ASK THE EXPERT:Teaching children the importance of doing a poo regularly is a tricky issue for parents
Q I have a question on potty training. I trained my third child (aged three years and four months) last March and she is still having difficulties with the whole area of poo. We have had a lot of change in the house in the last while, such as her father commuting to work, being away during the week and only home at weekends, and my return to work. She is being cared for by a close family member on a part-time basis (three days a week).
At the moment, doing a poo is very stressful and she refuses to do one. I am very conscious that she may get constipated but this hasn’t happened. Because she was sometimes staining her pants, her bottom is getting sore and this is exacerbating the problem.
There is now a link between poo and pain. She has done a few poos and realised that they didn’t cause pain, but I have had to use a nappy-rash cream to keep her bottom from getting sore. I have used a lot of praise and talked to her about how important it is to do a poo. I have talked about how it won’t hurt her if she does her poo gently, but she is refusing.
She can hold it up to three days and then go, but it’s stressful and she won’t let me clean her sometimes when she is sore. Something seems to trigger it as it’s not always an issue and then it flares up. I have done a lot of reassuring her and talking about things to her, but I feel I am getting nowhere.
AIn theory, toilet training is a very straightforward process, but in reality it can actually be a difficult time for children and for parents. Doing a poo in the toilet is quite a significant achievement for most toddlers and pre-schoolers, and there is a real sense of letting go, both physically and psychologically. Gaining control of your bowel and bladder is definitely an opportunity to move on developmentally.
It may be that your daughter has never really established a regular habit of using the loo. Additionally, she may have felt an emotional upheaval to do with the changes that have recently been happening in your family circumstances. Indeed, the potential for emotions to be the reason for her difficulties seems more likely when you consider that the pooing stuff is only an occasional issue.
To re-establish (or establish firmly a first time) a good toileting routine and habit, I suggest that you introduce a star chart. On the chart include each day (Monday to Sunday) across the top axis and down the left side axis include “breakfast”, “lunch”, “dinner” and “other” to indicate the times of the day when she will be rewarded with a star for sitting on the loo for a few minutes to see if a poo needs to come.
Then encourage her sit on the toilet at least those four times of the day and reward her efforts with a star, irrespective of whether a poo comes. If a poo does come during any of those sittings, she can get an extra two stars. At her age the stars themselves should be enough of an immediate reinforcement, but you can also plan it so that stars can be collected to amount to an even bigger reward over time.
Minimise the attention for any accidents and always suggest she sits on the loo after an accident. Do this even if she has held on and ended up staining her pants because the poo started to come anyway before she got to the loo. Make sure your childminder is also working with this plan.
At the same time as you are using the star chart, I suggest that you begin to acknowledge and empathise with the fact that she has had a lot of change in her life and that any change is unsettling and possibly upsetting.
In her case specifically, I wonder whether her attempts to hold on to poo are representative of her attempts to be in control when other areas of her life seem to be out of control. So, change or seeming to lose control might be the “trigger” that you wondered about.
Because she can’t influence the amount of change that has happened, she may be trying to exert control in one of the few areas where she unconsciously feels that she has control – her bowel movements.
If this is the case, then empathising with these feelings – saying things like, “It can feel awful when everything changes, sometimes change can even feel scary because we don’t know what to expect” – will help her to process and deal with her anxiety about the apparent unpredictability of her life.
As new routines emerge in her daily life, and she gets used to how things are now, I would imagine that her need to hold on to poo will diminish. Empathy, while life still settles down for her, in tandem with a regular habit for using the loo, will, I believe, help to resolve her need to hold on.
- David Coleman is a clinical psychologist and broadcaster. Readers' queries are welcome and will be answered through the column, but David regrets he cannot enter into individual correspondence. Questions should be e-mailed to healthsupplement@irishtimes.com
- www.davidcoleman.ie