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Poop Problems: The Hard Truth of Constipation

Whenever parents express concerns about a child's potty training issues, I find the...

Posted by Laura Jana, MD

Whenever parents express concerns about a child's potty training issues, I find the conversation is usually centered on a child's desire for independence, refusal to use the potty, and other behavioral challenges. For two-year-olds, these traits are commonly recognized obstacles to potty success, which makes for a worthwhile discussion.

Before taking on the behavioral challenges of the "terrible two's," let's think a bit more about what may be standing in the way of your child's willingness to poop in the potty.

As a pediatrician, constipation is one of the first things I check for when faced with children who stubbornly refuse to poop in the potty. That's because constipation has a distinct way of throwing a wrench in the best-laid potty training plans. Constipation also happens to be frustratingly common in young children.

Constipation can sometimes be easy to spot. But unless you know to be on the lookout for symptoms and take it seriously, it has a way of creeping up on parents and child care providers.

Once constipated, toddlers aren't often able to let you directly know that it's a problem. Some just become crabbier than usual, lack their normal appetite, and/or backslide on their potty-training progress. Some children may even seem to have diarrhea -- an ironic sign of constipation that makes sense. A hard, constipated poop can create a situation where a child has less control over what "sneaks out" around it.

It's important to recognize that trying to get a constipated kid to poop in the potty can be a painful process. It makes sense to remember that young children very quickly learn to avoid doing things that hurt.

This may seem like stating the obvious, unless you also think about seemingly defiant children who are dead set against pooping in the potty. The determination to withhold poop at all costs becomes far more understandable when a child feels constipated.

So what do you do with a potty-resistant child faced with the predicament of hard poops?

Be sympathetic. Potty training shouldn't be a painful process -- for you or your child.

Soften the situation. Helping to soften bowel movements often simply means committing to some dietary changes. Increasing the amount of dietary fiber and/or cutting back on constipating foods such as cheese, excessive amounts of milk, and even apples or bananas in some instances may help relieve constipation.

See your pediatrician. Getting potty training back on track may require the help and support of your child's doctor.

How many of you had a potty training-resistant child that you discovered was feeling constipated? Did diet adjustment or a pediatrician's treatment help get your child back to successful potty training? Let's all discuss the "scoop on poop!"View Thread

Posted byLaura Jana, MD

3 Replies | Reply | Watch This DiscussionReport This| Share this:Poop Problems: The Hard Truth of Constipation Whenever parents express concerns about a child's potty training issues, I find the...

A Guide to Potty Training Techniques

There's certainly no denying that there are a lot of potty training methods out...

Posted by Laura Jana, MD

There's certainly no denying that there are a lot of potty training methods out there for parents to use with their child. Have you discovered a method that is worth the effort and ditched the ones that will leave you tired, frustrated, and heading out to buy some carpet cleaner?

Let's review the potty training methods you have probably heard about:

Potty training infants. I'm often asked about this technique, and it is worth pointing out that many children around the world are potty trained as infants. This is especially true in countries and cultures that don't have readily available diapers and washing machines. This parent-intensive approach to potty training is based on paying close attention to babies' body language and cues, and then responding accordingly. But personally, I think the time spent analyzing your baby's every grimace could be better spent reading, singing, playing, and doing other activities with your child.

Potty training in a day. While I fear that the promise of single day success inevitably gives some parents unrealistic expectations, and sets their toddlers up for perceived failure, the general idea isn't too far off. Parents need to keep in mind the key aspects of general potty training techniques that help form the basis of this approach. The techniques include:

• Have supplies for this method, including underwear, a doll that can also go pee on the potty, and other items you feel may be needed.

• Make sure your child is both physically and mentally ready.

• Celebrate your child's potty training accomplishments.

• Be fully prepared to handle any accidents in a non-critical manner.

Some will be able to potty train using this method. Others who are disinterested and/or not developmentally ready, are sure to take longer.

Naked and $75.00 approach. While I'm on the subject of techniques that may be somewhat unrealistic, I should also mention this approach. It involves allotting several days during which you are supposed to keep your child naked while encouraging the use of the potty. You must anticipate the need for carpet cleaning (that's the $75.00 part) at the end of the process. Unfortunately, it has been my experience that being naked only seems to help a select few potty training toddlers to remember to put their poop and their pee in the potty. For the rest, it's just messy. If you have tried it and found success, and your carpets are in no worse shape, feel free to share your experience with using this technique.

Waiting until your child is ready. Most commonly recommended these days, this method involves treating potty training as a developmental milestone. I'm all for taking into account each individual child's degree of developmental readiness, and I do believe that when children are ready, they have the potential to all but train themselves.

I'm a little more of a practical realist. Let's face it, the reality of the situation is that sitting back and leaving potty training almost entirely up to your child may leave you faced with societal pressure, child care concerns, and a longer wait before bidding a final goodbye to diapers. Instead, I suggest introducing all of the necessary concepts, vocabulary, and tools of the toileting trade, to toddlers as young as 12 to 18 months old -- well before you ever expect them to get the hang of it.

It has been shown that the earlier you start potty training, the longer it takes for a child to master this skill. The way I see it, the bottom line is that whatever approach you take should incorporate positive parenting and realistic expectations!

Did you use any of these methods, or something else? Other parents in the community want to know your recommendations for successful potty training techniques, so let's hear from everyone!View Thread

Posted byLaura Jana, MD

3 Replies | Reply | Watch This DiscussionReport This| Share this:A Guide to Potty Training Techniques There's certainly no denying that there are a lot of potty training methods out...

Is Your Child Not Interested in Potty Training?

What should you do if your child shows absolutely no interest in potty training?...

Posted by Laura Jana, MD

What should you do if your child shows absolutely no interest in potty training? Knowing when to be concerned, if you should "force" the issue, or if you should seek professional assistance depends on your individual circumstances.

I think that it is never a particularly good (or successful) idea to pit your will against the will of a child. If by "force," you literally mean forcing a child to sit on the potty -- I'm not a fan.

There are alternatives. For example, there are all sorts of products, such as musical potty seats, that will entice children to start using the potty.

I also believe that when you put your foot down, it should be in instances where your child's health or safety is in question, and when taking a stand might pay off. Forcing a child to go in the potty falls into a category of interventions that I consider unlikely to be successful - like making a reluctant child fall asleep or demanding that they open their mouth to eat or take medicine.

When dealing with an unwilling child, I'm more of a fan of techniques like "coaxing" and "encouraging". Parents need to figure out why a child is uninterested or hesitant to pee or poop in the potty.

There are some instances when the true culprit is unrealistic parental expectations. Sometimes, a child may simply not be developmentally ready to begin potty training. Children who are not yet developmentally ready to potty train aren't aware of the need to go, and don't notice when they need to be changed. They are also not able to articulate the need to go or toddle their way to the bathroom and pull down their pants by themselves, which can lead parents to incorrectly believe a child is uninterested.

It is best to introduce children to the variety of skills and supplies involved in potty training long before they are likely to demonstrate all of the typical signs of developmental readiness. Do this without expecting a high degree of interest until your child is actually ready to begin learning to use the potty.

Constipation is another common reason for refusing to poop in the potty. Constipation can be very uncomfortable, if not downright painful. It makes sense that children will avoid repeated pain by doggedly refusing to poop on the potty. Your child's diet is an important consideration in potty training and possible constipation issues.

At times, disinterest can be a sign of a larger problem when children are getting beyond the 2 to 3-year-old age range and be a sign of a broader developmental delay. It can also pose a challenge for children with special needs of all ages.

And finally, reluctant potty training can turn into a monumental behavioral challenge. I have seen 4 and 5-year-olds so stubbornly refuse to poop on the potty that it led to serious constipation (not to mention very real parental stress). These examples definitely warrant an assessment and ongoing involvement of a pediatrician or other health professional.

Was your child potty-resistant? Tell others in the Parenting Community what finally resulted in potty training success for your child.
View Thread

Posted byLaura Jana, MD

2 Replies | Reply | Watch This DiscussionReport This| Share this:Is Your Child Not Interested in Potty Training? What should you do if your child shows absolutely no interest in potty training?...

When a Potty-Trained Child Experiences a Lapse

Every now and then, a potty-trained child will regress and start having accidents....

Posted by Laura Jana, MD

Every now and then, a potty-trained child will regress and start having accidents. This can be a very uncomfortable and frustrating experience for parents. A potty training lapse usually generates a fair number of questions and concerns by worried parents.

When a child reverts to pre-potty training behavior, parents need to first ask themselves what might be causing the change in their child's actions.

As a pediatrician, I can tell you that it's always important to determine whether there's a physical or medical reason to blame. Here are some of the most common causes of potty training accidents:

Urinary Tract Infection
A urinary tract infection can definitely cause children to have accidents. The sense of urgency and frequency typically associated with urinary tract infections can get the best of a child, and make it almost impossible for a child to avoid peeing in their pants. Other signs of a UTI, like foul smelling urine, a fever, or your child complaining that it hurts to pee, might not be present.

Constipation
Potty training regression can also be caused by constipation. Once kids are out of diapers and using the toilet more independently, constipation can creep up when you've stopped watching every trip to the potty. Ironically, constipation can be the cause of soiled underwear. Medical explanations can be ruled out by your pediatrician fairly easily.

Emotional Issues
One of the most common causes for regression is an emotional issue. You probably don't need me to tell you that young children experience strong emotions -- like fear, anxiety, independence or unease -- that they may not be quite ready to handle or express. These feelings and emotions sometimes lead to potty mishaps months after they've mastered their potty skills.

Accidents can occur in preschoolers, and in early elementary age children, too. Potty accidents definitely warrant a closer look at what's going on in your child's life. For some, it may be a new baby brother or sister, or a recent household move. For others, it may be a new fear of the toilet, the bathroom, the sound of the flush, or other aspects of potty use. In some children, it can be a case of defiance or the need for attention.

Try to handle the situation as calmly as possible. Accidents should be cleaned up matter-of-factly without any punishment or criticism. The specifics of how you get your child back into a routine that includes putting his/her pee and poop in the potty will depend on what's to blame for derailing it in the first place.

Fortunately, whether it's due to a recent move or a fear of the flush, regression in previously toilet-trained children doesn't typically last too long -- especially if you can determine the cause. Remain calm and work to communicate with your child.

Let me set aside my "pediatrician hat" for a moment to mention one more cause for children with wet pants: child-themed restaurants, family fun centers and birthday parties. That's right! For each of my three children, big events with ball pits, clowns, balloons and games (not to mention endless drinks) had a way of making my potty trained kids so excited and distracted that they'd forget to pay attention to the need to pee -- until it was too late. I suggest a two-drink limit and a mandatory bathroom break every hour, on the hour. And even then, I'd still bring a change of clothes.

Have you had a child undergo a lapse in potty training? How did you handle the situation? Tell others in the community about your experiences with potty training accidents.View Thread

Posted byLaura Jana, MD

0 Replies | Reply | Watch This DiscussionReport This| Share this:When a Potty-Trained Child Experiences a Lapse Every now and then, a potty-trained child will regress and start having accidents....

Accidents: A Part of Potty Training

I'll be the first to admit it — having to clean up after a...

Posted by Laura Jana, MD

I'll be the first to admit it — having to clean up after a not-quite-potty-trained child is one of my least favorite parenting responsibilities, ranking below emptying a dirty diaper bin and right around the same level as cleaning up vomit. Potty accidents can add a degree (or two) of frustration when a child who has already seemingly mastered the skills necessary to put his/her pee and poop in the potty, goes on the living room floor. But regardless of whether your child is just learning, or has almost mastered this much-anticipated life skill, I strongly believe that there is definitely a right and a wrong way for adults to handle potty accidents.

First and foremost: Never belittle or demean a child. This applies to you and to all of your child's caregivers. It's entirely normal for children to have accidents — even when they seem like outright acts of defiance -- or you think your child should know better. Even if your child is testing your limits, this age-appropriate behavior should never be met with anger, but rather with age-appropriate consequences. For younger children, this may mean taking your toddler, along with his poopy pants, and showing him where his poop should have gone (in the toilet). It also means you should consider and address any underlying causes of the accident.

Here are several important and practical ways to address potty accidents:

• Make sure your expectations are realistic and match your child's abilities. If he isn't ready to potty train, accidents are sure to happen.
• Remember that accidents might be related to any change in your child's daily routine, life, or health status. Fear, anxiety, a new sibling, constipation, drinking a lot, or a urinary tract infection are all possible reasons that can cause children to have accidents. If you suspect any of these, be sure to talk to your child's doctor.
• Children predictably act out as they test their independence -- and, at the same time, your limits. There are few things children have control of at the age of two, three or even four, so the ability to control where they poop and/or pee ranks takes on added importance to a child. (Along with going to sleep or opening their mouths to brush their teeth or try new foods). In my opinion, success is much more likely if you convince young children that they really do want to play along. You're not likely to win a battle of the wills.
• When it comes to how you handle the actual mess itself, soak, scrub, and clean up accidents very matter-of-factly. You don't have to pretend to enjoy it, but there's no need for anger or disgust.

Remember that it's the thought that counts. Remember to acknowledge your child's efforts -- even if you find yourself scrubbing poop stains out of the carpet only minutes after your child has refused to sit on the potty, or after an unsuccessful attempt to run to the potty when nature called.

Potty training is a learning process that includes skills like learning to sit on the potty just a little bit longer, and getting up to go to the potty just a little bit sooner. Like any other new skill, it will involve some trial and error.

What are your potty training thoughts and experiences? Did your child take a long time to potty train? Did you make your way through potty training relatively accident-free? Share your advice on what worked for you to help your child achieve potty success -- and also on carpet cleaning!View Thread

Posted byLaura Jana, MD

3 Replies | Reply | Watch This DiscussionReport This| Share this:Accidents: A Part of Potty Training I'll be the first to admit it — having to clean up after a...

Potty Training While On-the-Go

One of the cardinal rules of potty training (and parenting in general) is to be...

Posted by Laura Jana, MD

One of the cardinal rules of potty training (and parenting in general) is to be consistent. When potty training, this can simply mean making sure that your child has easy access to a potty, and is encouraged to use it regularly throughout the day. This is sometimes easier said than done -- and that's before you consider taking your child on the road.

Based on my own personal and professional experiences, the logistics of potty training should factor into any family travel plans. Leaving the comforts of home almost always involves your child departing from regularly scheduled visits to a familiar potty. I suggest you do some advanced planning to head off any reluctance on your child's part to use an unfamiliar potty.

Whether your travels tend to take you short distances around town, or longer treks over the river and through the woods, I suggest getting your child into the habit of going potty before you step out of the house. Treat this task as something that is expected -- like buckling up in a car seat or brushing teeth. Go about the process matter-of-factly. Instead of asking, "Do you have to go?" -- a question that you're bound to hear more "no's" than you'd like, simply make a pre-trip potty visit a routine event.

Once you're in the car, make sure that you're well prepared. By "well prepared," I mean that you do the following:

• Be prepared to stop the car with little or no notice of the impending need for your child to pee or poop.

• Limit the amount of fluids your child drinks just before, as well as during, your road trip.

• Bring along a change of clothes for any accidents.

• Come equipped with any necessary potty training accessories.

Regarding accessories, a stash of baby wipes and plastic bags for disposing used wipes is very useful. This is a habit I continued long after my children were potty trained. For my children, a portable potty seat was the best accessory for maintaining their potty successes when we were out and about.

You might be thinking to yourself that telling you to bring along a potty seat is stating the obvious. But many parents have never thought of putting a potty seat in the car. The practicality of packing a potty seat extends well past the immediate potty training period. After all, when a preschooler or a kindergartner has gotta go, they gotta go -- regardless of how close to a bathroom you happen to be at the time.

These are the best on-the-road potty training tips I have for you. What are other potty training travel tips and techniques you've tried? How well have they worked for you? Summer travel season is nearly upon us, so share here!View Thread

Posted byLaura Jana, MD

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Potty Training: How Young is Too Young?

For many parents, the stress of potty training involves worrying that you've waited...

Posted by Laura Jana, MD

For many parents, the stress of potty training involves worrying that you've waited too long. For others, your child may seem to lag behind others in mastering this highly prized skill. Given the pressures to potty train, it makes sense that parents wonder how to get a jump start on achieving this milestone.

I'm all for introducing young children to the potty and the associated potty training paraphernalia and routines sooner rather than later. But when I say sooner, I'm thinking of one-year-olds, not babies. When I see stories about the successes of potty training infants, I have to admit that it leads me to this question: How young is too young?

In the United States, we used to have a very different approach. Until the mid-1950s, potty training commonly took place in the first year of life. Potty seats were a common first (rather than 2nd) birthday present, and a vast majority of kids were successfully using them by no later than age 2.

Today, parents are expected to be more patient, and aim for potty training success sometime between the ages of 2 and 3 years old. Even then, pediatricians will often offer reassurance that not all kids are developmentally ready, willing, or able to use the potty.

So where does this leave us in answering the question of how young is too young? The answer depends on a couple of factors.

First, there's a difference between accomplishing the task and introducing your child to it. I'm all for immersing one-year-olds in a positive approach to potty training that includes giving them a potty seat, emptying dirty diapers into the toilet, letting them flush and reading books and talking about the process. I just don't expect them to master it yet. I think another important factor is to reframe the question and ask if you can potty train infants, or if you should.

It is possible to pay very close attention to a baby's subtle cues and potty train months or years ahead of other youngsters. I personally think it's not worth it, and parents should undertake potty training once children are developmentally ready.

I suggest that the extra time and attention you considered putting into potty training is far better spent bonding with your baby instead -- talking, singing, walking, playing and reading.

What are your thoughts on potty training readiness? How soon is too soon? Share your approach and experiences with potty training here!View Thread

Posted byLaura Jana, MD

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How is Nighttime Potty Training Going?

When it comes to being potty trained at night, there's more than enough advice to go...

Posted by Laura Jana, MD

When it comes to being potty trained at night, there's more than enough advice to go around.

Remedies range from no liquids after dinner time, making an extra trip or two to the potty before bedtime (or even a couple of hours after going to bed), using a bedwetting alarm, making your child participate in cleaning any nighttime wetting, and, in some cases, medication.

If you wonder why a child who is daytime potty trained seems unable to accomplish the same feat at night, then this post is for you.

Keep in mind that nighttime wetting -- also known as nocturnal enuresis -- is different from daytime potty skills. Children who are able to stay dry and use the potty during the day are more likely to eventually conquer the issue of nighttime wetting. But a child won't always master the two skills at the same time.

While a majority of children daytime potty train by age 3, nearly half of those children still wet the bed at night. Even at age five, one in five kids still wet the bed. As children get older, the numbers improve as they gradually master this eagerly anticipated, but sometimes elusive skill. By age 12, only 3% still wet the bed.

So when do you start to worry? That's a good question to ask your pediatrician.

What we know about children who are not staying dry at night (called primary nocturnal enuresis) is that it is rarely related to an underlying health problem. Your pediatrician can check for problems with the kidneys, the bladder, diabetes, or other medical issues.

We also know that there's a genetic tendency to wet the bed. In addition to your own childhood history, take a closer look at your child's family tree. I didn't have to search too far back in my family to find that several family members "suffered in silence" as children. For anyone whose child persistently wets the bed well beyond 3, 4 or 5 years old, chances are good that someone else in your family was a "bed-wetter" too.

No matter what is in your family history, you still have to face the issue of keeping your child's mattress dry, so what can you do? Sorry to say, but getting your child's bladder to mature is simply a matter of time.

The best approach is to limit drinks at bedtime, keep the mattress cover on your child's bed, and do your best to keep your child from feeling shame or embarrassment.

You and your child may decide that nighttime bedwetting alarms and medications are worthwhile temporary solutions despite the cost, sleep disturbance, and/or side effects. However, when your child is old enough to have sleepovers with friends, these remedies can be helpful.

How did you help your child overcome bedwetting? Was bedwetting quick and easy to resolve, or did you end up doing far more than your fair share of extra laundry? Share your experiences and suggestions with the community.View Thread

Posted byLaura Jana, MD

1 Reply | Reply | Watch This DiscussionReport This| Share this:How is Nighttime Potty Training Going? When it comes to being potty trained at night, there's more than enough advice to go...

Potty Training and Day Care

Potty training a child who attends child care is a topic that gets a lot of...

Posted by Laura Jana, MD

Potty training a child who attends child care is a topic that gets a lot of attention -- and if you ask me, rightfully so. Not only because an estimated 60% of kids under the age of five attend out-of-home care, but also because potty training in child care situations presents different challenges than potty training at home with a parent.

I say this not only as the parent of three children who attended child care, but also as the owner of a child care center. Owning a child care center has given me additional insight into the child care rules and licensing requirements that must be followed by centers and their staff members.

Let's address the common proclamation, "Your child can't move up into the preschool classroom until he/she is potty trained." I'm willing to bet that many of you have been told this as you look for child care outside of your home.

Perhaps you've been frustrated by having limitations placed on your child's learning experiences by something as seemingly trivial as peeing and pooping in the potty. Did you know that this may be a matter that's out of your child care center's control?

Professional licensing requirements often state that children who aren't potty trained can't be in a classroom that doesn't have a changing table. Most preschool classrooms don't have a changing table.

Also, licensing requirements often clearly define staff-to-student ratios. These requirements take into account how many staff members are reasonably needed to supervise and look after the children in each classroom. It takes additional staff to care for children who are not potty trained. Preschoolers -- usually 3 years old and above -- are generally presumed to be potty trained when this ratio is defined in the regulations.

I firmly believe that child care can provide the perfect environment for potty training to take place. With teachers who consider potty training to be a valuable life skill rather than a chore, a child care situation can be a great place for your child's potty learning experience.

Potty training at child care can provide the opportunity for a consistent approach to potty training, and a healthy dose of positive peer pressure. Seeing friends on the potty can be a powerful learning incentive for a child who isn't potty trained.

Be sure to check with your child's care provider(s) to make sure they share your positive approach to potty training. Be sure they incorporate routine bathroom safety (children not left unattended) and hygiene (hand washing & clean toilet facilities) into their child care practices. Also, make sure that your child has enough changes of clothes on hand in case the clothing they're wearing that day gets soiled.

What do you think about extending potty training to child care situations? Share your child care potty training experiences and potty training tips with the community.

Your suggestions will be much appreciated by those yet to embark on the experience!View Thread

Posted byLaura Jana, MD

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