Peeing in the toilet is no problem for your four-year old, but he’s suddenly developed an aversion to pooping there. He’s reluctant to even sit on the toilet and hasn’t had a movement for two or three days. When you ask him why he doesn’t want to go, he says it hurts.
It’s quite common for preschoolers to withhold bowel movements, says Fabian Gorodzinsky, a community paediatrician and an associate professor at the University of Western Ontario in London, Ont. Often, the problem quickly becomes a vicious circle: Your little guy probably got constipated and had an uncomfortable bowel movement. But now, not keen to repeat that experience, he fights the urge to move his bowels — which worsens his constipation. If you do manage to coax him back onto the toilet, another painful episode reinforces his fear (see Encopresis). Here’s help:
Not quite ready?
Gorodzinsky says withholding often happens after an attempt at toilet training when children just aren’t ready, emotionally or physically. Even at this age? Yes. According to the Canadian Paediatric Society, the age of readiness for toilet learning is anywhere between 18 months and four years. So it may be that simply backing off a bit and giving your child a few more weeks or months with diapers or using the potty will relieve the problem.
If a child who’s resistant to having BMs on the toilet asks for a diaper, give it to her, Gorodzinsky advises. Quite often children who have had a bad experience need to take another run at toilet training. Let her sit on the potty with her diaper on. Then, as she gets used to this, try removing the diaper and having her go on the potty. Once she is comfortable on the potty, try moving next to the toilet and take the same gradual approach.
The most important thing, says Gorodzinsky, is not to take a punitive approach. “And never shame your child about bowel accidents.”
Just too little?
Often kids are reluctant to use the toilet because they aren’t big enough to sit comfortably and bear down effectively; they’re too busy holding themselves up to be able to move their bowels, or their feet are dangling in mid-air. “You have to retrofit your toilet for your child,” says Gorodzinsky. A toilet seat insert and footstool will help a child feel more secure and give him the ability to bear down.
Not enough bulk?
A diet low in fibre or containing way too much milk or formula can contribute to constipation, says Gorodzinsky.
Encourage your child to eat lots of fruits, vegetables and whole grains; Gorodzinsky suggests adding a little bran to breakfast cereal. And make sure she’s drinking enough fluids too. “Fibre with inadequate liquid will worsen the problem.” Preschoolers should consume about two cups (500 mL) of milk a day.
Is it a medical problem?
Rarely, says Gorodzinsky. If constipation is a persistent problem, see your child’s doctor rather than resorting to mineral oil or laxatives. The doctor can prescribe an appropriate medication. You should also see the doctor if problems with bowel movements persist beyond three months; your child is four years old and still not toilet trained; or if you see blood in the stool.
Finally, figuring out what could help your nervous pooper relax might do the trick. It might be a warm bath to get the bowels moving or even a little levity. One mom we know says, “We turn on the tap and encourage her to make what she calls poo-poo faces, which are what she does when she’s bearing down. It seems to help to have a little fun with the situation.”
Chronic constipation (Encopresis)
When preschoolers poop in their pants, it’s usually a result of chronic constipation, says Fabian Gorodzinsky, a community paediatrician in London, Ont. A buildup of hard dry stool distends the bowel, which causes the nerves to lose sensation. The child actually stops feeling the urge to go and, when he does poop in his pants, he may not notice. “Kids quickly lose the ability to smell their own feces,” Gorodzinsky explains. “Of course, other people do smell it and this causes a difficult social situation, but it’s important that parents not take a punitive approach.” Fixing the problem most often involves relieving the constipation, so talk to your child’s doctor.
Originally published in 2009.