Stool toileting refusal

Stool toileting refusal in a 4 yr. old child.

"Stool toileting refusal" in a 4 year old child is not uncommon and may be associated with two main behavioural factors. The first is stool withholding causing constipation which can result in rectal impaction and primary encopresis. The second is lack of toilet training. A child who is not trained by 4 years of age can be a source of family conflict and great stress. Management depends on the individual child's situation, and for those who are constipated a combination of stool softening (mineral oil), mechanisms to stimulate bowel movements (laxatives, suppositories, enemas), limit setting, behavior modification and positive reinforcement are important. For those children who have a basic lack of toilet training, the parents should return the child to diapers with the following instructions. Underpants are only to be worn when the child stools in the toilet or potty. The parents should be asked to make no effort to toilet train the child for a period of at least 3 months. (Many parents are reluctant to do this as they consider it regressive, but it is an important component of management). They must be encouraged to empower the child, who will likely train himself, once the pressure of 'training' has been removed.

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