{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T12:11:48Z","timestamp":1778155908808,"version":"3.51.4"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003061","name":"Erasmus Medisch Centrum","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001828","name":"Erasmus Universiteit Rotterdam","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001828","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JPGN rep."],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Recognizing bowel dysfunction and toilet training issues can be challenging due to conflicting information about what is normal. This study aims to provide an overview of toilet training practices and bowel habits in healthy children up to 4 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study among 6850 parent\u2013child pairs was part of the Generation R Study\u2014a population\u2010based prospective cohort study\u2014and used questionnaires regarding toilet training and bowel habits. Logistic regression was used to analyze associations of demographic factors with toilet training start and completion, presented as odds ratios [95% confidence interval].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At 24 months, 60.1% of children had started toilet training, and at 36 months, 60.0% had completed it. Sex, maternal education level, and the child's ethnic background were associated with having started toilet training by 24 months (girls: 1.48 [1.31\u20131.67], high compared to low educational level: 0.65 [0.47\u20130.91], and Turkish, Surinamese, Antillean, and other (outside Europe), compared to Dutch: 1.71 [1.26\u20132.32], 1.73 [1.29\u20132.31], 3.79 [2.04\u20137.05], and 1.53 [1.23\u20131.91], respectively). Only sex and ethnic background showed associations with having completed toilet training by 36 months. Reported defecation frequency varied widely in early life but stabilized to 1\u20132 times daily for 81.3% of children by 24 months. Infrequent bowel movements and predominantly hard feces were present in up to 6.3% and 14.3%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates that 60% of children are toilet\u2010trained by 36 months. Additionally, it provides insights into healthy children's bowel habits and toilet training milestones, highlighting variations by sex, socioeconomic status, and ethnicity, which can help identify abnormal patterns.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jpr3.70163","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T21:28:50Z","timestamp":1773005330000},"page":"218-226","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Toilet training and bowel habits in children up to 4 years: Insights from a population\u2010based prospective cohort study"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7195-568X","authenticated-orcid":false,"given":"Demi","family":"Huijgen","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery Erasmus University Medical Center\u2014Sophia Children's Hospital Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarik","family":"Karramass","sequence":"additional","affiliation":[{"name":"The Generation R Study Group Erasmus University Medical Center\u2014Sophia Children's Hospital Rotterdam the Netherlands"},{"name":"Department of Pediatrics Erasmus University Medical Center\u2014Sophia Children's Hospital Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hendt P.","family":"Versteegh","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Erasmus University Medical Center\u2014Sophia Children's Hospital Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent W. V.","family":"Jaddoe","sequence":"additional","affiliation":[{"name":"The Generation R Study Group Erasmus University Medical Center\u2014Sophia Children's Hospital Rotterdam the Netherlands"},{"name":"Department of Pediatrics Erasmus University Medical Center\u2014Sophia Children's Hospital Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornelius E. J.","family":"Sloots","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Erasmus University Medical Center\u2014Sophia Children's Hospital Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2008.11.029"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.111.4.810"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004310051030"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.1977.tb07993.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1367\/1539-4409(2001)001<0079:FAWTTI>2.0.CO;2"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.99.1.54"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/DBP.0b013e3181ba0e77"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.29.1.121"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365599.2012.693537"},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","DOI":"10.1177\/2333794X20951086","article-title":"Development signs in healthy toddlers in different stages of toilet training: can they help define readiness and probability of success?","volume":"7","author":"Wyndaele JJ","year":"2020","journal-title":"Glob Pediatr Health"},{"key":"e_1_2_8_12_1","unstructured":"KamphuisM Van LeerdamFJM Wierenga\u2010van der HoevenCJ Bulk\u2010BunschotenAMW DeurlooJA BeltmanM. JGZ richtlijn zindelijkheid urine en feces. Nederlands Centrum Jeugdgezondheidszorg.2011.https:\/\/publications.tno.nl\/publication\/34634090\/ZyJjlJ\/kamphuis-2011-zindelijkheid.pdf. Accessed July 2024."},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.1977.tb07994.x"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1464-410x.2000.00737.x"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2004.02.022"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e318251482b"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1542-3565(05)00848-7"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2011-300539"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12098-013-1041-8"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-016-0224-9"},{"key":"e_1_2_8_21_1","unstructured":"New classification of population by origin. Replacing classification based on migration background and the concepts western\/non\u2010western. Statistics Netherlands.2022.https:\/\/www.cbs.nl\/en-gb\/longread\/statistische-trends\/2022\/new-classification-of-population-by-origin. Accessed July 2024."},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2006.03.004"},{"issue":"2","key":"e_1_2_8_23_1","first-page":"172","article-title":"Toilet training age and influencing factors: a multicenter study","volume":"57","author":"Tarhan H","year":"2015","journal-title":"Turk J Pediatr"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e31817efbf7"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2023.113559"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.03.035"}],"container-title":["JPGN Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jpr3.70163","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jpr3.70163","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jpr3.70163","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T11:30:35Z","timestamp":1778153435000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jpr3.70163"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,6]]},"references-count":25,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/jpr3.70163"],"URL":"https:\/\/doi.org\/10.1002\/jpr3.70163","archive":["Portico"],"relation":{},"ISSN":["2691-171X","2691-171X"],"issn-type":[{"value":"2691-171X","type":"print"},{"value":"2691-171X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,6]]},"assertion":[{"value":"2025-04-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}