Our two year old won't poop in the potty--he held it for three days!

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Our two year old is toilet trained for peeing but he’ll only poop in his diaper.  We tried not giving him one, but he held on for three days and we gave in (he then had a huge bowel movement).  What can we do?

You’re describing a fairly common pattern that gets in the way of completing toilet training.  A child has learned to use the potty or toilet for urinating but resists having a bowel movement anywhere but in his diapers.  There are a number of variations of this pattern.  One child will happily wear underpants until he feels the sensation of needing to have a BM.  He will then demand a diaper, or even go to get one himself.  Another child may wait until his diaper is in place for a nap or at bedtime before having a BM.  Another will want to wear diapers all of the time and will let parents know when he needs to pee in the potty, but go off into another part of the house to have a BM in his diaper.  If parents try to take the child out of diapers altogether, the child may hold the BM in or have his BM in his pants, making a mess that most parents find very unpleasant.

What all of these patterns have in common is that the child is clearly feeling the sensation of needing to have a bowel movement, has enough control to wait for the time and place when he will let go, and yet, for some reason, is unwilling to use the "parent-approved" site for having his BM.  Since successful toilet training is accomplished primarily by encouraging a child to feel competent and proud about his own ability to control his body, parents who try to force a child out of this pattern may meet with even more resistance.

There is no single solution to overcoming this resistance once it occurs.  Most parents experiment with offering rewards and prizes for a child's cooperation, and for many children, this method is successful.  However, if you find yourself trying numerous methods to get your child to cooperate and your child continues to resist, it's a good idea to ease up on the pressure.  Children can have many reasons for resisting the final steps of toilet training, and a child whose parent focuses too much on this task may wind up developing even stronger and more long-lasting resistance.  For this reason, if you feel that you and your child have "tried everything" and you are not making any progress, it make sense to tell your child that he can continue his pattern for now, and you'll wait until he is older to take any further steps.  Stop urging your child in any way to change his toileting habits for at least six weeks.  At that point, try again.  If you are still getting nowhere, or if your child is acting upset, angry, or defiant about the issue, talk to your health care provider. It is often helpful to get an outside person's view of the situation, and many children respond very well to the interest and attention of the person their parents consult for help.

Another pattern of toilet-training resistance that a young child may develop is that of withholding a bowel movement until he is in just the right place.  Some children will only use a potty at home.  Other children or will insist on having a diaper on.   A few children will resist going at all unless they are in the mood.  A two-year-old can have enough control to begin to withhold his BM for days at a time.  This withholding is a problem because when a child waits too long to have a BM, he is likely to become constipated.  The BMs he withholds will become hard, dry, and more difficult to pass the longer he waits to try.   If you see this pattern emerging, it's important to take three actions.  The first is to ease up on any pressure you have placed on your child to be toilet-trained or to use the potty in a certain way.  The second is to increase the amount of high fiber foods you offer your child, so that his BMs will stay soft:  fruit, whole grains, and cereals with added bran are popular high-fiber foods for most young children.  Third, observe your child for any evidence that having a bowel movement is painful or uncomfortable for him.   If you see him grunting or looking as though he has a stomach-ache before he has a BM, make an appointment with your health care provider to discuss this pattern.  By taking this last action, you can avoid having your child develop a more serious problem of resistance to toilet training, that of stool retention and soiling. (See the article on withholding elsewhere on my site)

When a young child continues to withhold his bowel movements and becomes constipated, the hard BM hurts when he finally passes it.  In order to avoid another painful experience, the child tries to hold on as long as he can to each BM.  In holding on, the BMs become larger and harder and, of course, more painful to pass.  If this pattern continues, a child's lower bowel can become stretched and the nerves that signal "time to go" become less sensitive.  This condition will usually become worse if left untreated and can even result in a child having involuntary leaking and soiling of liquid bowel movement that seep out around the hard mass of constipated BM.  In addition, the constipation can cause a child to have accidents with urination as well.  If you suspect that your child may be developing this condition, it is essential that you make an appointment with your child's health care provider.  Before your appointment, keep a record of your child's toileting pattern, noting the time, size and consistency of each bowel movement.  In most cases, a child with this problem will need to take medicine to soften and lubricate his bowel movements for an extended period of time.  As troublesome as this problem can be, it is one that can be resolved quite well with good medical supervision.

Most children don't struggle with their parents about toilet training, but some do.  Because so much of your life with a young child is spent on caretaking tasks like diapering, a prolonged struggle with toilet training can make you feel very tired and even inadequate as a parent.  It's important to remember that all two-year-olds struggle with parents about one thing or another, and whatever energy you are putting into this issue is being taken up by another issue in another family!

Meg Zweiback is a pediatric nurse practitioner in Oakland, California.  She frequently consults with parents whose children are having difficulty with toilet training, including withholding, retention, encopresis, and enuresis.