"How many of your kids are unwilling to sit on the toilet to poop?" Dr. Fred Daum asks two dozen parents at the Winthrop University Community Center in Mineola. Almost every one raises a hand, including a Levittown mom of 6-year-old twins, one of whom isn't toilet trained.
Her son refuses to go until he can't hold it back any longer, and even then won't use the bathroom. The family is held hostage: no pool, no beach, no predictability. "School is a major problem," she says.
"You think it's such a bizarre thing that there aren't other kids out there who are doing this. But there really are," the mom says. She asks that her name not be used so that when her son gets older, his friends won't Google this article and laugh at him.
Daum, chief of the division of pediatric gastroenterology at Winthrop University Hospital, specializes in helping such Long Island families, especially when the child is a special-needs child with autism or Down syndrome. Every month he runs a seminar called "All About the Toilet" to introduce his methods to parents who have toddlers through tweens who still have problems with bowel movements.
Parents usually first hear about Daum because they think their child is constipated and are referred to a specialist by their pediatrician or word-of-mouth. But there's a big difference between constipation and what Daum calls "stool withholding."
With constipation, a child wants to go to the bathroom, but can't. With stool withholding, the child refuses the bathroom. He will dance, hide, get red-faced and squeeze his buttocks in an attempt to prevent the passage of stool until the pressure and discomfort overcome the behavior, Daum says. "What they have is a very significant opposition, resistance," Daum says.
Dr. Daniel Miner is a pediatrician at ProKids in Levittown who has referred patients to Daum. "With potty refusal, if the parent tries to do it themselves it will usually fail," he says. "Often the pediatrician is able to work with parents on this. But there will be a few cases which are so difficult, where the parents are locked in an ongoing battle with the child, that we need to turn to someone like Dr. Daum to break the cycle. By the time the parents come to the doctor with the problem, they are at the end of their rope, frustrated, not knowing what to do and where to turn."
WHAT CAUSES IT
Stool withholding is caused by a variety of factors, Daum says. One, it might be that the child once was constipated and had a painful bowel movement that caused a fissure or cut that made subsequent bowel movements so painful the child decided it was better not to go at all, causing a vicious circle. Two, it could be an attempt at control. "I am going to be the focus of everyone's attention," Daum says. Three, it could be a reaction to stress at home, even the birth of a sibling.
"Our children have a behavioral issue and we are part of that issue," Daum tells the parents. "If you look at our homes right now, who is in control? Our kids." A few people in the audience murmur in agreement. Daum maintains that the child isn't happy soiling at 5 years old, either. "If you're in the first grade and you're worried about pooping in your pants, you can't concentrate," he says.
Daum advocates a regimented system of Ex-Lax, behavior modification and tough love. Daum meets with parents and child together before beginning the program.
Some parents resist the laxative aspect.
"Pediatricians often find the parents resistant to using laxatives in the doses that are necessary," Miner says. While it's true that it's unsafe for a parent to dispense higher doses themselves, it is necessary and safe under medical supervision, he and Daum say.
Other parents are resistant to the tough love aspect. The first days are hard work, with the child toileting frequently. Daum speaks with the parents nightly in the beginning to modify the plan as needed.
But Daum, who has been running his program for 12 years, says most children will be dry and clean within a week, though a program of maintenance continues for months. "There is light at the end of the tunnel," he tells the parents in the room. "Children don't have to suffer from this problem."
Just starting to potty train? Here are some products that can help:
The Potty Watch is worn by your child and reminds him or her that it’s time to go. Set the watch to 30-, 60- or 90-minute intervals and it alerts the child with music and flashing lights. Comes in blue or pink. $9.99 at Babies R Us
Drop a flushable foam Piddlers Toilet Target into the bowl and let your son aim at the floating target. Made from starch and food coloring; nontoxic. 30 targets for $5.99 at Babies R Us
The Potty Training Girl Doll by Potty Patty is an anatomically correct doll that drinks and holds the water until your child wants her to go. The 16-inch-tall doll wears a diaper underneath her two-piece outfit that your child can change to “big kid” underwear (included). $39.99 at pottytrainingconcepts.com.
Introduce your child to the concept of potty training with the “Elmo’s Potty Time” video. Elmo and Sesame Street friends, including Grover and Baby Bear, sing about learning to use the potty. They teach that it takes time and practice and that everyone has accidents. $8.99 at Amazon.com
We want to know: How did you potty train your children? Tell us in the comment section below!