What is toilet training resistance?
Children who refuse to be toilet trained either wet themselves, soil themselves, or try to hold back their bowel movements (thus becoming constipated). Many of these children also refuse to sit on the toilet or will use the toilet only if a parent brings up the subject and marches them into the bathroom. Any child who is over 3 years old, healthy, and not toilet trained after several months of trying can be assumed to be resistant to the process rather than undertrained. Consider how capable your child is at delaying a bowel movement (BM) until he or she is off the toilet and has a chance to hide. More practice runs (such as you used in toilet training) will not help. Instead, your child needs full responsibility and some incentives to spark her motivation.
The most common cause of resistance to toilet training is that a child has been reminded or lectured too much. Some children have been forced to sit on the toilet against their will, occasionally for long periods of time. A few have been spanked or punished in other ways for not cooperating. Many parents make these mistakes, especially if they have a strong-willed child.
How can I help my child with daytime wetting or soiling?
Most children younger than 5 or 6 years of age with soiling (encopresis) or daytime wetting without any other symptoms are simply engaged with you in a power struggle. These children can be helped with the following suggestions. If your child holds back BMs and becomes constipated, medicines will also be needed.
Transfer all responsibility to your child.
Your child will decide to use the toilet only after he realizes that he has nothing left to resist. Have one last talk with him about the subject. Tell your child that his body makes "pee" and "poop" every day and it belongs to him. Tell him that his "poop" wants to be in the toilet and his job is to help the "poop" come out. Tell your child you're sorry you punished him, forced him to sit on the toilet, or reminded him so much. Tell him from now on he doesn't need any help. Then stop all talk about this subject ("potty talk"). Pretend you're not worried about this subject. When your child stops hearing conversation about not going, she will eventually decide to go to the bathroom for attention.
Stop all reminders about using the toilet.
Let your child decide when she needs to go to the bathroom. Don't remind her to go to the bathroom or ask her if she needs to go. She knows what it feels like when she has to "poop" or "pee" and where the bathroom is. Reminders are a form of pressure, and pressure keeps the power struggle going. Stop all practice runs and never make her sit on the toilet against her will because this always increase resistance. Don't accompany your child into the bathroom or stand with her by the potty chair unless she asks you to. She needs to gain the feeling of success that comes from doing it her way.
Give incentives for using the toilet.
Your main job is to find the right incentive. Special incentives, such as favorite sweets or video time, can be invaluable. For using the toilet for BMs, initially err on the side of giving her too much (for example, several food treats each time). Remember that incentives work even better if it is a special treat that your child doesn't get everyday. If you want a breakthrough, make your child an offer she can't refuse (such as going somewhere special). In addition, give positive feedback, such as praise and hugs every time your child uses the toilet. On successful days consider taking 20 extra minutes to play a special game with your child or take her to her favorite playground.
Give stars for using the toilet.
Get a calendar for your child and post it in a conspicuous location. Have her place a star on it every time she uses the toilet. Keep this record of progress until your child has gone 1 month without any accidents.
Make the potty chair convenient.
Be sure to keep the potty chair in the room your child usually plays in. This gives her a convenient visual reminder about her options whenever she feels the need to go to the bathroom. For urinating, the presence of the chair and the promise of treats will usually bring about a change in behavior. Don't remind her even if she's squirming and dancing to hold back the urine.
Diapers, Pull-ups, or underwear.
Whenever possible, replace pull-ups or diapers with underwear. Help your child pick out some underwear with favorite characters on them. Then remind her "they don't like poop or pee on them." This usually precipitates the correct decision on the part of the child. Even if your child wets the underwear, persist with this plan. If your child holds back BMs, allow selective access to diapers or pull-ups for BMs only. Preventing stool-holding is very important.
Remind your child to change his clothes if he wets or soils himself.
As soon as you notice that your child has wet or messy pants, tell her to clean herself up. The main role you have in this program is to enforce the rule: "people can't walk around with messy pants." If your child is wet, she can probably change into dry clothes by herself. If your child is soiled, she will probably need your help with cleanup. If your child refuses to let you change her, ground her in her bedroom until she is ready.
Don't punish or criticize your child for accidents.
Respond gently to accidents, and do not allow siblings to tease the child. Pressure will only delay successful training, and it could cause secondary emotional problems. Your child needs you to be her ally.
Ask the preschool or day care staff to use the same strategy.
Ask your child's teacher or day care provider to let your child go to the bathroom any time he wants to. Keep an extra set of clean underwear at the school or with the day care provider.
When should I call my child's healthcare provider?
Call during office hours if:
- Your child holds back his or her bowel movements or becomes constipated.
- Pain or burning occurs when your child urinates.
- Your child is afraid to sit on the potty chair.
- Your child's resistance has not improved after 1 month on this program.
- The resistance has not stopped completely after 3 months.
Written by Barton D. Schmitt, MD, author of “My Child Is Sick,” American Academy of Pediatrics Books.
Published by RelayHealth.
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