Toilet Troubles

by Tripp Underwood on December 6, 2010

It seems like an unlikely trigger, but four years ago an automatic toilet turned Sarah Teres’s life upside down. At the time, her daughter, Molly, was maturing quickly: At 3 years old she was already walking, talking and fully potty trained. But the trip to a public restroom with a self-flushing toilet scared Molly right back into diapers.

“Something about the automatic flushing terrified her,” Sarah says. “After that she refused to go to the bathroom. Trying to get her to use the toilet was exhausting.”

Sarah and Molly’s problem was stressful, but not uncommon. Almost 25 percent of all children have some degree of difficulty learning to use a toilet after the suggested age of 36 months. And, as demonstrated by Molly, problems with pottying can occur at any point in the process, even after the child has begun using the toilet.

Struggling parents are often offered copious advice, both welcomed and unwelcomed, about the “best way” to get through the ordeal. From rigid, multi-step programs to free-spirited, diaperless trial and error, there’s no shortage of suggested methods. But what’s a parent to do when nothing seems to work?

“We went through so many pottying techniques, from pleading and bribing to outright begging,” Sarah says. “There was an unbelievable amount of mental anguish. You get so frustrated. It feels like nothing is going to work.”

In the year that followed the automatic flushing incident, Sarah and her daughter were locked in a battle of wills over potty training that left them both emotionally drained. The more they stressed, the harder it was for Molly to go; it wasn’t uncommon for a full week to pass without her having a bowel movement. After withholding, she often became painfully constipated, and the association of pain with the bathroom only escalated her fears.

After several months and countless failed attempts, Sarah and Molly met with experts at Children’s Hospital Boston for help. Molly was evaluated and referred to Children’s Toilet Training School, a subdivision of the hospital’s Pain and Incontinence Program, which educates parents and kids about toilet training.

The school meets for six sessions, with separate classes for parent and child, and focuses on achieving small, incremental goals each week. The step-by-step method gives parents the chance to step away from a stressful situation and gain perspective while the children have time to grow accustomed to using a potty.

“If you have a fear of water, jumping off a diving board into the deep end of a pool can be terrifying,” says Elaine LeClair, PhD, a psychologist and parent group leader for the Toilet Training School. “But if you start in the shallow end and gradually work your way deeper you can overcome your fear more naturally. The same can be applied to toilet training.”

Having potty problems?
Here are some of the most common causes for toilet training woes.Constipation. Even if a child is having fairly regular bowel movements, he may still be constipated.Diapers too comfortable. Modern diapers hold a lot of liquid without much discomfort, which lessens the incentive to toilet train.

Baby on the go. From daycare to a sitter’s house to home, today’s toddlers move around a lot. A lack of consistency in toilet training environment can cause problems.

Location. If your bathroom is a kid-friendly environment, toileting will be less intimidating.

Control. Toileting is big step toward independence for a child. Make sure she’s ready before you place expectations on her.

Toileting difficulties can happen for many reasons, but the frustration both parent and child feel as a result is almost universal. Worrying about a stressful scenario is normal, but LeClair reminds parents that they’re not the only ones responsible for their child’s success.

“By the time I see parents they’re pretty discouraged and often feel helpless,” she says. “I help them turn the responsibility over to the child, which disengages them from some of the emotional angst they’ve been experiencing.”

While the parents are sharing experiences and learning toileting strategies, the children are being taught the hows and whys of potty training from a nurse practitioner. The classes rely heavily on proven training methods and peer-modeling.

“It’s a really supportive environment, which helps them relax,” says Kim Dunn, PNP, another of the Toilet Training School’s instructors. “And there’s just enough positive peer pressure to make a difference for a lot of kids.”

Sarah agrees. “It’s a room of kids with similar issues learning and supporting each other. It’s like a Betty Ford clinic for 4-year-olds,” she jokes.

Dunn and LeClair suggest that parents still suffering potty training difficulties by the time their child is 4 talk with their pediatrician about the possibility of constipation, a common and treatable condition associated with toileting issues. Signs include multiple, small, hard bowel movements that can be very painful for children to pass and can lead to or exacerbate toilet anxiety.

Even though the child is ultimately in control of whether or not she’s ready to use the toilet, LeClair says parents still play a pivotal role in preparing their children. “Know your child and trust your child, but remember that you’re the parent and need to provide the structure and expectations.”

“Don’t be afraid or ashamed to seek help if it’s not going in the right direction,” adds Dunn. “Rather than getting angry or embarrassed about a child’s potty training issues, remember that there is help available. You’d ask for help if your child was facing other medical or behavior issues, so you shouldn’t be afraid to ask for help with toileting when it’s needed.”

It’s been three years since Molly graduated from the Toilet School, and Sarah is just about to begin potty training her youngest child. While mom is hopeful it will be an easier process for her son than it was for Molly, she feels prepared to handle any complications that could arise. “I know potty training is different for every kid. What works for one won’t necessarily for another,” she says. “But because we’ve been through the Toilet School already I feel like I have a better idea of what to do if we hit a bump in the road. I’m ready this time.

Children aged 4 to 16 years with bed-wetting, encopresis, enuresis and toilet training problems can contact the Pain and Incontinence Program (PIP) at Children’s to discuss evaluation and treatment by developmental behavioral pediatric specialists. Call the DMC Intake Coordinator for questions and intake information at 617-355-7025.

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