Toilet-Training Resistance - Encopresis

[Mary]

I have a 4 1/2 year old son who was potty trained by 3 1/2, right after he was finished training I had another baby and he regressed back into diapers and then pull-ups.  It took almost a year to get him back on track, basically due to the fact he would be starting Pre-School and he was very excited.  Since starting school in Sept. he has regressed again, but now he states he is afraid of the bathroom, has made himself constipated where even an enema as prescribed did not work too well.  We have been giving him Mineral Oil to soften his stool but he refuses to let anything out.  He crosses his legs and strains to NOT go and now he is even afraid to go pee in the bathroom.  He has had his share of accidents - but now he will also hide in another room and wet himself.  He wears regular underwear to school and only has grainy stains come out occassionally.  I have tried every trick in the book, from rewarding m-n-m's, pennies, quarters, toys, etc and have even tried the approach of ignore it - it will go away.  Nothing I seem to do is right and I am going crazy trying to not lose my cool as I don't want to scare him or his younger brother and have this go on forever -

Please, what can I do?????

[Kevin Kennedy, Ph.D.]

Dear Mary,

Two things will be important. One is to be sure to continue with the doctor-prescribed/guided stool softening regimen. The second is to be patient and continue with the incentive-oriented approach to encourage your son.

It's not uncommon for children to regress around stressful (for them) circumstances. Changes such as those you described (arrival of a sibling, commencing pre-school) often do precipitate some regression. If the child has become constipated and, as a result, has experienced some discomfort around toileting, there will for a time be reluctance. But this will change. It definitely requires patience and perseverance.

[s.meekin / clinical psychologist]

Dear Mary

I am unsure from your letter what behaviours you have been targetting with your rewards. I work in a children's hospital and your son is not unusual in the types of referrals I have received. I would advise that you forget about toilet training at the moment and simply concentrate on his toilet phobia. Concentrate your rewards on getting him to sit on the toilet or a potty - initially even with the lid down if this ensures success! Do not worry about getting pants down until he is perfectly happy sitting on the toilet or potty. A referral to a clinical psychologist or continence advisor may also be helpful.

Good luck.

[njschoolnurse]

A related discussion, Kindergarteners Soiling Themselves was started.