Potty-training complications are pretty common topics of discussion around here. Stephanie's question about one of the more common complications -- poop withholding -- often comes up at a time when many of us are frantically trying to get our toddlers ready for preschool in the Fall. The frantic pressure parents feel to get their toddler trained -- at any cost -- so that they can start school -- can be a major impediment to the natural process of potty training. The stress EVERYONE feels can then backfire in a major way -- in the form of potty training's major enemy, the dreaded CONSTIPATION. Constipation causes a lot of pain for tiny tushes, and often derails potty training completely.
Here's Stephanie's question:
Dear Dr. Heather,
I am sure I have fallen victim to what many moms before me have, and it's the sense that we have to have our toddlers potty trained for preschool. My eldest, just turned 3, advanced to his new classroom where all the kiddos were "poop-potty-trained", and mine was not. They said they would work with him. We had been talking about it and reading funny books about it at home. But with this new classroom I upped the ante at home, and disaster has resulted!
He pooped in the potty 2 times and I rewarded him HUGE with toys and praise. He then pooped at school and everyone got super excited for him. And that is where my story ends. Prior to his successes he has pooped hit and miss, not consistently in the potty. And I am embarrassed to say if I caught him pushing in his underwear I would walk/run him into the potty and tell him to poop here and say things like "I know you can poop in the potty, I have seen you do it before. If you poop in your pants Mommy will not be happy. You are a big boy and need to poop in the potty." I thought I was motivating him and he knew he would get toys/rewards for pooping.
So now we have a withholder. He dances around on tip toes and is trying to hold it in. I see him trying. I try to encourage him and still nothing. After 4 days we used a glycerin suppository and he got relief. Then another 4 days goes by with this same behavior. Another glycerin suppository with positive results. Now we have these frequent (20+) smears a day in his pull up. I am encouraging him to poop-even if it is in his pull up. He won't sit on the potty anymore, but will still pee in the potty standing up-no problem! I realize now we and school have stressed him out. But now what??? How do I get him back to normal bm's?
I took him to the pedi and they said he wasn't impacted and his "tone" was normal. So now this is a control deal, right?
Yes, unfortunately now this IS a "control deal". And your little guy is proving to you that HE is in control -- and he IS -- of his pooping.
The common preschool policy of "toilet independence" by age 3 is completely ridiculous, in my opinion. It puts too much pressure on at a time that can easily lead to the complications you're experiencing. I say, what's wrong with a few more months of diapers or Pull-Ups? Many schools do understand this, and although they may not advertise it, WILL work with each child on an individual basis. Each child's timeline is a little different. Giving your child control over the issue is the secret to simplified potty training. The more parental interference, the more complications.
The only thing to do now, Stephanie, is to back off, completely. And by that I mean NO mention of the potty or toileting behaviors, at least for a couple of weeks.
But first, explain to him that "I can see we pushed you too hard to poop in the potty, but YOU are in charge of your pooping. You decide where and when you want to poop." At this age, he CAN'T understand the rationale that "poop is inside of you and needs to come out, for you to be healthy". So quit any attempts to reason with him about this. In his preschooler's mind, he believes that he can WISH away the poop with the FORCE OF HIS MIND. Don't argue with his fantasy wishes. Rather, back off completely from all pressure to go in the potty. You can still rescue him from long-term withholding by taking the pressure off, and eventually letting nature take it's course.
Also, your child's personality is a major driver of the process. Some kiddos are relaxed and easy about the process (only 1 out of my 4 were), but others have their personality-driven quirks. Check out my book for more on these potty personalities, as well as the Pull-Ups website for more.
For now, use whatever he prefers; let him choose. Don't pay attention if he dances around and tries to hold it in. Force yourself to ignore it, but not in a frustrated way. If he poops in his pants or Pull-Ups, don't reward or praise him, just act very matter-of-fact. You want to unload all the emotion out of this issue. You want him to feel comfortable pooping, first of all, since withholding can really cause problems, in the long-run. Then, make sure EVERYONE is on the same page; parents, sitters, teachers, grandparents. You are all on a 2-3 week-hiatus from potty training.
In the meantime, I suggest doing a major fiber-loading of his diet (of course, with his pediatrician's approval and direction). The doctor might also suggest something like Miralax to add to his juice in order to "speed things along", and to minimize the chance of withholding and constipation. (Sneak it in to his drink, so he doesn't feel manipulated by you.) And make sure to pretend not to notice any accidents or staining, or clean them up without commenting negatively. "Oops, here, let me clean this up," is enough. You can also check out this excellent book on the subject by my friend and colleague Steve Hodges, MD: It's No Accident: Breakthrough Solutions to Your Child's Wetting, Constipation, UTIs, and other Potty Problems.
Huge rewards can also complicate matters. Over-doing it with the toys and praise takes away from your child's own internal sense of satisfaction with mastering this important skill. A huge response, positive or negative, tells the child that he's doing it for YOU, not for himself. So when you do use rewards, keep them low-key. Stickers, token rewards, and simply stated praise shows your approval for his progress. But it's HIS progress. You're just a supportive observer to the process. And about the suppositories: While effective, they can be rather harsh, from a psychological perspective. It tells the child, "I am forcing you to poop. I am in charge of your body, by forcing this inside of you....YOU are not in charge." Ideally, we want to reinforce the notion that the child is in charge of his OWN body. Suppositories and enemas can be experienced by the child as a violation of his own fragile sense of bodily control. And while they MAY be necessary if, later on, he has a more severe problem with this, right now I do think it's premature to resort to that degree of intervention. But if needed in the future, so be it.
After a couple of weeks, it will become clear whether this has already settled into a negative, long-term pattern, or whether he is willing to turn this around. Try this approach and let us know what happens. Good luck!
Mom of Four, Parenting Expert
Hey, parents! Make sure you scroll through the comments below. There are lots of interesting questions, with my answers, below -- this is one of my most "googled" posts! (Oh, I'm so proud.)