April 1, 2021

What To Do When Your Child Refuses To Go 

Every parent will agree that toilet learning is best when it is a natural process. A child will observe and do it when they are old enough and emotionally ready. 

However, problems may arise when a child is coerced or pressured before they are ready, for instance, due to pre-school demands or a new baby's birth. When rushed, your child may comply for a while and then decide months later that they prefer the pull-up to the toilet. What worked before to get poop in the toilet will be a no-go once a child recognizes that they control their own bodily functions.   

Painful bowel movements (usually related to constipation) also may lead to your child refusing to use the toilet. But whatever the reason, withholding of stools can lead to significant discomfort in children and the resulting parent-child drama may lead to emotional issues that exacerbate the problem.     

When to Seek Help  

Children aged 4 and older who resist using the toilet (or actively withhold) should be seen by their pediatrician to rule out a medical explanation. Protracted withholding can lead to constipation incontinence, where the fecal mass becomes too big for the child to pass naturally, and then softer fecal material oozes around the mass and into the child's underwear. Regular withholding also may result in megacolon, distending and making it flabby, causing the child to lose the colon’s sensation of being full.   

It is important to emphasize that withholding is an anxiety-based disorder, not defiance. Follow your pediatrician’s suggestions.  

Helpful Tactics:  

  • Make sure your child’s diet is high in fiber and increase water intake.   
  • Accept the limits of your control and work on your own anxiety related to this issue.  
  • Assure your child they are in charge of where they put their poop and pee.  
  • Avoid coercion, nagging, and pleading.  
  • Never threaten, scold or punish your child.  
  • Share an atlas of the human body so your child can understand pooping. Children's books may be helpful, but using them can also be coercive.  
  • Do not talk about toileting with your child for more than 5 minutes per day.    

If Withholding Continues:  

  • Try pediatric massage and progressive relaxation techniques to reduce the child’s stress. (Great resources are online.)  
  • Validate your child’s stress and fear but remind them to talk back to their “worry brain.” Encourage brave thinking if they are fearful of the toilet or painful poops.  
  • A daily bathroom schedule with a pull-up on may be in order. Allow your child to use a pull-up while in the bathroom. Once the child is successful pooping near the toilet for two weeks, place them on the toilet in their pull-up with the lid closed. And then try it with the lid open (and pull-up on), and so forth until successful.  
  • When the child is successful, be judicious with praise. Match your child's level of excitement and do not exceed it. 

More than anything, parent-child collaboration will be the key to success. Parents should tread carefully to help their child resolve this issue. Consultation with a child psychologist may be helpful to ensure your child’s success in managing toileting issues.  

Dr. Pat BlackwellDr. Pat Blackwell is a licensed psychologist who has worked with families for over 30 years. See her website for more information and her blog: patblackwellphd.com.

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