Q. My grandson is 4 1/2 and still not potty trained as far as his bowels. He's in preschool, before and after school care, and has been in child care since he was 6 months old. He usually holds his bowels throughout the long, 12-hour day. His pediatrician says it's a psychological power thing.
-- A Grandmother in Minneapolis
A. By 3 1/2 , most kids are potty trained. After that, parents need a strategy. No more "waiting until the child is ready," or writing the problem off as a power struggle.
"I'd encourage the parents to do anything they can to get the child to the level of functioning," says Jan Faull, author of the step-by-step guide, "Mommy I Have to Go Potty!: A Parent's Guide to Toilet Training" (Raefield-Roberts, 1996).
Last week's Parent to Parent focused on how it's important to match the reason for the toilet training delay with a matter-of-fact approach suited to your child. This week: tips from parents. Neither column is a substitute for professional advice.
"We had a similar problem. A doctor advised us to have set potty times for bowel movements," says a mother from Rhode Island. "We had our son sit and try for 10 minutes each morning and each night. We gave him special books and small toys he could use only during that time. Eventually, he got into a routine."
Several parents link the delay, which is more common in boys, to one of these three reasons:
The child holds back his bowels to avoid discomfort and needs treatment for constipation.
The child fears he'll tumble into the toilet.
The child is too busy playing to go to the bathroom.
Some parents have found that if they spend more time at home, limit the use of diapers and get all caregivers in tune with the child, their new training plan succeeds.
"We reached a similar point, at which I thought our son was never going to be trained," says one mother, who turned to the Web site, www.soilingsolutions.com for help. To carry out timed potty sittings for her son, the family reduced their evening activities for about three weeks.
"As hard as it is in our busy lives, sometimes you have to set aside time for something as important as this," says the mother, who lives near Toronto. "It's more disruptive to have this problem continue than to curtail your schedule for a few weeks."
One mother made her son responsible for cleanup duty if he opted not to use the toilet.
"Sometimes our son just didn't want to take the time out of his day, which would result in an accident," says a mom from Indian Trail, N.C. She taught him how to rinse his underwear before she put it in the washer. "He didn't like this one bit," she says. "It only took a week or two before he realized that this would be a regular chore unless he went to the toilet."
A mother from Loveland, Colo., was told her son was "too lazy to use the restroom." After seeing several physicians, the boy was diagnosed with encopresis.
A child suffering from encopresis withholds his stools, his colon becomes more and more impacted, and he begins to lose the sensation that signals the need to have a bowel movement, explains Charles E. Schaefer, psychologist and co-author of "Toilet Training Without Tears" (Signet, 1997), a popular guide for parents. Although constipation is evident, watery stools leak past the impacted feces and soil the child's underwear. The soiling may appear to be the opposite problem, diarrhea.
Whether your child is too busy, stubborn, or afraid to use the toilet, after age 3 1/2 , the problem won't solve itself, experts say.
Other tips to discuss with a professional who has expertise in delayed toilet training:
On the advice of a pediatrician, one mother gave her son one teaspoon of mineral oil in a cup of juice each day for several weeks to lubricate the bowel. He realized his bowel movements no longer hurt, and he was potty trained within two weeks.
A Providence, R.I., mom saw improvement soon after taking her son to a constipation clinic.
Can you help?
I love my wife, but there's a great deal of animosity between me and her 16-year-old daughter. My wife allows my stepdaughter to curse at me. I've told the girl she needs to leave if she can't respect me, but her mother says they're a package deal.
-- A Stepfather in Texas.
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