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674 PED IATR ICS Vo l. 61 No . 4 A pril 1978
Early T oile t T ra in in gTo T H E E D IT O R :
In the ir superb stu dy of to ile t tra in in g (Pediatrics
60:170,Augus t 197 7) , deV ries and deV ries rem in ded m e tha t
I hadheard of ea rly to ile t tra in ing befo re . A ccord ing ly ,
inqu irie sam ong our pa tien t popu la tion here a t M onte flo re
rev ea ledtha t th is p rocess w as n o t un comm on am ong Jan ia
icans wh enthey res id ed in Jam aica . I fo und no instances of ea
rly to ilettra in ing am ong Jam aican s a fte r th ey m oved to
the UnitedS ta tes, even though they h ad prev io usly don e it in
Jam aic a.The m etho ds used w ere essen tia lly the sam e as tho
se used bythe D igos : the use of sou nds , en dearm en ts , rew
ard , and th eabsence of pun ishm ent. T he o n ly add ition w as
the use of acham ber po t ca lled the ch imm y to ca tch th e s too
l andur ine. Th is ch imm y is he ld be tw een the m o th ers legs
un tilthe ch ild is o ld enough to sit on i t u ns up po rt ed . I
jus trecen tly h eard th at th is p rac tice is used in R u ss ia
in a sim ilarw ay .
T he m erits o f the deV rieses a rtic le w ere n o t to dem
on-s trate the exc lus iveness o f th is m etho d am ong a particu
la rpeop le . W hat I be lieve they d em onstra ted , am ong o th
erth ings , is tha t ou r p rev ious th ough ts o f to ilet train
in g w ereincorrec t; train ing can be accom plished an d has
beenaccom plish ed a t a m uch earlie r age . If it can be done ,
sh ou ldit be don e? The ques tio n now is w he ther ea rly to ile
t tra in ingm ay in itse lf be h arm fu l. T he lib ido theory
sugges ts tha t ea rlyto ilet tra in ing m ay cau se perso na lity
tra its such as su sp i-c iou sne ss, p ars im ony , and nega tiv i
ty . In 19 49 , O rlanskyaddressed h im self to tha t po ss ib
ility . H e dem ons tra ted nore la tio nsh ip be tw een behav io r
o r ch arac te r tra its and to ile ttra in ing m etho ds.
Severa l recen t in vestiga to rs , A nd rew N . M eltzo f f
andM arsha ll H . K laus , have dem ons tra ted o th er ea rly in
fan tb eh av io r invo lv in g the in terac tion of n io the r an d
ch ild fromb ir th on . Is it too early to ask w hether th ese
early soc ie ta llym ean ing fu l in te rac tio ns m ay have som e
sa lu ta ry e ffe ct o nin fan t an d ch ild behav io r? T hese in
te rac tions, w hich requ irea lm ost co n tinuo us in terac tio n
be tw een m o the r an d infan t,h av e been no ted by an th rop o
log ists to have jus t such asa lu tary effec t on the p eo p le th
e have stud ied .
E ven b efo re the ev idence is in , m igh t w e ped ia tric
ianssu g g e s t cer ta in chan ges in in fan t ca re tha t w ou ld
foste r am ore in tim ate rela tio nsh ip betw een m o the r and ch
i ld?
MA R V IN J. C ER 5H , M.D .Ped ia tric Am bula to ry S erv ice
,M ontef lo re H osp ita l am id M edica l C en te r
11 1 La st 2 10 t /m S tre e tBronx , .V1 1 0 4 6 7
REFERENCES1 . O rla ns ky : P sych o l B u ll, 1949.2 . K laus M
H , e t a l: T he m other-new born re la tionsh ip . I
P e d i a t r 91 :1 , 1 977 .
(Pediatrics 60:170 , August 1 977 ). In south ern Ind ia , esp
e-c ia lly in la rge ex tended fam ilies w here th e grandm other o
ro ther re la tives ac tive ly partic ipa te in b rin g ing u p
andtrain ing ch ild ren , th is has b een the usua l p rac tice
overcenturies. Ab sorbent d iap ers o r p ott ies a re hard ly ever
u sed .T he m other consid ers it qu ite n atu ral to to ile t-
train thebab ies in ea rly in fancy. Th e in fants usu ally ind
icate th ed esire to eva cua te b y fac ia l gr im ace s like pou
tin g or eveng run tin g w hich are fam iliar sign als to th e m
other .N ot on ly d oes th is b ring abou t c lose r m other-in fan
tin te raction , con tac t, and comm unica tion , bu t it a lso e
lim i-na tes fu tu re a t t emp t s a t u nn ec es sa ry coerc ive
m eth ods on are lu ctan t todd le r.
S ta ten Is land , N Y 10301
S. RAV INDRANATHAN , M.D .S ta ten Is land M edica l G rou p
,and S t. V incen ts M ed ica l C en te r
Pharyng ea l G ono rrh ea in C h ild renTo T H E E D IT O R
:
The artic le G ono rrhea in P reado lescen t C h ild ren byFo
llan d e t a l. (Pediatrics 60:153 , A ugu st 1 977) success fu
llyb rin gs to the a tten tion of th e p ed iatr ician d iverse c
lin ica laspec ts of th is in fe ction and its im po rtan t im
plica tions . Iw ou ld like to ca ll a tten tio n to ano ther m
eans of p resen ta tio nof th is cond ition -ph aryngea l gon
orrhea . T h is cond ition hasb een d esc ribed in cre asin g ly in
the m ed ica l lite ra tu re in thelast fiv e y ea rs an d I had
the o pportun ity to d iagnose it in fivech ild ren (th ree o f
them in a sc reen in g procedure). A lth oughnone o f th em w ere
ser iou sly ill, it is feas ib le fo r phary ngea lgonorrhea to b e
th e star ting po in t fo r gono co cca l seps is o rarthrit
is.
Pharyngeal gonorrhea can b e presen t in one o f th ree w
ays.The re m ay b e d iffuse e ry them a and edem a of th e p
harynxwith or w ithou t su perfic ia l erosion s, m uch as in s
trep to -cocca l pharyng itis ; th ere m ay be pa tch y ery them a
of thetons ila r a rea and uvu la ; o r the re m ay be a no rm al-
lo ok ingth roa t. T he d iagno sis is b ased on cu ltu re and su
gar ferm en -tation te sts . Su sp icio n aris es f rom a his to ry
of con tacts ,d isrup t ive l if e h is to ry , h isto ry of fe lla
tio , o r s im ply a pers is-ten t so re th roa t th at is nega
tive fo r /3 -hem oly tic S trep tococ -cus .
111 Michigan Avenue NW.Wash ing ton , D C 20010
T H O M A S J. S ILBER , M.D .D ep artm en t of Child H ea
lth
an d D ev elo pm en t,C h ild ren s H o sp ita l N a tiona l
Med ica l Cente r
B IBL IOGRAPHY
On To ile t T ra in in gTo T H E E D IT O R :
I w ou ld like to end orse the observa tio ns and co nc lu sions
ofdeVries and deV ries on early to ilet tra in ing in E as t A
frica
C hu e PW Y : Gonor rhea : I ts na tu ra l h is to ry , o ra l m
an ifes ta -tions , d iag nos is , treatm en t and preven tion . I
A m D en tAssoc 90 :129 7 , 1975 .
Giv an KF , e t a l: T he iso la tion o f N eisse ria spec ies
fromunu sua l site s . C an M ed A ssoc I 1 1 1: 107 7 , 19 74
.
S ilbe r TJ , C on tron i G , K or in D : Phary ngea l gono
rrhea inch i ld ren a nd a do le sc en ts . C lin P roc 33 :4 , 19
77 .
Wiesmer PJ , e t a l: C lin ica l spec trum of pharyn gea l gon
o-cocc al in fe ctio n . N E ng i I M ed 181:288, 1973 .
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1978;61;674PediatricsMarvin J. Gersh
Early Toilet Training
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