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Children demonstrate the emerging ability to regulate their physical processes in order to meet both their internal needs and external demands in accordance with social and cultural contexts.

Physiological regulation refers to children’s capacity to regulate their bodily processes. Very early on, children are working on organizing their sleep-wake and elimination cycles and body temperature.

While these processes first start off as involuntary actions, they eventually transition to tasks that children gain control over. Caregivers help children with the organization of their day and night wake-sleep rhythms.1 During the first eight weeks of life, children sleep in shorter stretches, without focus on whether it is night or day. However, by three months there is an increase in the length of their sleep periods. For most children, these increased stretches occur at night.

Children’s sleep continues to become more organized and consolidated. The number of naps decreases, as children take one or two naps that increase in length, and night-time sleeping stretches longer and longer. These consolidated patterns also occur in children’s feeding schedules. At first, children need to eat every two to three hours; as they grow, their eating schedule becomes similar to that of an adult. Elimination patterns also form during these years, and depending on children’s cultural expectations and physical and cognitive abilities, potty training may be conquered by the end of 36 months. While not all children will be potty trained by this time, most will have an aware- ness of using the bathroom and recognizing their bodies’ cues. Expectations for children’s physiological abilities depend on cultural beliefs and practices, and will influence when and how children master these regulatory tasks.

Toilet Training

The ability of children to learn how to control their bladder and bowel movements is an important developmental milestone. However, when it is achieved varies across different cultures.2 Toilet training is a very personal process for families and rooted in both cultural and societal expectations. Caregivers can experience conflicting advice from friends, doctors, and family members who may not understand different childrearing practices. It can be a stressful time for children and the caregivers who are supporting them in learning this big skill.

The most important aspect of toilet training is that both the child and caregiver are ready to attempt this process. Children need to be emotionally ready and have the cognitive and physical abilities to begin the process. When and how to take on this developmental task are decisions that should be made by the primary caregivers, with support from those they feel they can benefit from. Most importantly, caregivers should remember that there is not a right answer when it comes to toilet training.

Birth to 9 months

Children’s biological rhythms are supported and impacted by their caregiver(s) in order to establish their sleep/wake, feeding, and elimination patterns. Children also begin to develop awareness of stimuli in their environment.

Indicators for children include:

  • Begins to demonstrate a pattern in sleep-wake and feeding cycles
  • Signals for needs, e.g., cries when hungry, arches back in discomfort
  • Disengages when overstimulated, e.g., turns head, glances away, falls asleep, spits up
  • Uses sucking to assist in sleeping

Strategies for interaction

  • Provide consistent routines in caring for the child
  • Follow the child’s cues and respond thoughtfully
  • Use touch to help the child regulate, e.g., swaddle, hold, cuddle, rock to help soothe the child
  • Minimize stimuli in the child’s environment, e.g., limit colors, sounds, and objects

7 months to 18 months

Children, through the responses and support of their caregiver(s), become increasingly organized in and begin to adapt their sleep/wake, feeding, and elimination patterns. Children are also beginning to organize and habituate to stimuli in their environment.

Indicators for children include:

  • Demonstrates consistent sleeping and feeding times throughout the day
  • Increasingly organized and consolidated internal schedule for sleep/wake, elimination, and feeding, e.g., decreases the number of naps but extends the length of the naps
  • Communicates with a wide range of signals as crying diminishes, e.g., smiles, gestures, uses words
  • Begins to exhibit certain behaviors when overstimulated and/or unfocused, e.g., becomes aggressive, lashes out, bites
  • Increased desire for independence and control

Strategies for interaction

  • Establish a routine for sleeping, eating, and diapering
  • Recognize the child’s sensitivity to sensory exposure and adjust accordingly
  • Minimize stimuli in the child’s environment, e.g., limit colors, sounds, and objects
  • Provide redirection and be consistent in helping the child regulate in overwhelming situations, e.g., use distraction by sharing a different toy or object
  • Allow the child to express emotions through newfound movements, e.g., jumping for joy
  • Provide the child with some responsibility and choices, e.g., ask the child for help building a tower with blocks

16 months to 24 months

Children have established basic, consolidated patterns in sleep/wake, feeding, and elimination functions. Children use nonverbal and verbal communication to signal needs to caregiver(s) for support in regulating. Children also begin to manage internal and external stimuli.

Indicators for children include:

  • Uses gestures and symbolic actions to demonstrate feelings and needs, e.g., lays head on caregiver’s lap when tired
  • Becomes frustrated and displays regressive behaviors when overstimulated, e.g., temper tantrums
  • Communicates needs with one or two words, e.g., says or gestures “milk” for “I want milk”
  • Begins to have an awareness of bodily functions and begins to demonstrate an interest in toileting, e.g., recognizes a “potty”

Strategies for interaction

  • Recognize and respond to the child’s communication efforts
  • Establish a schedule throughout the day that includes sufficient time for feeding and resting
  • Provide sensory play for the child who is having difficulty remaining regulated due to lack of sensory input, e.g., play dough, water play
  • Read the child’s cues to determine how to support the child during challenging instances, e.g., use of a soothing voice or gentle touch; or ensure the child is safe and allow them to express their emotions through a more physical manner (lying on the floor, stomping feet)

21 months to 36 months

Children begin to independently manage functions of feeding, sleeping, waking, and eliminating with some support from their caregiver(s). Children can now manage and begin to discriminate internal and external stimuli.

Indicators for children include:

  • Calms down in order to sit and read a book with a caregiver
  • Uses movement to express an emotion, e.g., jumps up and down when excited, stomps feet when upset
  • Recognizes patterns throughout the day, e.g., grabs a pillow and blanket after lunch, when it is nap time
  • Communicates needs more thoroughly, e.g., “I am hungry”
  • Manages overstimulation in a more organized manner, e.g., disengages, walks away
  • Demonstrates a readiness to begin toilet training

Strategies for interaction

  • Provide words to the child’s feelings and physical actions
  • Teach the child about respecting personal space and provide objects to help them define this space, e.g., individual seat cushions during circle time
  • Continue using soothing and calming behaviors when helping a child regulate
  • Listen to child when expressing needs and wants; watch for verbal cues carefully
  • Slow down and be present for the child; limit overstimulation and provide support for the child as needed
  • Approach toilet training within the context of the home culture and the primary caregiver’s guidance

Real World Story

Stella is 20 months old and attends childcare a few days a week. The class is getting ready to sit down and have a snack. Stella’s primary caregiver, Jean, places bowls of yogurt and crackers on the table for each child. She signals Stella to sit down. Stella sits down and grabs her spoon. Jean sits between her and another child. Stella slowly feeds herself yogurt, with very little spilling. She continues to feed herself, and then begins to drop some yogurt on her chin, shirt, and the table. Jean reaches to help her and Stella pushes her hand away. Jean offers Stella a napkin, and Stella grabs it and begins to wipe her mouth. Again, Jean makes a move to help her and Stella shakes her head and says, “No.” Stella slowly moves the spoon from her bowl to her mouth and leans toward the spoon slowly. She continues to eat in this manner, and often stops to wipe her mouth. With yogurt still in the bowl, she hands her bowl to Jean and says “All done.” She grabs her napkin and starts to smear the yogurt that she has dropped on the table. Stella continues to do this until Jean stops her and hands her a clean napkin. Jean says, “Help me clean the table.” Stella follows Jean around the table, moving the napkin over the table in a sweeping manner.

IN THIS EXAMPLE, Stella is building her abilities in feeding herself. She refuses help from Jean and lets her know with both verbal and nonverbal communication. Even though Stella has not mastered this skill, she realizes that if she moves her head forward she may spill less. She does not seem bothered by the spilling that she is doing, and again refuses help from Jean to wipe her mouth. Stella uses her developing abilities to feed herself and wipe her mouth. She does not give up, nor does she become frustrated with the spilling. Stella recognizes her body’s signals as she lets Jean know she is full by simply saying “All done.” Stella also uses imitation and observation as she helps Jean clean the table. Jean recognizes, encourages, and supports Stella’s development of these tasks and her growing independence.


  1. Shonkoff, J. & Phillips, D. (Eds.). (2000). From neurons to neighborhoods: The science of early childhood development. Washington, D.C.: National Academy Press. Online version
  2. Gonzalez-Mena, J. (2001). Multicultural issues in child care. Mountain View, CA: Mayfield Publishing.
Reviewed: 2012