Development of bladder control in a population that is potty-trained early - A follow up study in Vietnamese children

Abstract

The overall purpose of this thesis was to advance the knowledge of bladder function development in children with the focus on early onset of potty training. Specific aims - To describe, longitudinally, the development of the micturition pattern in healthy children who are potty trained early, from birth to the age of three (Papers I and III) - To describe mothers’ experiences of an ongoing potty training process in healthy children and how children and parents communicate these needs (Paper II) - To compare, longitudinally, the voiding pattern and emptying ability of healthy children who are potty trained early with children who are potty trained late (Paper III) - To investigate if potty training already from infancy can affect bladder dysfunction in boys with posterior urethral valves (PUV) (Paper IV) Participants: Papers I-III. Forty-seven healthy Vietnamese children, 0-3 years of age, were followed longitudinally every 3 months. Paper IV. Seventeen children born with (PUV), 0-4 years of age, 18 months follow-up. Methods: Quantitative follow-up using 4-hour voiding observation and qualitative interviews. Comparisons are made between groups and also with Swedish healthy children. Results: Infants in Vietnam rarely used diapers; daily potty training was applied to most of them from the age of 3 months and daily to all the children at the age of 12 months. Compared with the Swedish children, none had started potty training at that age (Papers I and III). By the age of 24 months, potty training had been completed for 98%. In the Swedish group, 5% had started daily potty training by the age of 24 months and by the age of 36 months 55% had completed potty training. The difference was significant (p<0.001). Potty training performed daily affected the emptying ability positively: at the age of 9 months, no residual urine was found in the healthy children. These results differ significantly from the group of Swedish children. The frequency of voiding was lower in the Vietnamese children than in the Swedish group. Bladder volumes increased by age in both groups, but in the Vietnamese children it was significantly lower than in the Swedish children. The potty-training process showed communication developing between the mother and child (Paper II). In the child’s first months of life, the mothers tried to recognize signs of the need to urinate. The mothers supported these signs using a whistling sound at certain times as a reminder. Furthermore, findings from the 4-hour voiding observation showed few symptoms of dysfunctional bladder in the Vietnamese boys with PUV (Paper IV): the emptying was almost complete. Conclusions: It is possible to perform potty training in infant children by learning to communicate needs. Potty training performed daily affected the emptying ability positively in all children including the boys with PUV: at the age of 9 months, no residual urine was found in healthy children. The frequency of voiding and the bladder volumes were lower in the Vietnamese children than in the Swedish group. Early potty training reduced the symptoms of bladder dysfunction in boys with PUV.

Key words: Bladder, children, communication, content analysis development, potty training, reference values, signs urethra valves, urination

ISBN 978-91-628-8737-7