School readiness and continence is an ECEC conversation
In the 1950s and 60s, 97% of children completed daytime toilet learning by the age of three. In Australia today the figure is around 51%. The three factors that best predict a later finish are all things an early learning service is positioned to influence.
What changed
In 1962, the American paediatrician T. Berry Brazelton published outcomes for more than a thousand children toilet trained during the 1950s and 60s. Mean completion for daytime dryness was 28.5 months. More than 97% had finished by 36 months, and fewer than 1% were still in nappies during the day after 42 months.
By 2004, a prospective study of 378 children reported a mean completion age of 36.8 months, with 16% not finished by 42 months. In the 1950s that threshold applied to fewer than one child in a hundred.
The international literature now puts completion by 36 months at between 40 and 60%.
Children’s biology has not changed. Bladders have not changed. What changed is what adults do, and when.
The three factors that predict a later finish
The 2004 study also tested which factors predicted a later finish. Three came through:
• Later start
• Stool toileting refusal
• Frequent constipation
Not one of them is a fixed characteristic of the child. Not one is about family income, education, or commitment. All three are about method and timing, and all three are modifiable.
All three sit inside the hours that children spend in ECEC.
The start point is a decision, and right now nobody makes it
Take the first factor on its own, because it is the one most often assumed to be outside ECEC control.
A study of 221 parents of children aged 15 to 35 months, all using day care weekly, found that 30% were uncertain about the right time to start, and 18% reported not having the time to guide their child through it.
In the same study, 74% said day care and parents should play an equal role. They are already asking for a partner.
Even so, 40% had no idea whether their child’s service used the same method they did.
Not a different method. No idea.
A service with intentional pedagogy changes what the start point is. It becomes an observation against known indicators, documented in the planning cycle, timed to the child, discussed with the family, and then taught.
It stops being the fortnight that happens to be free and becomes a professional judgement, made alongside the family.
Stool refusal and constipation are the same loop
Functional constipation has a median age of onset of approximately 2.3 years, peaking during the toilet learning period between two and four.
Its most common mechanism is stool withholding, which typically develops after a single painful or frightening bowel motion and then reinforces itself: retention increases water absorption in the colon, producing a harder stool, a more painful motion, and more determined withholding.
A child who has one bad experience and no skilled response can enter that loop within a fortnight. Whether they get out of it depends on whether the adults around them recognise what they are looking at. Childhood constipation continues beyond puberty in up to a third of children followed up.
The child is two years old. Children in centre-based day care now attend an average of 34.1 hours a week, close to eight hours a day across four days.
This is not a process we observe from the sidelines.
What the delay is associated with
If late completion were simply a slower route to the same destination, the argument would end here as a matter of convenience. It is not.
A prospective cohort study found that initiating toilet learning after 24 months was associated with persistent daytime urinary incontinence at school age, while initiation between 12 and 24 months was associated with more favourable outcomes. That is the same variable the 2004 study identified as the strongest modifiable predictor of late completion.
Later starts are associated with later finishes, and later finishes with continence difficulties that persist into the school years.
Why nobody is raising the alarm
A study of 1158 parents of children aged 30 to 36 months, drawn from 50 randomly selected schools, asked whether they saw the trend towards later completion as a problem.
81.9% said they did not.
Most parents are not aware of the possible negative consequences later completion can entail. Families are not ignoring a known risk. For the overwhelming majority, there is no known risk.
That is not the same as families being untroubled. In 2021-22 the National Continence Helpline took 1,436 paediatric calls, the most common query being faecal soiling and toilet training practices.
Parents do not see a problem in the abstract. They ring when it is their own child.
What Australia actually measures at school entry
The Australian Early Development Census assesses children in their first year of full-time school across five domains. The 2024 collection covered 288,483 children.
Physical health and wellbeing is the domain in which toilet independence sits. It has three subdomains measuring reasonably discrete concepts: physical readiness for the school day, physical independence, and fine and gross motor skills. Vulnerability across the domain as a whole was 10% in 2024, and it has been rising.
The AEDC does ask a question about independence in toileting habits. It sits within the physical independence subdomain, alongside handedness and hygiene. It is simply not reported on its own.
What this looks like when the children reach school
In a population-based survey of children starting primary school in Sydney, 19.2% had experienced at least one episode of daytime wetting in the preceding six months.
Only 16% of the families with an affected child had sought medical help.
Roughly one child in five arrives at school with an unresolved daytime continence difficulty, and more than four in five of those families have never raised it with a clinician. By then it has usually been present for years without ever being named.
It was present when the child was with us, in ECEC.
The assumption that they grow out of it
Many children resolve this without intervention. The question is what happens to the ones who do not, and at what point waiting stops being reasonable.
Australian clinical guidance is more specific than the wait and see default suggests. Drawing on the International Children’s Continence Society, a lack of bowel control at four years and a lack of bladder control at five years requires assessment and intervention. Incontinence is treated as a chronic condition once it persists beyond six months.
A four-year-old without bowel control is at that threshold. A four-year-old is also in our rooms.
Longitudinal cohort data following 8,751 children from ages four to nine found that only 63% followed a normative path of day and night bladder control. For the one in three who did not, the associations run a long way forward.
• The persistent group had 23.5 times the odds of bedwetting at 14, and close to seven times the odds of daytime wetting.
• Adolescents whose bladder control had merely been delayed, and who then caught up, still showed poorer self-image and more negative perceptions of school at 13 and 14.
• At 18, continence difficulties reported at 14 were associated with roughly three times the odds of generalised anxiety disorder and twice the odds of depression.
The evidence that teaching it deliberately works
The only cluster randomised controlled trial of a centre-delivered group toilet learning method was conducted in daycare centres in Flanders. Centres were randomised to an intensive group session delivered on site, or to a control condition in which families proceeded in their own way.
Median toilet learning duration was two weeks in the intervention group, against five in the control group, and across the six-week follow-up the likelihood of becoming toilet trained was twice as high.
It is a single trial, and a small one. It is also the only published evidence available.
Our own pilot points the same way. Go Time–Potty Time Early Learning was piloted at a single Australian early learning service with 90 approved places as a proof of concept. Before it began, 66% of educators felt confident managing toilet learning and 70% said toileting frequently interrupted learning. Afterwards, educator confidence was 100%, 84% reported that accidents had reduced, and educators and participating families wanted the program to continue.
That is unpublished single-site data, self-reported by educators and families, with no control group and no independent measurement of child outcomes. It is a proof of concept rather than evidence of effect.
Taken together, the trial and the pilot point in one direction. When a service teaches this deliberately, as a group, with a method, children learn it faster and educators are working from an evidence base.
Why this cannot simply be handed back
Families are not being reached. The 16% help-seeking rate is not a statement about family motivation. When 81.9% of parents do not regard later completion as a problem in the first place, a help-seeking rate of 16% is the predictable result of an information gap.
The Continence Foundation of Australia put this to the Commonwealth in its April 2023 submission to the Early Years Strategy. Its language on the prevailing default is unambiguous:
Current early childhood health and development practice encourages parents to wait for their child to demonstrate readiness for toilet training. This has resulted in the adoption of a wait and see approach to childhood incontinence, based on recognition that most children will achieve independent toileting over time. However later commencement of toilet training practices may have detrimental effects on children.
Its fourth priority is training for early childhood education and care workers, its fifth calls for investment to help services build capacity, and its sixth asks government to begin counting how many children start school before learning independent toileting.
That number is closer to hand than the recommendation implies. The question is already being asked of every child in the country. It has simply never been reported on its own.
To be clear about where the gap sits
Educators have never been trained to teach toilet learning, and it is not specifically included in the qualifications. Where guidance exists at all, it tends to be sporadic rather than a shared method.
Meanwhile it sits squarely in the EYLF as a curriculum to be intentionally taught. Toilet learning is the only domain treated as something families drive and services accommodate without a pedagogical anchor. Everything else has intentional teaching, a planning cycle, and documentation.
They do it with real care. They do it without a method. Only one of those is something the sector can change.
The gap is structural. It sits in the system, not in the people.
Questions for pedagogical leads and executive teams
• Where does toilet learning appear in your pedagogical documentation, and is it framed as a care routine or as intentional teaching?
• Who decides when a child begins? If your service waits for the family to raise it first, what happens for the child whose family is waiting for a sign nobody has defined?
• Under Quality Area 2, what would you produce at assessment and rating to show it is taught rather than accommodated?
• If a child had not opened their bowels at your service for three days running, would anyone notice, would it be written down, and would it be raised with the family?
• Do you know what proportion of your three-year-olds are fully independent? Could you find out this term?
None of these asks an educator to make a clinical judgement. They ask whether a service notices, records, and communicates, in the same way it already does for sleep, for what a child eats, and for a bumped head.
What we are actually deciding
The variables driving later toileting independence are ones we can influence in the early years: when it begins, whether stool refusal is recognised and responded to, and whether constipation is caught early.
A child who leaves us with this behind them starts school with one fewer thing that can go wrong in front of everyone.
Language, numeracy, social competence, and emotional regulation each began as something we assumed happened naturally at home, and each became something we teach with intention, document, and improve.
Toilet learning is the last of them still waiting.
Children deserve the best chance we can give them, in the years we have them.
Go Time–Potty Time Early Learning is a structured, whole-centre toilet learning framework for Australian early childhood education and care services, mapped to the EYLF and the NQS. If you would like to talk about what this looks like in a service, we would be glad to hear from you.
Sources
• Brazelton, T.B. (1962), Pediatrics, 29, pp. 121-128, as reported in Blum, N.J., Taubman, B. and Nemeth, N. (2004), Why is toilet training occurring at older ages? A study of factors associated with later training, The Journal of Pediatrics, 145(1), pp. 107-111. Blum et al. is also the source of the 40 to 60 per cent completion range, the mean completion age of 36.8 months, and the three factors associated with late completion.
• Australian completion figure, Christie, A. (2010), Toilet training of infants and children in Australia, as cited in Continence Foundation of Australia (2023), Submission to the Early Years Strategy.
• van Nunen, K., Kaerts, N., Wyndaele, J.J., Vermandel, A. and Van Hal, G. (2015), Parents’ views on toilet training, Journal of Child Health Care, 19(2), pp. 265-274.
• Kaerts, N., Vermandel, A., Lierman, F., Van Gestel, A. and Wyndaele, J.J. (2014), Toilet training in healthy children: results of a questionnaire study involving parents who make use of day-care at least once a week, Neurourology and Urodynamics, 33(3), pp. 316-323.
• Australian Early Development Census (2025), AEDC National Report 2024. Subdomain structure and the toileting independence question per correspondence with the AEDC.
• Austin, P.F. et al. (2016), Neurourology and Urodynamics, 35(4), pp. 471-481, as cited in Continence Foundation of Australia (2023).
• National Continence Helpline call data, Continence Foundation of Australia (2023).
• Ng, K.S. et al. (2021), BJGP Open.
• Joinson, C. et al. (2009), Journal of Developmental and Behavioral Pediatrics, 30(5), pp. 385-393.
• Sureshkumar, P. et al. (2000), The Journal of Pediatrics, 137(6), pp. 814-818.
• Heron, J. et al. (2017), BMJ Open, 7, e014238.
• Grzeda, M.T. et al. (2017), European Child and Adolescent Psychiatry, 26, pp. 649-658.
• Gordon, K. et al. (2023), European Urology, 84(5), pp. 463-470.
• Childhood functional urinary incontinence and school performance: a nationwide matched cohort study (2025), The Journal of Urology.
• Van Aggelpoel, T. et al. (2021), European Journal of Pediatrics, 180(5), pp. 1393-1401.
• Average weekly attendance of 34.1 hours for centre based day care, Report on Government Services 2026, table 3A.18.
• Australian Education Research Organisation, learning trajectories, physical development.
The Blum cohort was drawn from a single suburban United States paediatric practice serving predominantly white, middle and upper-middle class families. The van Nunen study was conducted in Antwerp, Belgium, where nursery school begins at 30 months, creating a structural deadline that does not exist in Australia.