A multicenter prospective evaluation of a decision chart for toilet training initiation.

Background: There are currently no widely accepted standardized guidelines for determining the optimal timing to initiate toilet training in children. This study aimed to develop and evaluate the effectiveness of a newly designed tool-the Toilet Training Initiation Decision Chart (TTIDC). Methods: This multicenter, prospective, open-label intervention study included children aged ≥18 months attending 70 nursery schools. Participants were divided into an intervention group, which utilized the TTIDC, and a control group, which followed conventional toilet training practices employed by each school. Weekly observation records were collected from July 1, 2022 to June 30, 2023. The primary endpoints were the duration of toilet training and the age at which toilet training was completed. The TTIDC was developed based on a prior pilot study. Results: Of the 354 children enrolled, 43 completed toilet training during the study period. There was no significant correlation between the age of toilet training initiation and the duration required to complete training. However, the median age at completion was significantly younger in the intervention group (37.5 months) compared with the control group (40.8 months; P=0.002). Conclusions: This chart may serve as an effective tool for initiating toilet training at an appropriate developmental stage. This chart may be associated with completion of toilet training at a younger age, without prematurely accelerating initiation or unnecessarily prolonging the process.