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| |    Potty Refusal: When a Child Is Reluctant to Use the Toilet for a BM by Robert Needlman, M.D., F.A.A.P. reviewed by Robert Needlman, M.D., F.A.A.P. What do you do when your toddler decides that he will not sit on the potty to have a bowel movement? He's happy to use the potty for urine, and stays dry all day. But when it comes time to have a bowel movement, he demands to have a diaper on, soils his underpants, deposits the stool in a corner of the house, or tries to hold it forever. Although all of these strategies are unpleasant, the last one can lead to medical problems. The longer the child holds onto his BMs, the larger and harder they become. When they do eventually pass, they hurt. The child responds by holding out even longer, the stools get even larger and harder, and a vicious cycle ensues. The end result is often chronic constipation, which can be hard to treat. Why it happens There are any number of reasons why a child might develop this behavior. Clearly, young children think differently about their bodily functions than adults do. They haven't learned yet to be disgusted by feces; instead, they are fascinated by this product they made. To some young children, a bowel movement can seem like a part of their bodies that has become detached. The idea that this part falls out into a potty and then is flushed away can seem frightening or distasteful. Others have interesting misconceptions about bowel movements, including making a connection between BMs and babies. (After all, they both come out "down there.") A young child might even have the notion that if he holds on to his bowel movements, he can produce a baby! Whatever idea sets off the potty refusal, the issue can quickly become a power struggle. Young children can't control much in their lives, after all, but they can control what goes into their mouths, and, to a certain extent, what comes out the other end (or at least how they'll dispose of it). When parents are dead set on making rules about these bodily functions, toddlers often respond with an equally intense determination to do the exact opposite in order to hold onto control. This is a battle that parents almost always lose, but it's the child that pays the price: usually a delay in acquiring independent toileting skills, and loss of the pride that comes with that accomplishment. Who develops the problem? From the one large study of children with potty refusal, it appears that boys and girls are about equally likely to have it. Surprisingly, perhaps, children who refuse to use the potty for stool are not more likely than others to have a high number of other behavior problems; as a group, they are as cooperative as their peers when it comes to picking up toys or following parental commands. It is only in one area-their BM habits--that they hold out against authority. What can you do? Although we may not know what sets off the problem in each individual child, there is a simple treatment that appears to work in most cases:
This may go against your instincts--parents sometimes worry that giving a child a diaper gives him "permission to be a baby." Actually, just the opposite happens. The diapers let the child know that he is in control, which makes him feel more grown up. Going back to diapers also stops any power struggle between a parent and child on this front; the toddler knows he can make his own decision now, without having to feel that he is giving in and losing his self-determination. Potty refusal is one of those early problems that plagues well-meaning parents and children who are healthy in all other ways-and one that, thankfully, often goes away without a trace. If parents allow themselves to be caught in a power struggle, however, or if a child develops stool withholding and chronic constipation, potty refusal can lead to bigger problems. Now that you know what to look for, you can keep that from happening to your child. Click here to join the discussion on Toilet Training.
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