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4 year old son toilet training.

Question:

Hi there, I have a 4 year old son who has been diagnosed with encopresis. He was given a picoprep sachet to remove any 'blockage' and is now on a stool softening solution twice daily to keep him regular. Despite all of this, he still manages to hold on at kindy all day and refuses to use the toilet, or even use a pullup there if I supply one for him (he uses a pullup at home quite happily). I think he is too embarressed to go at kindy. I am worried he is going to block himself up again and also, I have been advised that after 3 months of using the stool softener to reapproach toilet training again and am wondering what the best way to do this would be. I have tried the sitting on the toilet in the pullup approach (prior to medication) but failed. He urinates in the toilet everytime without a problem. Thanks heaps.

Answer(s):

It is common for children who have a history of constipation to withdraw from toileting as they subconsciously associate the toilet with discomfort or pain.

Get your son to practice sitting on the toilet after breakfast, with the emphasis being on sitting there rather than passing a bowel motion.  Use a foot stool to support his feet, and get him to sit with his elbows on his knees.  This position opens up the muscles around the anus and allows the bowel motion to come out more easily.  Give him a toy of activity to be used only in the toilet so he has some incentive to go in there. 
The goal should be to get him passing a bowel motion in the mornings so that it is not an issue to him later in the day.

Star charts are great as children can see that they are making progress or reaching goals.  Rewards donít have to be costly Ė just some one on one time with a parent can be reward enough.