 7. Huschka, M. : Child's response to coercive bowel training. Psychosom. Med., 4:301, 1942. 8. Isaacs, S.: On Bringing Up of Children. New York, Brunner, 1952. 9. Prugh, D.: Childhood experience and colonic disorders. Ann. N. Y. Acad. Sd., 58:355, 1954. 10. Reichert, J. L. : Constipation in infants and young children. Pediat. Clin. N. Amer., 2: 527, 1955. 11. Richmond, J. B., Eddy, E. J., and Garrard, S. D. : Syndrome of fecal soiling and mega colon. Amer. J. Orthopsychiat., 24:391, 1954. 12. Spock, B., and Huschka, M.: The Psychologic Aspects of Pediatric Practise, Vol. 13. (Prac titioner's Library of Medicine and Surgery). New York, Appleton-Century, 1938, p. 775. Downloaded from www.pediatrics.org by Cynthia Ferrell on April 15, 2011
<strong>128</strong> TOILET TRAINING 13.Bromfeld,J. M., and Douglas,J. W.: Bed wetting prevalence among children aged 4- 7 years. Lancet, 270:850, 1956. 14. Cole, N. J.: Assessment current parental prac tises. Amer. J. Orthopsychiat., 27:815, 1957. 15. Gesell, A., and Thompson, H.: Psychology of Early Growth. New York, Macmillan, 1938, p. 142 if. 16.Ford,F. R.:DiseasesoftheNervousSystemin Infancy, Childhood and Adolescence. Spring field, Ill., Thomas, 1952. 17. Escalona, S.: Emotional Development in the FirstYear of Life.New York,Macy, 1952. A P@nc@i.@ OUTLINEFORPREPARINGM@ ICAL TALKS AND P@i@iis, Robert M. Zollin BOOK REVIEW ger, M.D., William G. Pace, III, M.D., and George J. Kienzle, B.A. New York, Macmillan, 1961, 57 pp., $1.95. This booklet of 64 pages is as simple, prac tical, and prosaic as the reminders inside its front and back cover for the medical man when (A) returning from meetings (â€œAnswerac cumulated mail. Report interesting and new information to staff. Outline plans for new projects.â€) and when (B) preparing for visitors (â€œPlancoffee breaks. Special honorarium must be arranged well in advance.â€).Between these covers there is a wealth of useful detail, some of it also a little self evident, but well worth the time of any speaker or writer, and required 18. Sears, R. R., Macoby, E. M., and Levin, H.: Patterns of Child Rearing, Evanston, Ill., Row, Peterson & Co., 1957. 19. Conrad, S. J.: Study of preschool children. Amer. J. Orthopsychiat., 18:340, 1948. 20. Hill, L. F.: Expected behavior in children. Minnesota Med., 41:114, 1958. 21. Leitch, M., and Escalona, S.: Reactions of in fants to stress, in Psychoanalytical Study of Child, Vols. 3 & 4. New York, International Universities Press,1949.p. <strong>121</strong> if. 22. Senn, M. J. E.: The Healthy Personality, Vol. 2. Macy, 1950. reading for most. The eight pages devoted to medical writing are scarcely enough for their purpose, but the rest of the booklet, with its brief sections on the various sorts of self-made slides and of those requiring technical assistance, is excel lent. Perhaps most welcome of all is the section on projection screens, with its diagrams of proper relationships between screen size, room size, wattage tor. of bulb, and focal length projec The Director of the Department of Visual Education of the Children's Hospital Medical Center tells us: â€œ¿This booklet is well done, authentic. I approve heartily.â€ Coming from F. B. Harding, this approval is impressive. Downloaded from www.pediatrics.org by Cynthia Ferrell on April 15, 2011 C.A.S.
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