Aims of study
To analyse the evolution of toilet training methods in children in the last three generations and to search for a possible cause for increase of lower urinary tract dysfunctions.

Methods
A questionnaire of 25 questions, previously validated, was handled out to persons in public places together with a letter explaining the purpose of the study. The questionnaires were recollected via a special mail box and by personally picking them up. The first 10 questions were about the personal, social and family data. The next 9 questions were specific about the potty training and the last 6 questions inquired about the age at which bladder and bowel control had been reached and about the duration of the training. The reliability of the answering to this questionnaire had been tested before.

Results
We received 812 replies (32%)filled out by 321 persons (97% of them were female). This population was divided in 3 groups: Group I 87 persons > 60 years old(mean 69.8 years) who trained 276 children; group II 104 persons between 40 and 60 (mean age 50.3 years old) who trained 262 children; group III 130 persons between 20 and 40 (mean age 32.8 years old) who trained 274 children. The number of children pro family decreased from group I to III as expected. We could observe a major change in toilet- training methods over the years. The start of the training has been significantly postponed. As reason to start the training, bladder control during the afternoon nap has lost its importance. The season (summer) became a more important factor as well as start of school. Bladder drill, formerly widely used, was progressively abandoned and a more liberal attitude was adopted by the youngest parent group. The choice of diapers became very different. The baby chair with a hole in the seat became less popular in the younger generations and has been replaced by a normal toilet in a majority of cases in group III often even without a reducing seat or support for the feet. Younger parents do not use one method anymore but try several things mixed. Prompting was used in 76% in group I, 23 % in group II, 8 % in group III. All groups used rewarding more often than punishing. The attitude of the parents when an attempt to void did not succeed was significantly different between the groups: suggestion by running a tap, special noices made by the parent were used more in group I. The invitation to push was only used in group III. The training took less than 6 months in the majority in all groups. Day-time bladder control was achieved before 18 months in 71 % in group I, in 17% in group III. Night-time control was achieved before 18 months in 61 % in group I, in 23 % in group II and in 8% in group III. Bowel control during the night preceded bladder control in most children in all groups. For 90% the potty-training was done at home. In group I 48 % of the grandparents and in group II 80 % of the grandparents estimated that they actively participated in the bladder training.

Conclusions
Our data show that a big change has occured in bladder training over the last 60 years. Potty training has gradually been started later and the very strict schedules used in previous generations have been mostly abandoned. Prompting has not been advocated any more and parents are recommended to adjust the onset of the training to the child's individual needs [1].Several authors are convinced that bladder and bowel control are mainly maturational processes which cannot be accelerated by training. Our findings do contradict this theory. There seems to be a great concordance between the programs proposed today for the treatment of dysfunctional voiding in children and the traditional bladder training methods used by parents 60 years ago [2-3]. It might be possible that starting bladder training when the child stays dry during the afternoon-nap and prompting are ways to avoid bladder dysfunction is children. Further study is being performed.

References
1. Largo RH, Stutzle W. Longitudinal study of bowel and bladder control by day and at night in the first six years of life. Dev Med Child Neurol 1977; 19: 598-606.
2. Gesell A. Infant and child in the culture of today. Harper and Bross, New York 1943.
3. Hoebeke P, VanDeWalle J, Theunis M, DePaepe H, Oosterlinck W, Renson C. Outpatient pelvic floor therapy in girls with daytime incontinence and dysfunctional voiding. Urology 1996; 48: 923-927.