As part of normal toilet learning, children should be taught to recognize the feelings they have when "their poop or pee wants to come out." We do not need to teach a child to think of their feces as having feelings since animism comes naturally! The additional information I add is about the desire of their stools to attend the "Poop Party under the house! Poops can only get there when passed into the potty chair or toilet, though, not by being dumped in from the diaper as some clever children may assert. I then turn to the parent to ask, "Do your poops go the Poop Party?" providing a knowing wink if necessary. But sadly sympathize with the child that, "Too bad, your poops don’t get to go." Suddenly, doubt has been generated in the child about their choice to withhold!
If the child does not ask to use the potty after several weeks of really implementing these techniques, having several soft stools per day, and having previously shown the understanding and ability to use the potty, the method of room restriction can be used. In this method the child is restricted to one room of the house, perhaps naked, along with a potty chair starting half an hour before the time that has been determined to be typical for a stool to occur. In the room, the child can play but should not get special attention or use any electronics, and cannot leave. Once the potty has been used for a poop, he will be free to leave, go outside, and have other privileges for the rest of that day until the next scheduled stool. If he instead poops in his diaper, he continues to be restricted for the rest of the day. This plan is continued until the child is successful, which usually takes no more than 3 days.
Typically, the above approaches (not including the need for room restriction) will result in a child requesting to use the potty or toilet within 2-3 weeks. It is critical to coach all caregivers to act indifferent to this request, shrug, and say, "Okay, if you want to." Once a child does what they experience as conceding to using the toilet, there should be no prizes, calls to grandma, or celebrations as these can cause a reversal of the child’s willingness to show autonomy in this function. After all, it’s his poop!
Dr. Howard is assistant professor of pediatrics at the Johns Hopkins University School of Medicine, Baltimore, and creator of CHADIS (www.CHADIS.com). She has no other relevant financial disclosures. Dr. Howard’s contribution to this publication was as a paid expert to Frontline Medical Communications. E-mail her at pdnews@frontlinemedcom.com.