Tuesday January 29 2013
There is limited evidence whistling works as a potty training method
'Potty training? Try whistling!' is the headline in the Daily Mail, as 'Vietnamese families credit it with getting their babies out of nappies by nine months.'
The news is based on research that quizzed 47 Vietnamese mothers about which potty training techniques they used, and whether they thought these methods were successful.
The researchers found that all of the mothers used a whistling sound at certain times to help their child begin to urinate, and to encourage the child to continue urinating once they had started (a technique reported to be widely used in Vietnam).
Using this technique, all children in the study were considered to be able to use a potty by nine months of age, and most of them were regarded as being able to manage the potty independently by the age of two.
In contrast, most children in the UK don't achieve "potty independence" until they are around the age of three. A more "baby-led" approach (where parents judge when their child is able and willing to undergo potty training) is usually encouraged in Western countries such as the UK.
While this very small study is fascinating, it provides very limited evidence that whistling to help toilet train very young children is effective.
Parents in the UK who are considering "fast-tracking" potty training should be aware that there are some practical drawbacks to the methods used by the mothers in this study, not least that the whistling technique requires keeping babies partially or fully naked, which isn't always suitable in the British climate.
Where did the story come from?
The study was carried out by researchers from the University of Gothenburg, Sweden and other Swedish institutions. Sources of funding were not reported, although the researchers stated that they had no financial conflicts of interest. The study was published in the peer-reviewed Journal of Pediatric Urology.
The researchers say that children in Western countries usually start potty training later than they did in the past, and that families may wait until the child is around the age of three before they begin potty training.
The study's findings are covered accurately by the Daily Mail, which also gives some useful cultural background to the news: "Early toilet training has traditionally been regarded as a badge of pride in Vietnam."
What kind of research was this?
This was a qualitative study looking at Vietnamese mothers' experiences of potty training their child early on in the child's life (before the age of two).
Qualitative research uses individual in-depth interviews, focus groups or questionnaires to collect, analyse and interpret data on people's behaviours and the reasons behind these behaviours. It reports on the meanings, concepts, definitions, characteristics, metaphors, symbols and descriptions of things. It is often exploratory and open-ended, and the interviews and focus groups usually involve relatively small numbers of people.
Qualitative research can often provide useful insights into subjects and issues, but it cannot provide "hard evidence" in the same way as quantitative research, such as a randomised controlled trial.
What did the research involve?
The researchers recruited 53 mothers of healthy children (no twins). The parents were signed up at a Vietnamese hospital when they were attending for health check-ups. To be included, their children had to have no history of urinary tract infections or bladder problems.
Each mother was interviewed for an average of 15 minutes by the lead researcher at seven different time points: when the baby was newborn, and when they were 3, 6, 9, 12, 18 and 24 months old.
The researchers say the interviews were conducted in an open and narrative manner similar to a conversation, and that mothers were encouraged to speak freely without interruption. Each interview started with the questions, "Can you tell me how you manage your child's pee and poo?" and "How does your child manage that?".
The lead researcher then compiled all of the interviews into a single text and carried out a qualitative analysis. Meanings were extracted from the text, coded and sorted into categories that included "recognise signs of need", "follow routines" and "use whistling sound". This analysis was then separately reviewed by the other two researchers, and further analysis was performed until an agreement was achieved.
Observations of the child's potty skills were reported as being carried out by the researchers in connection with another part of the study.
What were the basic results?
Of the 53 participating mothers, six dropped out of the study after two visits, as they were unable to attend interviews. Of the remaining 47 mothers, 70% were first-time mothers, while 55% of the children were boys and 45% were girls. The authors report that according to Vietnamese tradition, "good mothers" are expected to potty train their child early. Results from the qualitative analysis included:
- almost all the mothers started potty training at newborn age
- according to tradition, mothers used a whistling sound at certain times to help their child begin to urinate, and to encourage the child to continue urinating once they had started
- mothers frequently checked for signs of need, such as specific facial expressions, crying, red face or touching or holding the genitals, and learned that their child should be reminded to urinate
- nappies were reported as being rarely used
- the weather was regarded as an important factor in potty training, and that the process was easier in warmer months
- at the age of three months, all mothers tried to potty train their child by using a whistling sound while holding their child over a potty or in the garden
- using the whistling technique, all children used the potty by the age of nine months
- from the age of 18 months, children were regarded as having bladder control almost all of the time
- at the age of 24 months (two years), potty training was regarded as complete and most of the children managed the potty independently
How did the researchers interpret the results?
The researchers conclude that it is possible to start potty training with good outcomes very early in life. They say this process can be achieved through an "ongoing communication between parent and child".
The process they refer to includes not using nappies and looking for early signs of need. However, to succeed the child also needs to be emotionally supported and reminded to use the potty.
The authors note that the benefits of potty training in this way need to be studied further and investigated in different settings.
Despite the interesting nature of this study, it provides very limited evidence that whistling is effective as a method of helping very young children to toilet train. The study design – which had no comparison (control group) – means that no firm conclusions can be drawn. Other limitations include the small number of participants included, and that the study was carried out in only one hospital location and in one country.
It is not known if the same findings and meanings would be found for UK mothers who try toilet training their children at a very young age, or at the usual toddler age. It is also unclear whether culture and tradition have a role to play.
Among the host of unanswered questions thrown up by this study is how willing most UK parents would be to attempt using the whistling method. In a country where nappies are cheap and readily available, many busy parents may believe that the extra time and effort taken to potty train a baby at an earlier age is not worthwhile.
Overall, this very interesting study only provides a limited picture of the experiences of a small number of Vietnamese mothers when toilet training their children.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.