What is toilet training resistance?
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 a parent brings up the subject and marches
them into the bathroom. Any child who is over 3 years old,
healthy, and not toilet trained after several months of
trying can be assumed to be resistant to the process rather
than undertrained. Consider how capable your child is at
delaying a bowel movement (BM) until he or she is off the
toilet and has a chance to hide. More practice runs (such
as you used in toilet training) will not help. Instead, your
child needs full responsibility and some incentives to 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.
How can I help my child with daytime wetting or soiling?
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.
Transfer all responsibility to your child.
Your child will decide to use the toilet only after he
realizes that he has nothing left to resist. Have one
last talk with him about the subject. Tell your child
that his body makes "pee" and "poop" every day and it
belongs to him. Tell him that his "poop" wants to be in
the toilet and his job is to help the "poop" come out.
Tell your child you're sorry you punished him, forced
him to sit on the toilet, or reminded him so much. Tell
him from now on he doesn't need any help. Then stop all
talk about this subject ("potty talk"). Pretend you're
not worried about this subject. When your child stops
hearing conversation about not going, she will
eventually decide to go to the bathroom for attention.
Stop all reminders about using the toilet.
Let your child decide when she needs to go to the
bathroom. Don't remind her to go to the bathroom or ask
her 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
keeps the power struggle going. Stop all practice runs
and never make her sit on the toilet against her will
because this always increase resistance. Don't
accompany your child into the bathroom or stand with her
by the potty chair unless she asks you to. She needs to
gain the feeling of success that comes from doing it her
way.
Give incentives for using the toilet.
Your main job is to find the right incentive. Special
incentives, such as favorite sweets or video time, can be
invaluable. For using the toilet for BMs, initially err on
the side of giving her too much (for example, several food
treats each time). Remember that incentives work even
better if it is a special treat that your child doesn't
get everyday. If you want a breakthrough, make your child
an offer she can't refuse (such as going somewhere
special). In addition, give positive feedback, such as
praise and hugs every time your child uses the toilet. On
successful days consider taking 20 extra minutes to play a
special game with your child or take her to her favorite
playground.
Give stars for using the toilet.
Get a calendar for your child and post it in a
conspicuous location. Have her place a star on it every
time she uses the toilet. Keep this record of progress
until your child has gone 1 month 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 go to the bathroom. For urinating, the presence
of the chair and the promise of treats will usually
bring about a change in behavior. Don't remind her even
if she's squirming and dancing to hold back the urine.
Diapers, Pull-ups, or underwear.
Whenever possible, replace pull-ups or diapers with
underwear. Help your child pick out some underwear with
favorite characters on them. Then remind her "they don't
like poop or pee on them." 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. Preventing
stool-holding is very important.
Remind your child to change his clothes if he wets or soils himself.
As soon as you notice that your child has wet or messy
pants, tell her to clean herself up. The main role you
have in this program is to enforce the rule: "people
can't walk around with messy pants." 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 in her bedroom 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. Pressure will only delay successful
training, and it could cause secondary emotional
problems. Your child needs you to be her ally.
Ask the preschool or day care staff to use the same strategy.
Ask your child's teacher or day care provider to let
your child go to the bathroom any time he wants to.
Keep an extra set of clean underwear at the school or
with the day care provider.
When should I call my child's health care provider?
Call during office hours if:
Your child holds back his or her bowel movements or
becomes constipated.
Pain or burning occurs when your child urinates.
Your child is afraid to sit on the potty chair.
- Your child's resistance has not improved after 1 month
on this program.
The resistance has not stopped completely after 3 months.
