Hi Dr Justin,
I have started toilet training my daughter who will be three in April. She’s really good at doing her wees on the toilet and potty but not so good when it comes to poo. She will get hysterical, cry and say she doesn’t want to do it but is in agony from holding on to it. When she finally calms down and does go she pushes and grunts and strains herself.
I have read that this is called the poo challenge. I have offered rewards and comforted and reassured her, is there anything else I can do to help her realise that it’s not bad to do a poo? I have showed her mine and make a big deal out of it by giving high fives and hugs.
Any suggestions would be greatly appreciated.
Kind regards,
Sarah
Dr Justin responds:
Questions about toilet-training are quite poop-ular for parents of children around the age of three. It seems to be something we get really bogged down in. Some parents find it hard to digest all the advice that’s out there, and working it out can seem quite strenuous.
OK … enough with the bad dad jokes.
It is likely that your daughter wants to poo in the potty. Children are wired to develop, improve, grow, and learn.
Unfortunately, some children get a little pre-occupied with other things (like playing, eating, sleeping, and so on) and so the delay going to the bathroom. Or perhaps they have had a difficult experience with poo previously, so they feel somewhat anxious. Sometimes poo will become painful due to a change in diet, or dehydration.
For any of these reasons, a child will hold onto their poo and then suffer the pain of trying to evacuate the bowel with more poo than will comfortably come out. This can cause more anxiety about future poos.
Of course, the longer a child delays their poo, the more painful the poo is. And then there’s the anxiety build-up – along with the other build-up – before the next poo and the cycle continues, even worsening over time. Each poo hurts more than the last. The child becomes increasingly anxious about pooping. Then more pain eventuates, justifying the anxiety, and a self-fulfilling, self-defeating cycle grows.
There can be health complications such as anal fissures from straining. So it is serious business.
What is normal?
Children, on average, become toilet-trained around 28-30 months of age, but it is not at all unusual for it to take substantially longer. This is especially the case with poos. It seems that the more pressure we put on our children to use the toilet or potty, the more anxiety they experience around toileting, and the less likely they are to actually use it properly. In the same way that we do not rush a child to walk, read, tie laces, or start dating, we need to be patient and calm. If your daughter is not ready to poo, don’t force it.
Breaking the cycle
Your initial reactions to use big incentives, praise, and other rewards to increase motivation are common. Some parents enjoy great success with them. However, I suspect this is less about the rewards and more about the developmental readiness of their child. Some research suggests this approach will actually be unhelpful and counter-productive. I do not recommend it.
Similarly, there is no reputable research to indicate that having your child watch you use the toilet and examine your habits will promote toilet training.
Instead, your first steps should be:
Put your daughter back into nappies. She may be more comfortable pooping in a nappy.
Do all you can to soften her poo, and make it slippery. I’d check with your GP on the best way to do this. Some laxative products are better for children than others. You want something that will create an urge, and will literally make her poo slide straight out.
Once your daughter has had a week or two with some easy poos, you can invite her to use the potty when she is ready. I can assure you that it will not happen overnight, but it will happen within a reasonable timeframe in most instances.
If you are concerned about your daughter’s wellbeing, if there is blood in her poo, or if you have other concerns I strongly suggest you visit your GP for advice. And if these tips are unsuccessful over the course of around six weeks, you may find it helpful to visit with a psychologist who specialises in paediatric toileting difficulties. This is an unlikely eventuality, but in some cases it may be necessary.
So stay calm, be patient, make poos easy with some dietary assistance, and let your daughter work things out without pressure. In a short time you should see some positive results.
How did you overcome potty issues in your home?
If you’d like more information, take a look at my ebook titled Toilet Training: Easy as One, Two, Wee?. It will help you flush out a few more answers.