Q&A: Parents need help in solving son’s potty problem

Q: For nearly 3 years, our son has been unable or unwilling to stool in the toilet. He has excellent control over his bowels and has never had an accident. He uses the bathroom to stool but will only stool in a training diaper. The stool comes out easily and then he spends about 5 minutes singing and looking out the window before finally asking for help in cleaning up.

He waits a long time between stools--2 or 3 days. We have tried everything from exerting pressure on him to exerting no pressure on him. We’ve tried seeing a nutritionist and even offering him any reward he wishes. We have stopped short of refusing to give him a diaper because our physician has warned us that if he holds it too long he may become encopretic. Actually, we tried "running out of diapers" once but the fit he threw worried me, so my husband went out to get diapers. – R.A., a North Shore mom

A: This is more a problem of control and limit setting than it is about stooling. Medically speaking, your son has no problems stooling – he just wants to do it his way. Encopresis is a complication of long standing constipation where loose stool oozes around very firm stool so the child starts to have accidents. Your son is clearly not constipated as he goes easily and regularly. Stool frequency actually varies among individuals – some stool daily and others a few times a week. That said, I agree you’d want to monitor his stool frequency and call your pediatrician if you notice a change in his pattern or the ability to stool.

Reading between the lines, I get the sense you know the solution lies in your ability to be firm about where your son has to stool and that diapers are just not appropriate for a 5 year old. While fits are not fun to experience they are a sign of deep frustration in a child. Giving in actually reinforces the bad behavior. Instead of being worried about the fit, focus more on why the fit occurred – he did not get his way. For us as parents to help our kids become all grown up and follow certain rules, we have to let them grow up – that means allowing some fits and being willing to lay down the law.

I’d suggest formulating a plan with your son with expectations, rewards and consequences. The consequences may be not watching a TV show or not going on a playdate. I know this sounds harsh but if your son wants to do other “big boy” things you have to hold him to those expectations uniformly. As part of this process, be sure you express to him that while you love him you are incredibly frustrated and disappointed by his behavior. The 2 issues to focus on are using the toilet to stool and in cleaning himself. You could use a stepwise approach or cold turkey. Perhaps if he poops in the toilet you’ll still wipe him for a few days more, that sort of thing.

A house with a strong foundation is certainly more able to withstand a greater variety of internal and external strain than one with cracks in it. So, patch your small crack today with a bit of tough love and you’ll avoid a much larger and harder to repair crack down the line.

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