How do you persuade a child to have a bowel movement on the toilet?
One of the main things to do is check the consistency of your child's stools. Most children who refuse to toilet (they'll have their bowel movements in their diapers, disposable training pants, or pants, but not in the toilet) have had problems with constipation. Make sure your child has soft, formed stools. Hard stools, large stools, or small pebbly stools are all signs of constipation, and the most common reason for stool withholding or "toileting refusal" is that the child has had one or more bowel movements that were painful or uncomfortable.
The main way to soften the consistency of a child's stools is through his diet, by getting him to eat more fiber and by monitoring his intake of dairy products. The easiest way to calculate the amount of dietary fiber your child is getting is to look it up on the nutritional information label on his food. A good rule of thumb is that children should eat enough grams of fiber to equal their age plus five (for example, a 4-year-old needs 9 grams of fiber each day). It's also best if the fiber is distributed equally among the three meals, rather than eaten all at once.
It can take weeks, sometimes months, for a child to get over having a painful bowel movement. Although I hear all the time that a child has accidents because he is angry or resentful, this is rarely the case. He has accidents because he holds back his painful stools until he can't hold them anymore.
Once your child is routinely having soft, formed bowel movements, keep track of when he has them to see if there is any pattern to them. If you can tell that it's about time for him to poop, you can encourage him to sit on the toilet.
I also recommend what I call toilet sits, encouraging your child to sit on the toilet several times each day, without any pressure to have a bowel movement. These toilet sits are more to get him accustomed to sitting on the toilet than they are to get him to use it. It's all right to have him do a dozen toilet sits each day without his ever having a bowel movement there. Your goal is to get him to learn to relax while sitting on the toilet.
Also, make certain that he can place his feet firmly on the floor, if he's on a potty chair, or on a step stool or two if he's on the regular toilet. Being able to plant his feet on the floor means that he can get on the potty chair or toilet easily, that he feels stable and secure when seated, and that he can push with his feet to give him leverage. All of these are important to independent toileting.
Other common problems
- Frequent bed-wetting
- Handling accidents
- Maintaining interest
- Won't sit on the potty
- Going to the bathroom in public places