Discuss possible caregiver reactions to toileting. Include ways they may foster autonomy or create feelings of shame and doubt.

HUMAN DEVELOPMENT AND DIVERSITY
 
Toilet Training
 
Every human culture has practices to remove waste products from close proximity to the social group. The effort to teach children how to dispose of human waste in a culturally appropriate fashion is the focus of what we in the United States refer to as toilet training or potty training. Any approach to this task reflects a combination of technology, beliefs, and practices. One of the basic issues is whether one believes that the regulation of this training should be left to the child, drawing on a sense of developmental readiness, or given over to others, which usually suggests a training program (Valsiner, 2000).
 
In psychoanalytic theory, toilet training symbolizes the classic psychological conflict between individual autonomy and social demands for conformity. Children must subordinate their autonomy to expectations for a specific routine regarding elimination. In the United States, the contemporary approach to this dichotomy between autonomy and conformity is advocated by the American Academy of Pediatrics (American Academy of Pediatrics, 2016; Stadtler, Gorski, & Brazelton, 1999). The American Academy of Pediatrics website has an extensive list of articles addressing various aspects of toilet training, including readiness, choosing a potty, and dealing with accidents (https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/pages/default.aspx).
 
Their advice about toilet training combines waiting until the child is ready and introducing toileting in a guided, systematic fashion. They suggest three areas of readiness: physical maturation, including the ability to sit, walk, dress, and undress; cognitive maturation, including the ability to understand and comply with directions; and social maturation, including the desire to imitate and identify with adults as well as a desire for self-determination and mastery. The process is expected to begin at around 18 months when infants show some interest in the potty and be complete by around age 4 when toddlers will be able to accomplish both day time and night time toileting. Even when they are managing well during the day, many children continue to have difficulty staying dry through the night well into their middle childhood years.
 
Experts suggest starting with bowel training and then moving on to urinating in the potty by allowing the child to play near the potty, dropping the contents of the dirty diaper in the potty so the child sees the connection, reminding the child to use the potty when needed, but not to show disappointment when he or she misses or forgets. Patience, reassurance, and praise are suggested while the caregiver encourages increasing compliance with toileting practices (Mayo Clinic, 2014).
 
This approach, which you may find extremely sensible and right, can be contrasted with the practices of the Digo, a group living in coastal Kenya
and Tanzania. The Digo live in huts with mud floors. The smell of urine mixed with the mud is extremely unpleasant and difficult to remove. So the Digo are eager to have their infants urinate out of the hut as early as possible. Training begins at 2 to 3 weeks of age. The caregiver sits on the ground outside the hut with feet outstretched and places the baby in the appropriate position for urinating. The baby is placed on the caregiver’s feet, facing away from the caregiver but supported by the caregiver. While in this position, the caregiver makes a low sound (“shuus”), which serves as a conditioned stimulus for urination. This is repeated frequently, day and night, until the baby urinates in this position following the sound. When this happens, the baby is rewarded with breastfeeding. By the age of 4 to 5 months, Digo babies are trained to urinate only in the culturally approved position and setting (De Vries & De Vries, 1977). In contrast to the recommendations of the American Academy of Pediatrics, this approach places a strong emphasis on training and shows a perception of readiness that is much earlier than the perception of readiness held in the United States and other Western cultures.
 
Discuss possible caregiver reactions to toileting. Include ways they may foster autonomy or create feelings of shame and doubt.