Toilet Training Goes High Tech

June 20 -- FRIDAY, June 19 (HealthDay News) -- For countless generations, parents have been trying to get toddlers to pee in the toilet. Now, Belgian researchers think they have come up with a 21st century solution -- electronics.

Researchers at the University of Antwerp are working with a diaper alarm that alerts grown-ups, especially day care attendants, when tots do their business in their diapers. The alarm emits a pleasant musical sound when wet and does not harm the kids.

The theory behind the study comes straight out of the annals of behavioral and biofeedback psychology. By responding faster to dirty diapers, attendants can give appropriate encouragement and help children focus on bladder control more efficiently, said Jean-Jacques Wyndaele, study co-author and professor of urology at the University of Antwerp.

The technique had not been tested among healthy toddlers, although alarms have been used successfully to help older children overcome bedwetting problems and teach mentally retarded children to use the toilet, Wyndaele said.

"There's overall very little research in this area," he said. "We wanted to see if this would work."

The team picked 39 healthy youngsters at several Belgian day care centers. The kids, who were 18 to 30 months old, were chosen for their relative maturity and readiness to begin toilet training.

Training started as soon as the children arrived at day care and continued throughout the day for three weeks. Special diapers made by the researchers consisted of a light alarm box attached to a self-adhesive strip in the diaper. When the strip got wet, the diaper emitted a ringing sound, and the child was taken to the potty and encouraged to finish.

Researchers rewarded their tiny test subjects if they completed their business on the toilet.

All children wore the same type diapers, but only about half wore diapers connected to the alarm box.

The alarm plus positive reinforcement seemed to work. Children wearing the alarmed diapers achieved independent bladder control nearly 52 percent of the time, researchers said. That was significantly better than the others' 8.3 percent, according to the study, published in Neurology and Urodynamics. What's more, the effects seemed to last at least two weeks beyond the test period.

One of the key advantages of the wetting alarm diaper-training method is that the child and the caregiver are immediately informed of leakage, Wyndaele said. The alarm itself distracts the child and strengthens the awareness of bladder behavior. By bringing the child to a bathroom at that moment, further reinforcement is given.

Wyndaele said the technique could be especially useful in Europe and the United States, where a large percentage of children regularly attend day care.

"The participation in the toilet-training process of the day care providers is thus valuable because they are often among the first to recognize when a child is developmentally ready to be toilet trained," he added.

And though intrigued by the study, two pediatricians in New York expressed some doubt that the Belgian method is better than the tried-and-true methods used by so many moms.

"I'm just not sure," said Dr. Marc Childs, who practices in Brewster, N.Y. "I usually find that toilet training works if you make the child think it's his need, not yours. My advice is, don't make diaper changing particularly enjoyable and reinforce others in your family when they go to the bathroom. He'll eventually get the message."

Dr. Peter Richel said that he did not see a downside to the alarm method, but would like to see more data.

"It's interesting and harmless, but the study is too small," said Richel, chief of pediatrics at Northern Westchester Hospital Center in Mount Kisco, N.Y. "Still, my philosophy is that if it doesn't cause the patient harm, then give it a shot."

More information

The Nemours Foundation has more on toilet training.

SOURCE: Jean-Jacques Wyndaele, professor, urology, University of Antwerp, Edegem, Belgium; Marc Childs, M.D., pediatrician, Brewster, N.Y.; Peter Richel, M.D., chief, pediatrics, Northern Westchester Hospital Center, Mount Kisco, N.Y.; April 2009, Neurourology and Urodynamics