Toileting skills in children with myelomeningocele: rates of learning.

Rates at which 173 children with myelomeningocele learned 20 different toileting skills were studied in an attempt to describe their acquisition of control over chronic urinary and stool incontinence. All had clinical or urodynamic evidence of neurogenic bowel and bladder dysfunction. Seventy-five other children were excluded because of intelligence quotients less than or equal to 70 points, uncontrolled hydrocephalus, spastic extremities, or other major disabilities. Inadequate follow-up or parent cooperation eliminated 27 other cases. Using a home inventory, parents recorded their child's accomplishments. An investigator contacted parents regularly to minimize inaccurate reporting and to screen data against preestablished criteria. The observation period lasted 2.5 years, but earlier achievements that met criteria were included in the cumulative data pool. Each child was categorized into one of four groups of motor paralysis (L2 and above, L3-4, L4-5, S1 and below), and calculations were made when 20%, 50%, and 80% of the children had attained each toileting skill. Intergroup and intragroup variances were often striking. Possible explanations for these variances include physical and psychosocial readiness as well as home and community support systems. For the child who meets the selection criteria, these specific learning rates can be used in evaluating treatment, describing current levels of bladder or bowel control, and setting realistic goals.