Re: Yang SS‐D, Zhao L‐L, and Chang S‐J. Early initiation of toilet training for urine was associated with early urinary continence and does not appear to be associated with bladder dysfunction. Neurourol Urodyn 2011;30:1253–7

Dear Editor, Françoise Dolto, an important psychoanalyst of the 20th century, pioneer in advising parents and a great researcher of child development, described that enuresis, is often so misunderstood. As result, many children were subjected to sadistic experiences by parents who forced them to sleep without a blanket on the floor to feel coldwhen urinating, some would make a garrotte around the boy’s penis with a shoelace knot to inhibit urination, or even let the child always wear the same pajamas and sheets so that the stench would bother them. According to Dolto, parents who want to train their children earlier ‘‘deprive their children’s bodies the freedom to develop the experienced satisfaction of their needs, which naturally occur when physical evolution has presented the means to do so.’’ Enuresis is due to the fact that, in most cases, the toilet training begins before the neurophysiological development occurs, which happens at about 27 to 28 months with the development of the functions of the ‘‘queue-decheval’’ or ‘‘equine tail,’’ responsible for the proper control of this function. Amore detailed reflection on sphincter education allowed to consider that induction of precocious maturation of the nervous system, responsible for urinary continence mechanisms, relates to the unconscious desire of adults that their children develop autonomy towalk, talk, and care for their personal hygiene than with the purpose of promoting the full development of the child. Proof of this is that the observations needed to understand small gestures, facial expressions or crying, that compose children functions, are fewer actions carried out by parents, because they were considered too costly or unnecessary tasks.Modern psychology encouragesmeasures more consistent and less punitive, instructs that the parents should be involved in the situation so that the child does not establish an inappropriate relationship of dependence on the mother, and not only involves the control of urinary function since in general the mother is responsible for the children’s hygiene. When the child is already grown, guides include that the child becomemore involved such as changing of the sheets and putting the bedding and pajamas at the site where they will be washed. Also according Dolto, the key is not demanding anything of the child but simply reassuring them they will be able to do same thing as adults do in the bathroom. Meanwhile they will continue to wear diapers. They will be taken off without making a fuss. The early sphincter control, imposed or requested at an age not over the development of the pyramidal nervous system can only be achieved by dependence on the mother. This early education can be followed by a period of rebellion and opposition to the wishes of the child ’s educator who oppresses the satisfaction of these natural needs. This creates a source of emotional changes. Already in the later stages ‘‘wet the bed’’ (bedwetting) can occur as a symptom of deeper emotional issues as demonstrated by studies that observed children that were war prisoners. During World War II, these children began bed wetting in response to the humiliation felt by believing they had a father who cowardly gave up fighting and was captured rather than remain and die in combat. It was as if the children renounced their growth by the frustration arising from this experience and stayed sexually undifferentiated, only children, expressing themselves through the ‘‘pee-maker.’’ When treated these children improved significantly after 5 or 6 weeks of therapy. Enuresis lasts longer in boys than in girls, being related to the male erection. Boys can experience mixed sensations with erections and sensations to urinate since both illicit urethral stimulation. This can cause confusion such that erection can cause the sensation to urinate and can initiate the micturational arc. Girls urination is not connected to the genitals, so urinary retention may be related to cystitis, also being subject to a specific complication as an excitation or contraction of the urethra can be felt as a stutter of the urinary canal, which resonates as a ‘‘yes or no’’ constant, causing painful sensations. Girls gain control and regulate their urination depending on the contents of the bladder. They perform spontaneous training through imitation, so the act of going to the bathroomwith the mother should be encouraged. However, at daycare or school, they are usually required by caregivers to use the bathroom from time to time to prevent soiling. So often end up acquiring the habit of saving some pee to eliminate in the next hour, and how not to urinate can become completely retentionist. Very young children may respond positively to the training they are imposed, and in fact learn and develop the desired behavior by the instructor, it is a biological characteristic of the species, but the significance of this acquisition and the consequences of these measures in the psyche of the child are still an underestimated and unexplored territory by broadcasters of early sphincter training techniques.