Toddler Refuses to Potty Train: Tips from a Pediatric Urologist

“My 5-year-old refuses to poop on the bathroom!!!” one mother emailed me. 

One other wrote, “My daughter is a nightmare to potty practice. She flat-out refuses to go to the toilet when she clearly must. Then she has an accident.”

The phrases “toilet refusal” and “toileting refusal syndrome” even floor in medical literature.

“Refusal” implies cussed, willful, unreasonable conduct. However let me provide a extra evidence-based clarification: Youngsters who resist utilizing the bathroom are both not developmentally prepared for toilet training or are chronically constipated. Within the second occasion, the kid’s rectum has grow to be stretched by a pile-up of stool and has misplaced the tone and sensation wanted for full evacuation.

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These children aren’t exhibiting defiance. They’re simply not getting the sign! And so they want remedy. No quantity of cajoling or incentivizing will change this reality. A stretched rectum received’t reply to guarantees of M&Ms or display screen time or to behavioral remedy. 

When potty refusal often occurs

With many children, potty refusal strikes round age 2, after they begin bathroom coaching forward of their preschool’s deadline. Mother and father search to get a soar on coaching, lest the kid lose their spot in class.

I completely get it, given how rigidly preschools implement their potty insurance policies. Drawback is, most 2-year-olds are too immature to toilet train. Certain, toddlers and even infants could be taught to pee and poop on the bathroom. However don’t be fooled: That’s totally completely different from possessing the judgment to heed your physique’s alerts in a well timed method, not 2 hours or 2 days later. 

Many children who practice early develop the holding behavior. Progressively, poop piles up within the rectum, an organ not designed for storage. The stool mass dries out and hardens, so pooping hurts. Loads. So, children additional delay pooping, extra stool piles up, and the rectum stretches additional, compromising its tone and sensation mechanism.

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In different phrases, the kid actually can’t squeeze out an entire bowel motion and even really feel the urge to poop.

However what adults understand is a scarcity of cooperation: “refusal.”

In some children, the enlarged rectum presses towards and aggravates the close by bladder nerves. The bladder contracts and empties with out warning. So, now the kid seems to be “refusing” to pee within the potty, too.

Continual constipation could possibly be the foundation reason for why a toddler refuses to potty practice

My analysis has discovered that children potty trained before age 2 have triple the risk of developing chronic constipation and daytime pee accidents than youngsters skilled between 2 and three. This doesn’t imply 2 1/2-year-olds are within the clear, however the odds are particularly excessive for teenagers beneath 2. 

Continual constipation not solely results in enuresis (daytime pee accidents and bedwetting) but in addition encopresis (poop accidents). In some children, the rectum turns into so floppy that stool simply drops out of the desensitized rectum, with out the kid noticing. If preschools eradicated potty-training deadlines, many circumstances of “potty refusal” could possibly be prevented. However early bathroom coaching is only one reason for continual constipation. Youngsters grow to be constipated for a lot of causes—genetics, fashionable bogs (which take us out of the pure squat place), concern of pooping outdoors the house—and these youngsters get referred to as “refusers,” too.

How is continual constipation handled?

Whereas I advocate a laissez-faire strategy to bathroom coaching, I like to recommend a proactive strategy to treating constipation and serving to the kid overcome the behavior of delaying poop. A mix of laxatives (to melt poop) and enemas (to scrub out the rectum) is often wanted. The routine I like to recommend, the Modified O’Regan Protocol, aka M.O.P., is spelled out within the M.O.P. Anthology.

However most children don’t get the remedy they want as a result of they’ve been labeled “strong-willed” or “refusers.” Faculties sometimes refer these children for behavioral counseling or advise mother and father to “say nothing,” on the idea that children will begin cooperating in the event that they aren’t badgered.

However children with “toileting refusal” don’t need assistance cooperating; they need assistance pooping!

Left untreated or under-treated, continual constipation usually worsens. I’ve an enormous caseload of teenage sufferers with enuresis and/or encopresis. Typically, the purple flags had been obvious by age 3. However the mother and father had been advised, “This too shall move.”

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A number of research join potty “refusal” with constipation. By and enormous, these research had been performed by psychiatrists and behavioral specialists, not by GI medical doctors or urologists, and vital conclusions had been neglected.

For instance, in a research that tracked practically 400 youngsters, over 24% developed “stool toileting refusal (STR).” Amongst this group, 93% of the children confirmed indicators of constipation—comparable to onerous bowel actions and painful pooping—earlier than the onset of STR. (Italics are mine.)

In different phrases, these children began bathroom coaching with a situation that makes bathroom coaching unimaginable! But they had been labeled “refusers.” 

Let’s retire the time period “potty refusal,” acknowledge the underlying constipation, and get these children the remedy they want.