Rx for Readers: Toddler training traumas

Is this standard behavior?

A toddler at a playground in Tel Aviv (photo credit: BEN HARTMAN)
A toddler at a playground in Tel Aviv
(photo credit: BEN HARTMAN)
 What is the accepted story for toilet training toddlers in Israel? When my son and daughter grew up in the 1970s in a far-off country, there were no disposable diapers.
The aim of the exercise was to toilet train children as young as possible so you didn’t have to wash a dozen dirty diapers every day. The children went along with this as they didn’t like wet diapers on their behinds. With the advent of disposable diapers, which guarantee the child will not feel wet, the whole scenario seems to have changed.
My son and daughter were toilet trained at 21 months and out of diapers at night at 24 months. They grew up without any psychological problems. The advice then was then that as soon as the child was aware of what he was doing, it was time to train him/her. I see children here who are more than three years old and still in diapers during the day. What’s wrong? Is it laziness on the part of the parents or the day-care facility? Disposable diapers are so expensive that I am surprised parents do not want their children out of them as soon as possible.
My stepdaughter has a boy who is nearly four years old. When he was about 21 months, he became aware of what he was doing.
He would say to her: “Ani rotzeh la’asot pipi” (I want to pee). She would reply “Lo nora” (it’s not terrible), so he would wet himself. I bought him a toilet seat with a ladder, as he was at the age where he was looking for something to climb. She assured me that this was only for girls, so I gave it away. Last week he was standing in front of the TV watching his favorite program.
He asked his mother to bring him a diaper so he could fill it while watching TV. His grandfather commented on this and was told this was a common problem among boys. I am so disgusted I can’t bear to go there any more.
Is this standard behavior? My daughter-in-law is such an “authority” on child behavior even though he is her first child. Being the “wicked stepmother” I am, I have always kept quiet and never given my opinions, even though I raised two children and am a teacher of intellectually handicapped children.
I am sad to see what was a very bright child being “dumbed down” by his mother. By the time he gets to school, he will have severe problems. He is afraid of loud noises, animals and apparently toilets. What will he be like by the time he starts school?
-G.T., Kiryat Tivon
Prof. Arthur Eidelman, an emeritus professor of pediatrics at Jerusalem’s Shaare Zedek Medical Center and at the Hebrew University Faculty of Medicine and Ben-Gurion University’s Faculty of Health Sciences, comments: This story is charming, but it mixes the issue of toilet training and the behavior of this specific child and his potential school readiness. Yes, there is an impression that since disposable diapers became available, toilet training comes later than it used to. I prefer to avoid discussing the specifics of his behavior.
Multiple studies (including that of the American Academy of Pediatrics) indicate no benefit from toilet training before 27 months and that is the age to begin the process.
An expert wrote in Pediatric Dermatology in 2014 that regardless of the country’s preferences for using cloth or disposable diapers, babies tend to wear cloth diapers for significantly fewer months than those wearing disposable diapers. Those using cloth diapers appear to be toilet trained at a younger age or are moved to disposable diapers as they get older.
Cultural norms greatly influence the age at which a baby begins toilet training.
High cloth diaper usage markets, such as India and China, tend to begin toilet training babies when they are younger than one year of age. Russia, although predominately a disposable diaper usage market, also follows this practice of early toilet training. There is remarkable international variance in the average age on initiation of toilet training. In European countries such as Germany, France and the United Kingdom, as well as the US and Japan, babies typically do not begin toilet training until approximately the age of two.
I am a 67-year-old man who has suffered from benign nasal polyps, stuffed nose and sinusitis for decades. I also have been unable to smell for many years. The polyps were removed in three operations over 16 years, but they always come back. Sixteen years ago, I had been scheduled for the third operation using a computerized device connected to an endoscope. In preparation for the operation, I was given prednisone and an antibiotic that made me feel so good that I decided to forgo the operation. Since then, when I cannot breathe easily because the polyps grow, I have been doing rapid aerobic exercise – often hundreds or thousands of kicks in the air while lying on my back – that releases adrenaline and cleared up my nose.
Recently, I found what I think is a very satisfactory solution; an otolaryngologist from my Clalit Health Services health fund prescribed an injection of Diprospan, a relatively long-lasting corticosteroid.
I received one intramuscular injection in April and a second in August. Immediately after the injections, my nasal breathing became completely free and stayed so free that my hundreds and even thousands of quick upward kicks (or any alternative aerobic exercise ) per day have been reduced to zero since April. Now I breathe nasally without aerobic exercise.
I would like to know how frequently one may receive injections of Diprospan (because its effect is beginning to wear off), and whether they cause any harmful side effects.
-A.M.S., Jerusalem
Dr. Uri Peleg, head of the nasal and sinus disease service in the ear-noseand- throat outpatient department at Shaare Zedek Medical Center, replies: If you are healthy without diabetes or hypertension, you can ask your doctor for a shot of Diprospan up to three times a year. You should also get steroids in spray form for your nose, such as Flixsonase, Steronase or Avamys. Also consider taking additional drugs such as Singulair (montelukast sodium) or clarithromycin.
I would be glad to give advice at our outpatient clinic.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or email it to jsiegel@jpost.com, giving your initials, age and place of residence.