Many Swedish pediatric clinics have quiet waiting areas, pastel walls, and a stack of pamphlets spread out close to the reception desk. At this point, a nurse may give a new parent a brief leaflet and say very little more. The message on that leaflet, which is currently being given out at baby checkups across the nation, may seem straightforward, but for many parents, it comes across as a subtle accusation: you might have waited too long.
The World Organization for Early Childhood Education’s Swedish chapter, Swedish OMEP, organized the distribution of 20,000 pamphlets on early toilet training as part of a larger effort to reevaluate national norms regarding when kids should be potty trained. It wasn’t a dramatic campaign. There were no celebrity endorsements or press conferences. Just paper that was discreetly given to parents at the 10-month checkup, reaching them before habits had taken hold. However, the dialogue it provoked has been anything but quiet.
Even though it hurts a little, the argument is supported by medical evidence. Three or four years old is “way too late” for a child to still be in diapers, according to Helena Bergqvist, a psychologist at Uppsala University Children’s Hospital and the author of the new guidelines. She contends that delayed potty training is directly linked to an increase in bladder and bowel control issues, which are completely avoidable but are becoming more prevalent. It’s possible that the Swedish healthcare system ignored this for years because no one wanted to be the one to inform parents that they were acting improperly.
Swedish babies were usually potty trained by the time they were eighteen months old. When compared to what is typical today, that figure—which Bergqvist mentioned almost casually—is truly startling. Extended diaper use became the norm as a result of a cultural, commercial, or possibly both shift. Pediatric nurse Kerstin Carlsson of Stockholm characterizes the trend toward postponed training as a “social syndrome,” despite the fact that she hasn’t observed a sharp increase in UTIs. She is aware of the increased risk, though. Small risks often have a greater impact than they first seem because they compound silently over time.
Professor Anna-Lena Hellström of Sahlgrenska University Hospital in Gothenburg has been researching mothers in Vietnam who teach their babies to empty their bladders at the sound of a whistle, starting from birth. This research provides the strongest edge to this debate. Vietnamese infants are completely diaper-free and self-sufficient by the time they are nine months old. By the time they are two years old, they are able to completely empty their bladder instead of releasing tiny amounts gradually, as children in diapers usually do. Incomplete bladder emptying increases the risk of urinary infections, as demonstrated by Hellström’s earlier research. It’s difficult to avoid feeling that Scandinavian pediatric culture has been ignoring something very evident for a long time when these two data sets are placed side by side.
Folded into those pamphlets is Bergqvist’s pragmatic advice, which is neither extreme nor complex. If at all possible, begin before the child begins to walk. Observe your body’s natural cycles, such as those that occur after meals and after waking. When the signs are present, let the child sit on the potty and create a calm environment. Sometimes let them go without a diaper. Professional training or specialized equipment are not needed for any of it. It does, however, necessitate that parents view early toilet learning as something worth starting rather than something to put off.
There’s a feeling that the true opposition here is social rather than medical. Extended diaper use fits neatly into Sweden’s parenting culture, which, like much of the West, was built around convenience. The pamphlets are subtly challenging a generation’s accumulated habits rather than opposing biology. To be honest, it’s still unclear if 20,000 copies will be sufficient to change something this embedded.
