대소변 가리기 훈련과 영향을 주는 인자에 관한 연구 = A study on the toilet training and influencing factors

다국어 초록 (Multilingual Abstract)

Purpose : We aimed to determine the ideal age for initiating toilet training and investigate the factors influencing the training.
Methods : The study population comprised 1,370 children aged 2-6 years, who visited the pediatric clinics in Jeonju, Iksan, and Gunsan. Their parents were given questionnaires in order to gather data about the types of diapers used, ages when toilet training was initiated and completed for each day and night, its adverse effects, and the educational level and employment and economic status of the mothers.
Results : The toilet training initiation age was low for those living in the country, having an elder sibling(s), and using cloth diapers, and for those whose mothers were employed and had a low economic status. The training completion age was 22.9 months when the training was initiated before the age of 18 months; this was lower than the training completion ages of 25.9 and 31.0 months when the training was initiated at the age of 18-24 months and after 25 months, respectively. However, the required durations in these cases were 8.4, 5.6, and 3.8 months, respectively. Encopresis and refusal occurred more often when the training was initiated before the age of 18 months than when initiated after this age.
Conclusion : Toilet training should begin at least after the age of 18 months considering the developmental status of infants. It is recommended for the future researchers to develop specific guidelines regarding toilet training.

국문 초록 (Abstract)

목 적 : 대소변 훈련 시기와 기간 및 부작용과 이에 영향을 주는 인자 등을 살펴보고, 부모들에게 적절한 교육이 되는 자료를 살펴보고자 이 연구를 시작하였다.
방 법 : 2009년 1월부터 2009년 2월까지 전주예수병원과 전주, 익산, 군산지역 소아청소년과 의원에 방문하는, 만 2-6세 아기 1,370명의 부모를 대상으로 성별, 주거 지역, 가족 관계, 기저귀 종류, 훈련 시작 시기, 낮과 밤에 각각 대소변 가린 시기, 부작용, 엄마의 교육 정도, 맞벌이 여부, 경제 수준 등에 대해서 설문조사하였으며, 대소변 훈련 시작 시기와 기간, 완료 시기 및 영향을 주는 인자와 부작용을 분석하였다.
결 과 : 훈련 시작 시기와 완료 시기는 남녀 차이가 없었으며, 군 지역 거주, 위에 형제 자매가 있는 경우, 천기저귀를 사용하는 경우, 맞벌이, 경제 수준이 낮은 경우에 빨랐다. 낮에 대변 가리기, 낮 소변 가리기, 밤 소변 가리기 완료 시기는 각각 23.7개월, 24.8개월, 32.7개월이었으며, 훈련에 필요한 기간은 각각 4.8개월, 5.9개월, 14.0개월이었다. 훈련 완료 시기는 훈련을 18개월 이전에 시킨 경우에는 22.9개월로 18-24개월의 25.9개월, 25개월 이상의 31.0개월보다 일찍 훈련을 마칠 수는 있었으나, 기간은 18개월 이전에 시킨 경우가 8.4개월로 18-24개월의 5.6개월, 25개월 이상의 3.8개월보다 더 걸렸다. 부작용은 유분증, 변비, 거부 반응, 숨기 순이었으며, 18개월 이전에 훈련을 시킨 경우가 그 이후에 시킨 경우보다 유분증과 거부 반응이 많았다.
결 론 : 대소변 훈련 시기는 최소한 18개월 이후에 아기의 발달사항을 종합적으로 고려한 후에 하는 것이 좋을 것으로 판단되었으며 향후 우리나라의 적절한 권고가 만들어져야 할 것이다.

참고문헌 (Reference)

• 1 Mota DM, "Toilet training: methods, parental expectations and associated dysfunctions" 84 : 9-17, 2008
• 2 Stadtler AC, "Toilet training methods, clinical interventions, and recommendations" 103 : 1359-1361, 1999
• 3 Stadtler AC, "Toilet training guidelines: the role of the clinician in toilet training" 103 : 1364-1366, 1999
• 4 Rugolotto S, "Toilet training" 113 : 180-181, 2004
• 5 Richmond JB, "The syndrome of fecal soiling and megacolon" 24 : 391-401, 1954
• 6 Stein Z, "Social factors in the development of sphincter control" 9 : 692-706, 1967
• 7 Schum TR, "Sequential acquisition of toilet-training skills: a descriptive study of gender and age differences in normal children" 109 : e48-, 2002
• 8 Martin JA, "Secular trends and individual differences in toilet-training progress" 9 : 457-467, 1984
• 9 Blum NJ, "Relationship between age at initiation of toilet training and duration of training: a prospective study" 111 : 810-814, 2003
• 10 Gerrard SD, "Psychogenic megacolon manifested by fecal soiling" 10 : 474-481, 1954
• 11 Largo RH, "Longitudinal study of bowel and bladder control by day and at night in the first six years of life. I: Epidemiology and interrelations between bowel and bladder control" 19 : 598-606, 1977
• 12 Brazelton TB, "Instruction, timeliness, and medical influences affecting toilet training" 103 : 1353-1358, 1999
• 13 Ahn HS, "Hong chang yee textbook of pediatrics. 9th ed" Daehan Printing & Publishing Co, Ltd 33-, 2007
• 14 Mark LW, "Guide to toilet training" American Academy of Pediatrics 1-89, 2003
• 15 Bakker E, "Changes in the toilet training of children during the last 60 years: the cause of an increase in lower urinary tract dysfunction?" 86 : 248-252, 2000
• 16 Steven PS, "Caring for your baby and young child: Birth to age five. 4th ed" American Academy of Pediatrics 321-323, 2004
• 17 Ivor BH, "Beliefs about the appropriate age for initiating toilet training: are there racial and socioeconomic differences?" 149 : 165-168, 2006
• 18 Howe AC, "Behavioral management of toilet training, enuresis, and encopresis" 39 : 413-432, 1992
• 19 Brazelton TB, "A child-oriented approach to toilet training" 29 : 121-128, 1962