Almost 4, withholding stool and refusing to poop in potty

[mommy2girls]

My daughter, 3 yrs, 8 months old, has been bladder toilet trained for 7months.  She was resistant to that idea but once we found an angle that worked for her and got her to pee in the potty she never had accidents, underpants all the way, except for sleeping and bowel movements. For bowel movements, she would get herself a pull up, go into the bathroom and poop, then let me know.  She went to preschool this past year and successfully wore her underpants everywhere, holding the bm until she was home with a pull up. On the advice of our pediatrician we set a date and told her "no more pull ups for pooping in when we get to this date".  She is very bright and very strongwilled- she got it but didn't like it.  We made her start trying to sit on the potty prior to going in a pullup when she felt the urge- intially she kicked and screamed, etc, but finally complied, holding out until she got a pullup on to go.  Once pull ups were discontinued, she still refused to go in the potty...she screamed, cried, clenched her legs and shouted, "No- I won't let it out!" She didn't. We spent hours in the bathroom. In 4 days she went once in the potty- it slipped out involuntarily.  Otherwise she held it in.

She has a history of constipation issues but has been on a stool softener for nearly 10 months and hasn't really had any issues since.  The ped. had us double her dosage as we went into this potty attempt to prevent withholding but somehow she was still able to hold it.  The one time she went she seemed happy and proud and we went out and bought her the promised reward- a princess bike- on the condition that she was "now a girl who does her poop in the potty".  After 24 hours of holding it again we had to to take away the bike, which she seemed indifferent to at that point.

Now the ped. had us tell her since she won't poop in the potty and that's her choice, she needs to wear pull ups all the time- no more underwear, as she isn't really "potty trained", until she chooses to do pee and poop in the potty. SHe was thrilled to have a pull up to poop in again, and mildly disturbed that her underwear was taken away but not so much that she's motivated to poop in the potty to get it back at this point.  I realize it became an enormous power struggle between us which had to be diffused by eliminating the object of the struggle.  But where to go now...?? I'm not satisfied with leaving her in pullups all day long term- it seems like a step back when she's been in underpants all day long, even nap, except to poop (though she's sitll usually peeing in potty now). I also don't like the message it sends- you were once competent enough to wear underwear but not anymore. Seems to negate pride in that achievement. Right now I'm simply leaving her in the pullup, changing her poop without comment and trying to show no investment in the outcome.

How do we get ourselves out of this situation, back into underpants, and ultimately pooping in the potty?

[Kevin Kennedy, Ph.D.]

My suggestion is to stay the course rather than switch strategies now. What you have in your favor is development - i.e., the momentum of development will help take care of this. There is a not-so-small percentage of children this age who have not concluded toilet training, so it is not as if she is dramatically outside the norm in this regard. Your stance of keeping some emotional distance in this matter and not displaying investment in the outcome is just right.

[rusalka]

A good site is dr.greene.com  It talks about all the problems associated with potty training.  Good luck and be prepared to be patient.

[mommie2]

I have a 3 year old with the same issue. She would hold in the poop for 2 or 3 days. I would go in the bathroom with her and sit, she would cry and say she did not have to go but of course she did, you can tell. I would tell her to sit until she could go and when she did the leg clintching thing i would hold her legs apart so she could not hold it in. She cried and was strong willed just like yours but so was I . It took about 3 weeks and she would hold it in like yours but now she goes all by herself. I think it is just a scary thing but once they realize that it is not so scary it becomes ok

[vibs97]

You are truly a godsend.  It makes me feel so much better to know I am not the only one in this situation.  My son is my son is 3.9 years old and we are going through a very similar experience.  He has been urine trained since he turned 3.  After reading Dr. Greene's advice I got as far as having him go poop sitting on the toilet wearing a diaper.  That is as far as we got.  Now months later he refuses to take off his diaper.  About a week ago he noticed he was running out of diapers so he came to me and told me that he had run out of diapers and that tomorrow he would poop in the toilet without a diaper and he would get his Jeep.  (A powerwheels jeep is his promised reward)  The next day after a few attempts he pooped and so I immediately took him to  Toys r us and bought him his jeep.  He was proud of himself and we were happy.  Then he held his poop for two days.  On day three, after starting him on lactalose, he announced to my husband and me that he was going to poop so he went and he did.  Then he went out and played on his jeep.  The happy success story ends there because the following day he witheld and yesterday and today I had to sit him on the toilet against his will so that he could go.  Today was worse than yesterday because I gave him the option of a pull-up.  The problem is that I told him that if he went in his pull-up we would put the jeep away until he was ready to poop without it.  Well my poor son was torn and he did not know what to do.  The whole thing was a mess, finally in desperation to stop the screaming and crying I tried making the decision for him by putting a pull-up on him.  Unfortunately and to my surprise he continued crying and holding it in so I took off the diaper and put him on the toilet and he finally could'nt hold it any longer and he went.  I feel horrible.  I feel I have traumatized him.  I didn't stay my course.  I confused him and now I don't know what to do.  To take the jeep away and give him pull-ups will break his heart.  To continue witholding the diapers will make him miserable.  To let him play with his jeep and poop in diapers will send the wrong message and confuse him more.  I don't want to hurt him anymore I just want him to be happy and I definitely don't want my actions to affect him in the future.  If anyone has any suggestions please help.

[who_is_this]

I don't agree with using big rewards like the Jeep or the bike someone else mentioned, b/c after that, there is no more incentive to "go".  I mean, are you going to buy them a car next?

What I did was to go get a huge fishbowl, and filled it with coveted little prizes (all wrapped).  I matter of factly explained that when they went, they got to pick a prize.  If there was an accident, no scolding or punishing, just acted sad and said, "well, maybe tomorrow you can pick a prize when you go potty".  Seriously, it was probably less than a week before they were doing well.  Wrapping the prizes kept them from judging how "good" the prizes were, and if they were worth pottying for.

I used it for pees and poops, but there is no reason you can't simply use it for poops.  This way, you don't give them some huge prize that you then have to consider taking away, or somehow coming up with something bigger if the witholding starts again.

[xmsrlong]

"I don't agree with using big rewards like the Jeep or the bike someone else mentioned, b/c after that, there is no more incentive to "go". I mean, are you going to buy them a car next?"

That statement would suggest that you are very uninformed as to child development ( I assume you don't mean it as it was written).  Each child is different and those differences need to be examined before a judgement is made as to the right path to take.  What works for one child (or one's own individual values) may not be right for another.  

I'll give you an example of how that attitude can effect someone.  Suppose you see a normal looking child in the grocery store.  Let's say that child is screaming and out of control.  How would you react?  Would you think to yourself that the child is ill behaved and that the parents are bad parents?  What if you knew that the child was autistic and that the sensory perception problems, caused by neurological "miswiring" which caused the child to see the flicker in the flourescent lights or that the childs auditory system could not process the many sounds heard in that environment.  Suppose I put you in a room with a stereo system at full blast with blinking lights, strobe lights and so forth.  Would that drive you "crazy"?  The point is that when others seek answers, they're not asking for value judgements but for advise.  

The attitude displayed by the aforementioned comment is the same type of comment experienced by parents of disabled children all the time.  Before your so quick to condemn someone else because what works for your child doesn't work for another (or before you give your unwanted value judgement on to others) I would suggest that you edify yourself about child development.  

[tomel]

I agree with xmsrlong. Every child is different and what works for one doesnt always work for another. I think the reward system with the fish bowl is a good idea, but I think the Jeep is a good idea as well. I use rewards for my son all the time, these include big and little items. Parents (especially the ones in the grocery store) you know who you are, spend to much time judging other parents and children. If someone isnt willing to help someone then mind your p's and q's.
I was in the store the other day and a mom with her 2 small children was having a HORRIBLE time with her daughter (complete meltodown) I wanted to go to the woman and just give her a hug cause I felt so bad for her, but she kept her calm and eventually left, but autistic and typical children experience these meltdowns. Which depending on the situation or child the parents might want to keep their child in the store so the child learns that the parent is the one in control, not them.
My son was Potty trained at 26 months (this was a child with a serious speech delay) there is a book called Toilet Training in less than a day. My husband and I did it in 5 days. THe book was written essentally for mentally retarded adults, but then the authors figured it could work with toddlers. The strategy is the child "potty trains" a doll, the doll get lots of candy and juice, when the child themselves starts using the potty they get alot of candy, juice and praise.  I hope Im not jinxing myself and knock on wood, we havent had any "major"potty problems with my son since. He goes by himself in the middle of the night (completly out of diapers) he started doing this at about 3 yrs. old. I know 2 other families that used this book and it worked to them as well.

[who_is_this]

But---the Jeep and the bike DIDN'T WORK for them.  They were right back to square one, with the child witholding stool again after the big payoff.  And if either one said their child was disabled, I apologize.  I must have missed that.

You're right, I'm not an expert in child development.  I've just raised a couple of kids and shared what worked for me with people who were asking for suggestions.  I voiced an opinion that a huge reward for one sucess in shaping a behaviour will frequently backfire.  That's my opinion, and it would seem reasonable to assume that after the payoff, the undesired behaviour will return and then you will have to come up with something bigger.

[tomel]

One more idea for the pooping thing. In the book "Toilet Training In Less Than a Day" they suggest using the childs favorite doll or character. Show the child the doll or stuffed animal pooping in the toilet, try using tootsie rolls and put them in the toilet so the child thinks their doll went in the toilet, then say "see Mickey Mouse went in the toilet, like a big boy", he gets a treat. Most children "idolize" some type of character at this age and usually find this as an incentive. It cant hurt.

[mom2_2goodkids]

HI there,
You've received plenty advice on potty training, so I won't add to it.  
One thing I would like to offer though is that you make sure you prevent encopresis.  Chronic constipation can lead to stool impaction which stretches/damages the internal rectal muscles.  As this muscle is damaged, the nerves require more and more stool to signal the brain that it's time to have a bowel movement.  Hence, the child can withold for 2 days, then 4 days, then 7 days until you'll see 10 days of no significant output other than peanut butter smears in their underware. (Which by the way is involuntary and they don't even know it's happening..it's simply stool leaking around the mass. Somewhere in this cycle, a child will eventually have a movement that is painful.  One painful bowel movement is all a toddler needs to decide "I'll never poop again. "  When that happens, the cycle continues.  Either that, or like my sons situation at the age of 18 months, an ignorant pediatrician will apply the "standard of care" for constipation...fiber and fluid....and when it doesn't work will apply the next standard....Enema....at which point a stool will emerge that creates fissures in the rectal tissue and then....welcome to encopresis.  It is 100% preventable.  
Please maintain very soft stools under a gastroenterologists care..preferably pediatric...preferably someone with encopresis in their background.  They'll most likely use a combination of Milk of Mag which draws water into the stool and is safe for VERY long term use...years...and kondremul, which is a mineral oil supension making the stool slippery. Both over the counter. If your child is not witholding already due to a pain induced phobia of pooping, then keeping her stools mushy (somewhere between loose and peanut butter) for several months will help her to forget it hurts and then as you slowly ween from meds, you can use positive reinforcement for proper output and neutral response for failures.  A shrug and say "That's okay, I know you'll do it when you're ready.  Until then, I'll help you with the medicine."

A word about meds....if you give a child a tsp of chocolate ice cream every day...they'll eventually fight you!!  Stay tough with the meds...using positive reinforcement for that too....and negative reinforcement...like no TV, no playdate, etc...until the meds are down. Just don't get mad.  Help her to make the right decision because she wants the reward.

I hope it helps.  I've been dealing with chronic constipation, witholding and encopresis for 6 years.  What was a nightmare is now a light at the end of a tunnel (praise God) and I just want to help others never go through what my son did.  My information comes from the University of Michigan hospital encopresis clinic which is part of the child behavioral health dept.   There are only a few enco clinics in the nation.  At the very least, have your pediatrician make a phone call and get some continuing Education from the specialists so he can better help you. You will find there are very few pediatricians who are up to speed in treating or preventing this very common (4-7% of all children, mostly boys)disorder.  
Best of luck!

[justanother mom]

Just wanted to let you know that I went through this same thing.  My daughter was potty trained for pee at 3 yrs old, and went through first year of pre-school not being fully trained - still asking for a diaper when she needed to poop.  When she approached her 4th birthday I told her that she was getting too big for diapers and they no longer fit her.  And once this bag of them was gone - they were gone.  So I started asking her to get the diaper when she needed it.  So, when they were gone and she asked for another one, she saw they weren't there.  I told her that either she had to go in her big girl underpants or on the potty.  She held it for several days probably at least 5 days and then finally went.  And hasn't looked back since.  My neighbor with a son the same age, went through the exact same thing as well... My pediatrician told me that going "hard core" and letting them hold it was ok - since it was going to come out 'sooner or later' and so I was glad I stuck to my guns.  Good luck to you.

[mommy2girls]

I'm the original poster- don't know if anyone responds to follow ups but I feel like my situation is getting worse instead of better.  My daughter has been back in the pull ups full time for almost 2 weeks now.  She is no more inclined to poop on the potty than she was before.  However, she is now peeing in the pull up with increasing frequency (maybe once a day) and telling people "I'm not potty trained" which is essentially what the ped. had told us to tell her when taking away her underpants and putting her in pullups, and what an older child who saw the pull ups recently said to her.  

I'm trying to make the poop a non-issue for me, since the last attempt became such a power struggle; if she mentions pooping in the toilet as an intention or a goal I try to be supportive and encouraging but not try and get her attempting it or anything. My greater concern is the steps back we are taking in the pull ups.  She went from being a child who wore underpants all day, even nap, for 6 months, with the exception of the 5 minutes a day it took her to go into the bathroom, poop in a pullup,and get changed. Granted, she was behind developmentally with the poop issue, but she's 3.9 and I've read that 25% of kids don't finish potty training until they're 4.She never had a pee accident, ever. Now we have told her (on the peds. advice) she isn't potty trained and stuck her in what are essentially diapers all day, and then we are getting angry at her for using them as such when she pees in them. My husband thinks we should punish her when she pees in them, since she knows better, but I think that we are setting her up to pee in them by leaving her in them all day and punishing her will only add fuel to the fire. Now I feel like we've just lost so much ground instead of getting ahead. When I tell her to go pee before we go to a park or something, since there won't be a bathroom there, she tells me, "Well, I can just use my pull up".  She used to at least do her poop in the pull up in the bathroom- now, since she wears it all day, she poops wherever she happens to be when the urge strikes.  Tonight I tried getting her to empty her bladder before bed, as usual, and granted she was exhausted but she started fighting me, saying she "wasn't going to let it out" and crossing her legs, exactly as she had done in the midst of the poop battle.  We sinply cannot be headed in the right direction here.

At this point, I'm just desperate to put her back in her underpants and at least get back to where we were a few weeks ago.  But we had told her, as instructed by the ped, that she wouldn't wear underpants until she pooped in the potty.  I'm not happy with the course this has taken,the direction this seems to be heading in and the peds. recommendations throughout this ordeal. Any thoughts?

[xmsrlong]

You originally wrote:  "Now the ped. had us tell her since she won't poop in the potty and that's her choice, she needs to wear pull ups all the time- no more underwear, as she isn't really "potty trained", until she chooses to do pee and poop in the potty. SHe was thrilled to have a pull up to poop in again, and mildly disturbed that her underwear was taken away but not so much that she's motivated to poop in the potty to get it back at this point. I realize it became an enormous power struggle between us which had to be diffused by eliminating the object of the struggle. But where to go now...?? I'm not satisfied with leaving her in pullups all day long term- it seems like a step back when she's been in underpants all day long, even nap, except to poop (though she's sitll usually peeing in potty now). I also don't like the message it sends- you were once competent enough to wear underwear but not anymore. Seems to negate pride in that achievement. Right now I'm simply leaving her in the pullup, changing her poop without comment and trying to show no investment in the outcome."

Aw, a ped. giving bad advise.  I'm not surprised and your original gut instinct was right.  Firstly, I must admit I have no expertise in this area as my son is not potty trained yet but he is making great progress in my mind.  He does basically what your daughter was doing, peeing in the potty, but not wanting to do the bm there, although he's done it 3 times since we started potty training 2 weeks ago (he's 39 mos. old.  What the ped. is assuming I think is that the "social desire" to wear underpants will serve as a reinforcement for doing a bm in the potty.  However, as you noted when you first asked the question your daughter was only mildly disturbed that her underwear was taken away, which tells me that she doesn't view the underwear as a desirable reinforcement for doing a bm in the potty.  Your right that its a step back to wear the pull ups all day and it says to your daughter that "you have failed" and therefore we lack confidence in your ability to self regulate.  This may help for some kids I guess, but not with your daughter nor with my son.  What helps with my son is the pride he feels when he has done something on his own.  My advise, and again, I'm not an expert in this area, would be to get her back to wearing underpants and peeing in the potty and then tell her that when she does the bm in the potty, she will receive something very reinforcing for her (toy, cake or whatever she really likes to have but doesn't always receive).  In this way, she will feel a sense of accomplishment for doing something on her "own" which could pave the way for future self determination skills.

[tomel]

I agree I think she needs positive reinforcement. Give her something she doesnt normally get when she does use the potty. If she is using the big potty, mabye go back to the potty chair. Mabye some kids are frightened of the big potty. When she does go to the bathroom in the small potty have her dump it in the toilet herself. I do think she should be scolded when she goes in her pants "No, you dont go in your pants, you go in the potty" THen proceed to walk her in to where the toilet is. Even take her from different rooms in the house to the potty so she realizes where it is always. I am telling you this works.  This is one of the techniques used in "Toilet Training In Less Than A Day". And yes I agree she never really was"potty trained".

[tomel]

I can honestly say this is the one area in my sons development that I can "brag" about, and there arent to many,especially because he is a boy and they generally take alot longer in this deparement. His pediatrician was very impressed when I told him how long he has been potty trained and everytime I tell someone how we did it they are generally impressed as well. However most parents dont want to spend the ENTIRE day and i mean the whole day, nothing else but potty training and it took us 5 days of nothing but that. But had I not known someone else who did it I may have not believed in it myself.

[xmsrlong]

Good work.  It's nice to have something to brag about.  I love the fact that my son can name all the planets, speak in 5 to 6 word sentences, knows how to read hundreds of different words and is doing pretty darn good with the potty training, all despite of his ASD diagnosis.

[tomel]

Yes that is awesome your son can read. I know its gona be hard teaching my son how to read, especially cause he had a speech delay,but hopefully in time. Its amazing what some of these kids can do.

[2brilliantbabies]

I totally understand the stress felt by trying to potty train.  My daughter is 3.6 and has no interest in potty training.  We have tried rewards, of all kinds, with no luck.  There seems to be nothing that motivates her.  She is speech delayed (recently diagnosed) and I suspect there are other delays as well. (We are going to be seen by developmental docs soon.)  She is not even urine trained.  She has no interest; is totally content to sit in a wet/dirty diaper for short periods; is not motivated by rewards; and kicks and screams when I attempt to put her on the potty.  We have tried the big potty, the smaller inset Dora seat, the potty chair; we have tried reading books, etc with no avail.  She is dead set against it.  I will put her on the potty, kinking and screaming, and as soon as she gets off, she will go in her pull-up.  We let her pick out some big girl underware, with no luck.  As suggested in a previous post, I have ordered Potty Training In One Day and am anxiously waiting to get it!

[tomel]

The book is by Nathan Azrin and it has a little girl on the potty on the cover, I know there are some copy cats out there. Although they may have the same idea, not sure.

[vibs97]

I'm the person who posted the comment about rewarding my son with a jeep for going poop in the toilet without his pull-up.  First, I must say I really sympathize with you.  My child's ped. wanted to give my son a rectal examine.  Some or in my experience most doctor's don't or won't listen.  That being said I'm happy to say my son has been going poop in the toilet for about two weeks now.  After almost a year of trying everything and anything to get him to go all it took was... well I really don't know what it was, but I think it was a combination of things.  I'm no expert, even thou my husband laughed at me for buying a book written by someone with the same degree that I hold, but I think it all comes down to "confidence."  I think my son wanted to go but he just did not believe in himself.  I say this because since he started going he has also started doing other things on his own and at times will refuse my help because he wants to do it himself.  I know one thing for certain and that is that he can regress we're still not in the clear, but I think as long as he has confidence in himself he will continue to go.  As for the potty training in one day book, I wouldn't run out and buy it.  I'm a stay at home mom I dedicated more time to toilet training than just five straight days to no avail.  I think it is important for us to remember that each child is different and will do things in his/her own time.  We can try and force and drill them in countless ways, sooner or later they'll learn it is up to us as parents to empower them.  I blamed myself for my sons failure to use the toilet but really now looking back I don't think I had that much to do with it.  My daughter who is eighteen months old said she had to use the potty after breakfast the other day.  I took her and she pooped.  Coincidence, maybe, but just maybe it had nothing to do with me and everything to do with her.   I guess my advice to you is to hang in there.  I don't know if you blame yourself but don't.  There are a lot of know it alls, quick to judge, try not to listen to them you're the only one that truly knows your situation.  If I were you (and I kind of was or at least it sounds like it)  I would put her back in underwear and give her pull-ups to poop in, then in about a month I would start offering incentives and really stress all the things she can do and what a young lady she's becoming.  Good luck and don't worry it will happen hopefully sooner than you think.

[tomel]

I agree with you every child is different. My son was the same way after we trained him he had more confidence in other things,it also mentioned this in the book. And the book aint for everyone but sometimes its nice to have ideas for different alternatives. I do beleive that rewards are always good. Since my husband and I wanted to focus on my sons speech development we wanted to get the potty thing done quickly and not waste everyday on that. Im very proud of him for doing such a great job on it. But again different strokes for different folks.

[Liza55]

Hmm..I'm one of the few that will side w/ the dad. I don't think kids need always the constant positive reinforcement. She was toilet trained at one time. She knows 'the right thing to do' b/c she was doing it! This is a power struggle and I think that she may understand there (like everywhere in life) is consequences to your choices. It's not that she doesn't understand the concept of where to relieve herself or that she medically can't do it- she's blatantly telling you, the parent, where she'll go?! I would put her back in her underwear and not say a whole lot beyond- when you must pee or poop, you know where to go, ask and I will help you. And then if she goes- great- go nuts! If she goes in her pants- have her clean it and comment how gross it is b/c it is! And, especially for the holding it in and telling she won't go, have a punishment ready. That makes it clear this is unacceptable behavior- period. Give dad's idea a chance.

[FSmom]

Hey, I feel your pain!  This has been a big issue for me with my girl since she was tiny. Always constipated.  Taking a week to poop since coming into this world!  She's now FIVE-AND-A-HALF and still is terrified to poop in the potty.

It is sheer fear.  Sheer terror.  I really don't think pediatricians know how to handle this properly. The stool softener (of which I sometimes quadruple the dose) does little 'cause she still holds it in.  We had her out of pull-ups for poops when she turned four, but then I got tired of having to deal with poop in the underpants.  And we got her back in pull ups.

I'd like to know of some strategies for alleviating irrational childhood fears like this one.  She seems almost ocd when pooping--trying to rid the bathroom of anything movable (towels, trash bins, step stools) etc.  She then paces, squats, leans, etc.

BTW, regular potty-training books really don't deal with this kind of situation.  

[calimarie]

My son is 4 and refuses to go poop in the potty. I've been trying a potty chart with prizes each time he goes and although he gets excited about the prizes and sticker chart and cheers when his sister gets her rewards, he is still refusing to poop in the potty. He instead "goes" in his pants in every room in the house and says he's sorry and that he'll go in the potty next time. I have been fighting getting frustrated and am at a loss as to what to do. I have actually had a few other parents give me the whole "oh, he's not potty trained!" stare like this is somekind of disease and I am starting to think maybe something is wrong with his not going poop in the potty. He has peed in the potty and stayed dry at night since he turned 3......He needs to start preschool soon and the ones I talked to said they didn't take kids that weren't fully potty trained. Also I don't want his sister to do this same thing. I kind of thought about using their competetiveness to get him to go, but I think that just may make them argue and fight more than they do already, and it would be against my trying to get them to "work" things out together as a team. Anyway, any help would be appreciated. Thank you.....

[bubbiesmama]

A related discussion, 4yr old twin boys won't poop in potty was started.

[suz656]

A related discussion, potty training 3.6yr old girl was started.