Living with children

One of the consequences of postponing toilet training until well past the second birthday (per the bad advice of most post-1960s parenting "experts") is a well-documented problem known as "stool refusal" _ children three and older who will use the toilet for urinating but stubbornly refuse to use it for a bowel movement. Fifty years ago, when most children were expected (and expected they were!) to use the toilet successfully before they turned 2, this problem was rare; today, it is almost commonplace. As one might imagine, it is one of the most frustrating of all parenting problems.

And so it recently was for the parents of a 3-{-year-old stool refusing boy. The parents had talked and rewarded and punished and talked some more, all to no avail. In the meantime, they were beginning to suffer self-induced baldness. Several Web-based experts weighed in, saying that stool refusal almost certainly indicates deep-seated psychological issues, implying that the road to solution would be long and longer still.

Over the past several years, a colleague and I have developed a program that has been very successful at persuading these kids that it is in their best interests to _ using contemporary vernacular _ "give it up" for the potty. This child was the perfect candidate. I recommended that immediately after breakfast on the morning of P-Day, the parents take this recalcitrant child to the bathroom, remove his clothes, and say, "We spoke to your doctor, and he said you have to stay in the bathroom, without any clothes on, until you have a poopy. When you have a poopy, call us to see, and then you can put on your clothes and play. Call us!" I told the parents to keep it short and simple and then cheerfully turn and walk away. If their son refused to stay in the bathroom, they were to gate him in, again explaining that such were the doctor's orders. When he produced a bowel movement, they were not to make a big fuss or reward him, but simply acknowledge his success in a low-key manner.

To the parents' amazement, their son had a bowel movement after five minutes in the bathroom on B-Day. They asked, "Now what?" to which I told them to stay the course. He took three minutes on day two. His mother wrote: "No crying, screaming, nothing. My husband and I have battled this issue for many months now, cried, and lost sleep over it. I'm sitting here absolutely astounded at how simple it has been. Unless told otherwise, we'll continue to use this method until we see him initiate the trip to the bathroom himself."

One week later, she gave me a second update: "As we bring tonight to a close, it marks a full week since we put into action your plan. We have had ZERO accidents this week. ... He is going to the potty on his own. He has been an absolute joy to be around since not having to fight the potty battle."

There was no trick to this at all. The solution involved nothing more than clearly stated expectations and a clearly defined boundary. In short, the parents stopped wishing (in the form of pleading, explaining, rewarding, and exploding) their son would poop in the potty and told him he was going to.

Conjuring the doctor's authority simply reduced any possibility of rebellion. Before closing this column, I would be remiss not to note that on occasion, stool refusal is actually constipation or the result of some other physical problem. Before coming to me for advice, the parents checked this possibility out with a physician. Any parent thinking of trying this should first do the same.