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  4. Vol 7, Issue 1, 2026

Associations between Diaper Use Behaviors and Toilet Training Success in Young Children: A Cross-Sectional Questionnaire Study

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DOI: 10.23977/medsc.2026.070110 | Downloads: 0 | Views: 17

Author(s)

Shaoxin Lin 1, Sha Wang 1, Xiaoxia Guo 2

Affiliation(s)

1 Pediatric Internal Medicine Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
2 Department of gynaecology and obstetrics, The First Affiliated Hospital of Jinan University, Guangzhou, China

Corresponding Author

Xiaoxia Guo

ABSTRACT

Toilet training is a critical developmental milestone in early childhood, yet considerable heterogeneity persists in training trajectories and outcomes. Despite its clinical and behavioral significance, limited evidence has clarified the influence of diaper-use patterns, caregiver knowledge and practices, and preexisting urinary symptoms on toilet training success and subsequent bladder function. This cross-sectional study enrolled 500 children to evaluate the impact of diaper-wearing duration, age at diaper cessation, caregiver awareness and behavioral responses, and urinary and bowel symptoms on toilet training outcomes, and to determine whether delayed training is associated with less favorable post-training bladder function. Standardized questionnaires were used to collect detailed information on daytime and nighttime diaper use, toileting behaviors, caregiver practices, and lower urinary tract and bowel symptoms. Participants were categorized into successful (n = 325) and delayed (n = 175) training groups. Descriptive analyses compared baseline characteristics between groups, and multivariable Cox proportional hazards models were applied to identify independent predictors of training success. Delayed training was strongly associated with prolonged daytime and nighttime diaper use, particularly durations exceeding 10 hours per day or per night, as well as later diaper cessation. Older age at training initiation and caregiver awareness of the potential enuresis risk associated with extended diaper use were independently associated with increased likelihood of successful training. In contrast, diaper cessation after 3 years of age, daytime diaper use ≥6 hours, nighttime use ≥8 hours, skin sensitivity, and preexisting urinary symptoms were significant negative predictors. Furthermore, children in the delayed training group demonstrated higher rates of constipation, increased daytime and nighttime wetting episodes, greater urinary frequency and urgency, and markedly lower rates of full-time underwear use following training. These findings suggest that prolonged diaper exposure, delayed discontinuation, urinary dysfunction, and suboptimal caregiver practices are important contributors to delayed toilet training, whereas timely initiation and informed caregiver involvement promote more favorable bladder-related outcomes. The results underscore modifiable behavioral factors that may inform evidence-based toilet training strategies and support optimal bladder development in early childhood.

KEYWORDS

Toilet training; diaper use; bladder–bowel dysfunction; urinary symptoms; caregiver practices; cross-sectional study; early childhood

CITE THIS PAPER

Shaoxin Lin, Sha Wang, Xiaoxia Guo. Associations between Diaper Use Behaviors and Toilet Training Success in Young Children: A Cross-Sectional Questionnaire Study. MEDS Clinical Medicine (2026). Vol. 7, No.1, 100-108. DOI: http://dx.doi.org/10.23977/medsc.2026.070110.

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