My three and a half year old refuses to use her potty or the toilet to poo. She doesn't mind most of the time doing a wee in her potty or the toilet but asks for a nappy when she needs to do anything ``stronger''. How can I encourage her onto the potty or toilet for all her toilet needs? 

Some toddlers often refuse to use the potty or toilet to do a poo.  Quite often what happens is that they ask for a nappy to do the poo, refuse to go to the toilet, but instead prefer to go into their bedroom and hide to do the poo in their nappy and then come and tell you.  There is often a few variations on this where they will ‘hide’ in other places, such as behind the couch, or in the back yard, behind their rocking chair and then will tell you or even not tell you.  In the later you often notice them walking differently and know that they have done a poo.

At times this anxiety about using the toilet or potty then grows and gets worse.  It gets to the point where the toddler actually holds onto the poo, hoping to delay the whole ‘going to the toilet process’.  Why do they hold on?  Lots of parents ask me – basically it is because they do not like doing the poo so their brain tries to make sense of the whole situation and thinks that – poo = pushing and I don’t like that so the best way to solve this problem is to hold onto the poo, then I don’t have to push it out or ask for the nappy.  Unfortanetly their brain is a little off track in this reasoning.

I have seen children hold for a few days, 5 days or even 8 days.  The result of holding then becomes a vicious cycle.  The longer they hold on to avoid doing their poo, the harder the poo becomes, it then tends to dry out on the end and also gets bigger as their bowel becomes full or compacted.  Thus as you can imagine when they finally have to do the poo because they can’t hold any longer, when they do have to push out this poo, the whole experience is worse.  The pushing, straining and size of the poo make it even more uncomfortable and it may actually hurt a lot.  Thus their brain then thinks ‘see I told you, doing a poo is horrible, so best to be avoided just hold on more!’.   I’m sure you can see that this is then a problem that goes around and around.

When children who hold eventually have to go, it usually involves a hour or two of hysterics, screaming, crying – it is extremely distressing to watch a child go through this experience for parents or for anyone.  Also the longer they hold, then they have the added problem of sneaky poo’s.  Which are a bit of leakage that sneaks around the side of the poo that is compacted, this is also seen with the use of laxatives.  Yes laxatives work to make the poo soft yet it doesn’t do anything to take away the fear and anxiety that these children are experiencing.

I have seen so many children who literally have liquid poos, and one would think that their brain would get and understand that how can it possibly hurt if it is now liquid like – yet the opposite holds true.  Regardless of the consistency, their brain has cemented that ‘poos hurt and are best avoid, so hold on!’.

To avoid this whole vicious cycle, I would encourage your daughter to use the nappy – that is quite ok – you really don’t want to add any pressure to her.  Give her the nappy but on one condition that she puts the nappy on and pushes the poo out in the toilet.  She does not have to be sitting on the toilet just in the toilet room.  Avoid the hiding part of this problem.  If she is already hiding then do her a deal – when she is calm and not needing to go – talk about this and say that she can have and use the nappy but she must then be in the toilet room to do the poo.

Once she has done the poo in the nappy, you and her need to tip the poo as best you can into the toilet, wipe her bottom.  Some flushable wipes are ideal for this part of toilet training, have the packet sitting on top of your toilet.  Wipe, and put into the toilet.  You are showing her and teaching her where all this must go.  Keep the end goal in mind!

The next step is to get her sitting onto the toilet while doing her poo in the nappy.  This step may take a while.  Be patient, stay calm yet be firm.  Do this whole process step by step.  Quite often children have individual differences in what they are comfortable or uncomfortable doing, so I build and design a step by step plan based on their own fears.

The next step again is too cut away the nappy or undo one side, again this is a step by step approach and you may need some assistance working this out.  All the way through this process you praise, be positive, no pressure and try not to get frustrated and cranky.  She will get there will the right guidance.

Often I get parents to use a prize box of little treats in a colourful box and once each step of the process has been achieved and there has been say about 3 successes then you quickly shift the goal post – ie. what they need to do in order to get a prize.  Please keep the prizes very simple ie. a crayon, a little notebook, a page of stickers, a car, small toy not the whole packet of crayons, 200 stickers etc.  All they need is little incentives.

You also need to talk about this whole situation – talk about how you have to push poos out, they do not just flow out like wees, they take a little time!  Talk about how their body works, food goes in and food goes out show them the simple biology of digestion.  When eating smoko is a great time to talk about the apple = poo and the water = wee……. Talk about the type of foods they need to eat and the water they need to drink to keep their poos soft.

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