Whitney Palmer

Healthcare. Politics. Family.

Not Too Early or Too Late, Potty Training Timing Needs to Be Just Right

Published on the Nov. 12, 2014, North Carolina Health news website

New research on the timing of potty training shows problems for pushing children too soon or waiting too long.

By Whitney L.J. Howell

The frustrating journey of toilet training a child is a struggle every parent faces. Starting kids down this path early can be tempting, but a new study from Wake Forest University found that pushing the topic too soon – or too late – can cause physical problems and lead to wetting accidents.

Children who are toilet trained prior to age 2 or after age 3 have significantly more daytime and nighttime accidents than children trained between the two ages, the study showed.

“Toilet training seems like a religious topic,” said study leader Steve Hodges, a pediatric urologist at Wake Forest Baptist Medical Center. “People can get so mad and say they trained their child at age 2 or 1, and [that] everything is fine. But training too early or late is a risk factor, and we want to prevent toileting problems in all kids with maximal effect.”

As long as a child stays in diapers, his or her bladder continues to grow in size. Being able to urinate freely increases the bladder’s fluid capacity and actually helps it learn to function more effectively, he said. Once toilet training is introduced though, that growth stops. So, according to research from the University of Oklahoma Health Sciences Center, children who toilet train earlier will automatically have smaller bladders, potentially setting them up for future toileting problems.

But the real culprit behind wetting accidents, Hodges said, is constipation. Increased fullness in the bowels presses on the bladder, making it harder for children to control the flow of urine. Over longer periods, that same fullness can also stunt the bladder’s growth, further inhibiting capacity. In addition, the muscles used to restrict bowel movements are connected to muscles that control urination; constriction can make it harder for children to learn proper toileting behaviors.

This study is the first research to connect constipation to wetting accidents in younger children.

“Across the board, most voiding complaints in kids are due to incompletely emptying the colon, not anything to do with the bladder,” Hodges said. “There’s nothing inherently bad about pooping rarely as long as everything leaves the colon. It’s when the colon doesn’t empty that we start to see bladder problems, such as daytime wetting and urinary frequency.”

In some cases, constipation occurs when a child resists parents’ efforts to introduce toilet training. Other times, outside influences, such as a new sibling, can stall a child’s progress.

Hodges’ team followed the toileting habits of 112 children aged 3 to 10 for six months. The majority were toilet trained between ages 2 and 3, and parents reported 38 percent had a history of constipation and 45 percent had experienced daytime wetting.

Although anecdotal evidence shows girls can toilet train earlier and easier than boys, Hodges’ research found being male didn’t increase the likelihood of constipation or daytime wetting.

According to the findings, the children who toilet trained before age 2 were more than three times as likely to suffer from constipation than children who trained between ages 2 and 3. Children who trained after age 3 experienced constipation seven times as often. In addition, when compared to other children, kids who trained early and late had daytime wetness nearly four times and five times as often, respectively.

These problems can frequently be overlooked, said Triangle Center for Behavioral Health clinical psychologist Rebecca Dingfelder, because parents aren’t comfortable broaching the subject with their child’s physician. Dingfelder has expertise in working with children who have toilet-training difficulties.

“A lot of problems stem from parents being embarrassed to talk with pediatricians – not about toilet training but about the constipation that might be going on,” she said. “Parents need to discuss with their pediatricians how things are going with pooping, especially if there are problems with wetting the bed or wetting at school.”

It’s important to remember, Dingfelder said, that children develop at their own paces. Currently, the N.C. Department of Health & Human Services – the agency that oversees day-care center licensures in the state – doesn’t require that children be toilet trained by a certain age in day-care or pre-school environments. However, many such facilities maintain a policy that children must be fully trained before progressing to a 3-year-old classroom.

In some cases, she said, that mandate puts unrealistic expectations on the child and family.

“If a child is cognitively and socially ready to move on, and if toileting is the only thing getting in the way, then day-cares need to cooperate with families to see how they can make it work,” she said.

For example, if day-care facilities don’t have a changing table in the older classes, then arrangements could be made for the child to return to the younger class for diaper changes.

Ultimately, Dingfelder said, she hopes Hodges’ research will relieve much of the stress and anxiety parents feel around toilet training their children as soon as possible. Toilet training isn’t a race to the finish line, she said, and parents shouldn’t feel pressure to push their toddlers too soon.

“Parents these days will say, ‘My kid will read when they read and ride a bike when they ride,’” she said. “We need the same acceptance for toilet training – that it’s OK to start later, and that it’s OK to talk about the stumbling blocks along the way.”

To read the article at its original location: http://www.northcarolinahealthnews.org/2014/11/12/not-too-early-or-too-late-potty-training-timing-needs-to-be-just-right/

November 12, 2014 Posted by | Family, Healthcare | , , , , , , , , , , , , , , , , , , | Leave a comment

Mid-Career Professionals Find Pathway to Enter Medicine

Published in the August 2004 AAMC Reporter

After teaching displaced families in Guatemala, home tutoring teenage mothers in upstate New York and educating Navajo Indians on a reservation in New Mexico, Summer Chapin was overwhelmed by the rampant health problems she encountered. Despite having years of teaching experience and an undergraduate degree in history and literature, she decided she could contribute more by becoming a doctor.

“I felt frustrated that I didn’t have the skills to address all those health problems,” Chapin said, describing why she applied to the Bryn Mawr post-baccalaureate  premedical program. “I decided I had to go back to school even though I’d been out for a few years.”

Not long ago, choosing to be a doctor was a decision students had to make within the first few semesters of their undergraduate education. But over the past 2o years, selecting medicine as a second career or applying to medical school after earing a liberal arts degree has become more common. Whatever the circumstances, students can now enter an accelerated curriculum, called a post-baccalaureate program, to pack required science courses into one year.

Bryn Mawr, Johns Hopkins University and Wake Forest University, along with other institutions, choose a select number of students each year to enter their 12- to 14-month programs, designed to put individuals changing careers or non-premed students on the fast track to medical school. Their programs range from seven to 75 students.

Growing Trend

“Post-baccalaureate students weren’t that prevalent 20 to 25 years ago, and the ones who applied to medical school were subject to questions concerning their motivation for entering the field,” said David Trabilsy, Ed.S., director of the Johns Hopkins program. “But when the applicant pool dropped in the 1980s, medical schools realized these students could be valuable contributors, and their previous careers could add diversity to the school.”

Post-baccalaureate programs release students from the intense demands of premedical curricula during their  undergraduate years, Dr. Trabilsy said. They have the opportunity to focus on and develop other areas of interest before settling into the rigors of medical training.

Applicants selected for most post-baccalaureate programs must exhibit outstanding undergraduate work or accomplishments in their previous profession. But Wake Forest’s program, the smallest of the three, focuses on minority and disadvantaged students who cannot compete with typical applicants  for a medical school slot, said Brenda Latham-Sadler, M.D., the school’s associate dean of minority affairs.

“These students are average so they’re not good enough to get into medical school right out of undergraduate,” she said. “They’re right at the edge, so they might want to use the program to reinforce what skills they already have.”

Wake Forest post-baccalaureate students typically have a 2.5 grade point average and a 21 on the MCAT. The national average MCAT score is 24. Maintaining a post-baccalaureate program designed for nontraditional medical students helps create a more diversified face for academic medicine, Dr. Latham-Sadler said.

Once enrolled, students complete courses in four basic sciences that medical schools require: biology, general chemistry, organic chemistry and physics. In addition, accepted students should already have completed calculus.

Relaxed Environment

According to Jodi Domsky, assistant dean of health professions at Bryn Mawr, post-baccalaureate  programs provide a less stressful, less competitive environment for students aspiring to be physicians. They find encouragement from both faculty and their classmates.

“The students work together, they study together and they get involved in special interest groups together,” Domsky said. “I think the students feel like there is a lot of individual support here.”

Each post-baccalaureate program works on a semester schedule with students with enrolling in the summer months and taking courses for the full year. In addition to class work, students have the option to gain hands-on experience by working in various clinics, often treating underserved populations.

Advisors also work with students throughout the year, monitoring their progress, reminding them of application deadlines and congratulating them on successes. Having advisors pay individual attention to students makes the rigorous program a bit more manageable, said Sasha Waring, a recent Bryn Mawr post-baccalaureate graduate.

“I feel like someone has taken a genuine interest in me,” he said. “It’s nice to have someone who cares about us and wants us to do well.”

After completing the program, students have the option to take a “glide year.” This time can be used for additional volunteer activities in medical clinics, as well as researching and applying to medical school. However, both Johns Hopkins and Bryn Mawr have linkage programs with various institutions that allow students to apply and commit to a particular medical school before completing the program, thus bypassing the glide year. Wake Forest does not have a linkage program or a glide year. Instead, the university strives to enroll its post-baccalaureate students in its own medical school as soon as they have completed the program.

April 8, 2010 Posted by | Healthcare | , , , , , | Leave a comment


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