Poop Withholding: What to do when your child refuses to go

All it takes is one unpleasant experience with stress or pain to turn your child off to the whole idea of depositing poop in the potty. Toilet learning is best when it is a natural process. When a child is old enough and emotionally ready, he will observe and do it. Problems most commonly arise when a child is coerced or pressured before he or she is ready. Parents may feel pressure to speed up toilet training due to pre-school demands or a new baby's birth. When rushed, your child may comply for a while and then decide months later that he prefers the pull-up to the toilet.  What worked before to get Junior to poop in the toilet will be a no-go once he understands that he controls his own body functions. The other problem, which is more of an organic issue, is a painful bowel movement (BM), usually related to constipation.  Either of the above stressors may lead him or her to withhold feces. Parents should tread carefully to help the child to resolve this issue. However, parent-child collaboration will be the key to success.

Children who are 4 years (or older) and are resistant to using the toilet or actively withholding should be seen by their pediatrician to rule out a medical explanation. Withholding of stools can lead to significant discomfort in children. Tears and parent-child drama may lead to emotional issues which exacerbate the problem. Protracted withholding can lead to mega-colon and constipation incontinence.  This happens when the fecal mass becomes too big for the child to pass naturally. Then softer fecal material oozes around the mass and into the child's underwear. Regular withholding eventually distends the colon (it becomes flabby). When this happens, the child loses the sensation that occurs when the colon is full. It is important to emphasize that withholding is an anxiety-based disorder, not defiance. Parents should follow their physician’s recommendations.

The following tactics may also be helpful.:

·        Make sure the child’s diet is high in fiber and increase water intake.

·        Parents must accept the limits of their control and work on their own stress and anxiety related to this issue.

·        Tell the child that they are in charge of where they put their poop and pee. Assure them that you will stay out of it.

·        Avoid coercion, nagging, or pleading even if the child is doing the “potty dance.” Parents must never, ever threaten, scold or punish.

·        Resistant children may find it interesting to see an atlas of the human body to understand pooping. Children's books may also be helpful, but this can also be coercive.  Do not talk about toileting with your child for more than 5 minutes per day.

If the child is withholding continues, try the following:

·        Try pediatric massage and progressive relaxation techniques to reduce the child’s stress. There are great resources online.

·        Validate your child’s stress and fear but remind him to talk back to his worry brain. Encourage brave thinking if he is fearful of the toilet or of painful poops.

·        For more entrenched withholding, a daily bathroom schedule with a pull-up on may be in order. Allow your child to use a pull-up but have her stand in the bathroom to go. Once the child is successful pooping near the toilet for two weeks, then place her on the toilet with the pull-up on with the lid closed. Then in two more weeks, try it with the lid open (and the diaper on). You can guess the next step.

·        When the child is successful, be judicious with praise and excitement. Match your child's level of excitement and do not exceed it.

·        Constipation incontinence will require a doctor's care. But with sensitive responses to withholding at the beginning of the problem, more severe issues may be prevented. Consultation with a child psychologist may be helpful to ensure your child’s success in managing toileting issues.