Toilet Training Resistance (Encopresis And Daytime Wetting)

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 the parent brings up the subject and marches them into the bathroom. Any child who is over 2 1⁄2 years old, healthy, and not toilet trained after several months of trying can be assumed to be resistant to the process, rather than untrained. Consider how capable your child is at delaying a bowel movement (BM) until she is off the toilet or you are on the telephone. More practice runs (as you used in toilet training) will not help. Instead, your child now needs full responsibility and some incentives to re- 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.

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.

Helping Your Child With Daytime Wetting Or Soiling

Transfer all responsibility to your child.

Your child will decide to use the toilet only after she realizes that she has nothing left to resist. Have one last talk with her about the subject. Tell your child that her body makes “pee” and “poop” every day and it belongs to her. Explain that her “poop” wants to go in the toilet and her job is to help the “poop” come out. Tell your child you’re sorry you punished her, forced her to sit on the toilet, or reminded her so much. Tell her from now on she doesn’t need any help. Then stop all talk about this subject. When your child stops receiving conversation for nonperformance (not going), she will eventually decide to perform for attention.

Stop all reminders about using the toilet.

Let your child decide when she needs to go to the bathroom. She should not be reminded to go to the bathroom nor asked 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 doesn’t work. She should not be made to sit on the toilet against her will because this will foster a negative attitude about the whole process. Don’t accompany your child into the bathroom or stand with her by the potty chair. She needs to get the feeling of success that comes from doing it on her own and then finding you to tell you what she did.

Give incentives for using the toilet.

If your child stays clean and dry, she needs plenty of positive feedback, such as praise, smiles, and hugs. In general, this positive response should occur every time your child uses the toilet. If a child soils or wets herself on some days and not others, this recognition should occur only when she is clean for a complete day. On successful days consider taking 20 extra minutes to playa special game with your child or take her for a walk to the playground. Sometimes special incentives, such as favorite sweets or video time, can be, invaluable. One of your main jobs is to find the right incentive. For using the toilet for BMs, initially err on the side of giving her too much (e.g., several sweets each time). The potency of these incentives is increased by reducing baseline access to them. Additional motivation can come from making a carefully orchestrated “fun trip” to the preschool, and then clarifying for the child that regular preschool attendance requires toilet training. If you want a break through, make your child an offer she can’t refuse.

Give stars for using the toilet.

Get a calendar for your child and post it in a conspicuous location. Place a star on it every time she uses the toilet. Keep this record of progress until your child has gone 2 weeks 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 urinate or defecate. For wetting, the presence of the chair and the promise of treats will usually bring about a change in behavior. For soiling, your child may need a pleasant reminder only if she is clearly holding back. You can say, “The poop wants to come out and go in the toilet. The poop needs your help.” Tell your child that you want sitting on the potty to be lots of fun. What would she like to do? A few children temporarily may need treats for simply sitting on the toilet and trying.

Diapers, pull-ups, or underwear.

Whenever possible, replace pull-ups or diapers with underwear. Help your child pick out some underwear with characters on them that “don’t like poop or pee.” 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.

Remind your child to change her clothes if she wets or soils herself.

As soon as you notice that your child has wet or messy pants, tell her to clean herself up immediately. The main role you have in this program is to enforce this rule. 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 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. Do not put your child back into diapers unless she needs to be on laxatives. Pressure will only delay successful training, and it could cause secondary emotional problems.

Ask the preschool or day care staff to use the same strategy.

Ask your child’s teacher or day care provider for unlimited privileges to go to the bathroom any time your child wants to. Keep an extra set of clean underwear at the school or with the day care provider.

CALL OUR OFFICE During regular hours if:

• Your child holds back her bowel movements or becomes constipated.
• You think your child is constipated again.
• Your child’s bowel movements continue to hurt.
• Pain or burning occurs when she urinates.
• The resistance is not improved after 1 month on this program.
• The resistance has not stopped completely after 3 months.
• You have other questions or concerns.