Join 3,494 readers in helping fund MetaFilter (Hide)


4th grader will not use toilet!
March 11, 2012 2:16 PM   Subscribe

Some friends of mine have a son who is in the 4th grade. He is not yet fully toilet trained. He pees in the toilet but he will not poop in the toilet. When he needs to poop he puts on a pull up diaper, does his business, takes the diaper off, and cleans himself up. They have tried everything they can think of, including therapy, to no avail. He is a decent student, plays sports, music, has friends, etc. But he won't use the toilet. There was no event that anybody is aware of that may have triggered his fear of the toilet. His parents have given up. They figure he will eventually just figure it out for himself. But he will be entering middle school in September, and I can only imagine what his peers might do if they somehow find out about this. It could be unspeakably brutal. Any advise for how his parents might solve this problem?
posted by Seymour Zamboni to Health & Fitness (61 answers total) 6 users marked this as a favorite
 
Therapy before bribery? That's a bit too modern for me Seymour Zamboni.

The wife and I use good old-fashioned incentives. My wife made my son a "poopy chart" and he got a sticker each time he pooped on the potty and when he got 30 of them, a much-desired turntable for his Thomas trains. He picked it out, he knew the prize in advance, and we talked about it frequently as he made progress. He was also quite happy to get one of the stickers to put on his chart.

Once he got used to pooping on the potty, he sort of just lost interest in the nappies.

Never anything negative. When he soiled his nappy, only, "Well no sticker this time. Maybe next time." When he pooped on the potty, lots of praise and we made it a big deal to pull off the sticker and put it on his chart.

Worked like a charm with both of my kids.
posted by three blind mice at 2:25 PM on March 11, 2012 [4 favorites]


He's a cognitively intact utterly functional outlier who is aware of the social preference and pressure, has been seen by a mental health counselor, and presumably had organic causes ruled out by his pediatrician.

I don't think his parents need advice; I think they are doing exactly what they need to be doing right now, which is to let their son work through his chosen social difference on his own and then provide positive support for him as needed and revisit the issue with their pediatrician should their be a physical or psychosocial change.
posted by rumposinc at 2:28 PM on March 11, 2012 [19 favorites]


*should there be
posted by rumposinc at 2:29 PM on March 11, 2012


Honestly, I would probably stop buying pull-ups. A pull up is easy to deal with. Caked on shit in your underwear that you have to launder yourself? Not so much.
posted by lilnublet at 2:33 PM on March 11, 2012 [25 favorites]


Here is a bit of advice that might be helpful, including specifically: 6 year old will only poop in pull-up (at the end of the page).
posted by gubenuj at 2:34 PM on March 11, 2012 [3 favorites]


Seconding rumposinc's succinct and erudite answer, and just want to say that peer pressure may do it, or not. Sounds like the parents are certainly bothered more than the kid. (I know I would be, too.)

But in the long run, as long as he can handle it without being making a mess or stinking or becoming sore, I guess everyone will have to deal.
posted by BlueHorse at 2:37 PM on March 11, 2012


When he has the pull-up on, does he walk around and poop standing up? Maybe he's having problems doing it sitting down? If ever I've been a bit constipated I get up and walk around and it helps ( I go back to the toilet before the event though).
posted by KateViolet at 2:44 PM on March 11, 2012


which is to let their son work through his chosen social difference on his own and then provide positive support for him as needed

Ahem.

I can only imagine what his peers might do if they somehow find out about this. It could be unspeakably brutal.

Brutal is putting it kindly. rumposinc, with all due respect, I assume you do not have children and do not have much experience with them. Letting the kid work it out this particular "chosen social difference" on his own, in his own time, is like sending him to school with a "kick me" sign on his back. A fourth grader using a nappy is gonna get picked on mercilessly and that's gonna fuck with his head in ways far worse than being pressured to adopt social norms of toilet use by his parents.
posted by three blind mice at 2:45 PM on March 11, 2012 [55 favorites]


I know someone who got over this hurdle by giving their child the pullup, and

1) having them sit on the toilet, first with the lid closed, as the place to be when they poop.
2) having them sit on the toilet, lid open, as the place to be when they poop in the pullup.
3) cutting a hole in the seat of the pullup, so that the poop would land in the toilet, then finally
4) pooping in the toilet.

IIRC it took a couple of months to progress through all the steps, but they did it. Definitely second making sure the child is not constipated as well.
posted by ambrosia at 2:46 PM on March 11, 2012 [4 favorites]


Well, assuming that the parents are working with their medical and mental health professionals, I think at this point you can stay out of it. If they're talking to you about it, suggest that they talk to his doctor again.

Three Blind Mice's stuff works for 2 year olds but a 9 year old is different.

Also, middle school starts at 5th grade? Wow.
posted by k8t at 2:46 PM on March 11, 2012 [2 favorites]


Honestly, I would probably stop buying pull-ups.

The parents of a kid (age 8) I babysat for had this problem. They took away the pull-ups and she started holding all of her bowel movements in. It was a disaster. She could hold for up to five days and they had to seek medical attention on more than one occasion because she got impacted. It was horrible. I think it ended up with her being diagnosed with OCD, and the treatment for that helped with the poop issues.
posted by OsoMeaty at 2:48 PM on March 11, 2012 [3 favorites]


The boy might appreciate a gift of The Worst-Case Scenario Survival Handbook: Middle School. There's an entire chapter on how to cope with changing into gym clothing for PE which any reasonably bright kid will immediately realize exposes one's undergarments to one's classmates.

It's a pretty good book for any kid entering middle school, potty trained or not.
posted by jamaro at 3:03 PM on March 11, 2012 [4 favorites]


I think it is important not to respond from a place of anxiety - that not 'handling' this will cause him to be bullied at school-and who wants that? We really don't know this boy's situation or if he would be bullied. I mean, we don't even know what the bathroom situation is at his school. We also don't know what reasons he gave, if any, about why he is pooping in his pants.

I'm still with rumposinc, though my own more fear based way of looking at things, a part of me would totally want to snatch away those pull ups because I would be afraid he'd be ridiculed. I'd probably wait til middle school to see what happens.
posted by anitanita at 3:07 PM on March 11, 2012


I was going to suggest something similar to ambrosia. But I would add that if he's a skinny little dude, maybe one of those kid sized toilet seats that fit over the regular one will make him feel more secure. My daughter was much much younger, but I discovered by accident using the bathroom at a children's clothing store that having the kid-sized hole made her way more comfortable.
posted by looli at 3:08 PM on March 11, 2012


I think something like ambrosia's suggestion of *slowing* moving toward using the toilet might be the best bet, better than bribery or just waiting it out until the social peer pressure kicks in.

As long as it isn't a physical issue, moving in slow steps like this should work and help the kid get comfortable slowly moving toward more normal bowel movement routine.

I would suggest working with an ABA specialist or behavioral psychologist. They would be able to set up the small steps and analyze and talk with the child about why he feels the need to use the pull-up, and/or why he finds it discomforting to use the toilet. The child could start even more slowly than ambrosia explains, simply taking a step closer to to toilet each time he has a bowel movement. It may be difficult to set up with a professional, though, since bowel movements don't always happen on schedule and only happen about once per day. Maybe the psychologist could plan out a weekly goal for the child, with one mini-goal step closer to using the toilet with each bowel movement. They could have a journal of steps or a secret picture reminder posted in his house so that he remembers his new goal whenever he sees his reminder.

The psychologist should talk with the child and see if it is easier for him (or if he feels it would be easier for him) to use the restroom in his home, or in the therapy office bathroom, or in a public bathroom. Maybe there are triggers in his home or school bathroom. Who knows?

Working in small steps like this increases the comfort level of the kid while moving closer to the goal. In addition to a behavioral-type reinforcer, it also acts as exposure therapy. Working with a psychologist helps, in my opinion, because it's good to have someone with a fresh start examine the situation, and it can be more comfortable for a child to talk to someone new and nonjudgmental, since his parents are probably (understandably) at their wits end and showing their frustration in trying to come up with solutions, possibly making the kid feel worse.

Good luck to your friend's son and his family.
posted by shortyJBot at 3:10 PM on March 11, 2012 [6 favorites]


Based on what you said, I would not be overly concerned. I don't see issues of phobia (he pees in the toilet) nor of unhygeinic behavior (he cleans himself up) nor developmental delay (he's able to control his bowels enough to go and get the nappy).


Now on point 1 - the school.... Since you say he goes to get his nappy before pooing, rather than walking around with it all day, I wouldn't worry about schoolmates finding out....most students don't poop at school (I said MOST) so if he can pee in the toilet/urinal, and hold his poop until he's home, who's to know.

On point 2, what to do about it.... Have his parents ASKED why he does this? Again - it's not a toilet phobia if he pees in it. One of the first things I thought of when you described what he does is, "hey! he doesn't have to worry about splashback!" (sorry to be gross...but poop splashback is more common than pee splashback, and grosser) Also, as someone else said, perhaps it's an arrangement issue. Sitting on the toilet is really not a great way to poop - your rectum isn't positioned comfortably. Squatting is better, which could be what he's doing in his diaper.

My recommendation? I would have his parents get a baby toilet or container, keep it in the bathroom (maybe under a cabinet), and see if he'll poop in that. He can transfer the waste to the toilet and flush, then wipe out the container.

If he's willing to do this, I honestly wouldn't worry - it will probably result in him having a healthy intestinal system overall if he squat-poops than toilet-poops. He might be a bit odd as a grown-up, but who isn't. When he has his own house, he can actually install a squat-toilet with plumbing....
posted by Lt. Bunny Wigglesworth at 3:16 PM on March 11, 2012 [2 favorites]


three blind mice--I totally hear and empathize with the alarm and psychosocial concern for this child. As it happens, I'm a mom and in pediatrics (which possibly alarms you more). But truly, I speak from the experience of working with children who have this concern at this developmental level, clinically.

If indeed, the parents have ruled out organic causes with their providers, and the child has seen mental health (ruling out concerns that may be addressed with appropriate interventions and pharmacotherapy), then this exact behavior is understood to be a kind of developmental artifact where it it best to provide positive familial support and education and monitor quietly. I like jamaro's book rec--we rec that one a lot, because it gently lets the child know how social expectations will change. Also, he's ten, so developmentally, he is likely reserving this behavior for home where it is not observed by his peers (and I have worked with patients who continue this kind of behavior through adolescence as such, maintaining appropriate social interactions, and still the artifact fades).

These kinds of blips of development are not well understood, but they happen quite a bit more than one would think (with all kinds of different sorts of behaviors) and we have learned that watchful waiting and excellent family support is evidence-based care. The family does need support, and sometimes education and help with thinking through IS the intervention.
posted by rumposinc at 3:19 PM on March 11, 2012 [31 favorites]


A "poopy chart" is not going to work for a fourth grader. Younger kids are easy to manipulate with such charts, but not fourth graders.
posted by HotPatatta at 3:23 PM on March 11, 2012 [3 favorites]


"Brutal is putting it kindly. rumposinc, with all due respect, I assume you do not have children and do not have much experience with them."

Aww shucks, I bet you say this to all the pediatric care providers.

"Letting the kid work it out this particular "chosen social difference" on his own, in his own time, is like sending him to school with a "kick me" sign on his back. A fourth grader using a nappy is gonna get picked on mercilessly and that's gonna fuck with his head in ways far worse than being pressured to adopt social norms of toilet use by his parents."

The kid has presumably already worked out ways to hide this habit from their peers, which will presumably work just as well as they get older and smarter, until of course the toilet gets less scary. By avoiding making this a big deal, the kid gets to figure it out on their own and not have it be a big deal.
posted by Blasdelb at 3:23 PM on March 11, 2012 [1 favorite]


Honestly, I would probably stop buying pull-ups. A pull up is easy to deal with. Caked on shit in your underwear that you have to launder yourself? Not so much.

Punishment, while popular on the internet for all childhood behavioral issues, is a terrible way to deal with pooping-related problems. Associating pooping with negative consequences can lead to bowel impaction, which can get bad enough that it requires surgical intervention.

If the parents are actually looking for advice from you, one possibility might be to try another therapist -- maybe one specifically trained for OCD patients (not that he would be diagnosed as such, but that they might have more effective methods for breaking through this kind of rigidity).
posted by palliser at 3:26 PM on March 11, 2012 [16 favorites]


And as an illustration of these kinds of developmental artifacts--the movie Thumbsucker features a protagonist who persists in a behavior of an earlier developmental phase while understanding the social difference of it. A lot of the family fears, consequences of piling on treatment after treatment, and misunderstanding by both the family and the adolescent layer into that story. In that protagonist's case, as in so many of these, the behavior does begin to remit on its own. What's useful to realize, too, is that often even social pressure will not encourage remittance which is why supporting the family and patient to work through ways to avoid the worst consequences of that social pressure (thinking about where the behavior safely occurs) is palliative. There's a lot of dysfunction in that movie, too, but it's one I think of when I think of these kiddos. It's all pretty interesting, how we work through our own developmental stages, from a neurobiological perspective, and the strange side trips that can happen along the way.
posted by rumposinc at 3:39 PM on March 11, 2012 [2 favorites]


So maybe this will not change for whatever reason and he will still have to go to middle school. My suggestion would be to ask the school to allow him special access to the bathroom in the nurse's office or any other single person bathroom. He could keep diapers/pull-ups there as well.

Shame around poop tends to lead to retention which can be physically damaging so, anything that would avoid that is good. I mean, ideally he'd just poop in the toilet, but there's something to be said for harm reduction by keeping him from being bullied to the extent possible.
posted by the young rope-rider at 3:41 PM on March 11, 2012 [1 favorite]


It's remotely possible that his peers finding out and the resulting taunts/harassment might be just the "on" switch the kid needs. That the folks continue to provide him with pull-ups simply boggles.
posted by BostonTerrier at 3:56 PM on March 11, 2012 [3 favorites]


What's useful to realize, too, is that often even social pressure will not encourage remittance which is why supporting the family and patient to work through ways to avoid the worst consequences of that social pressure (thinking about where the behavior safely occurs) is palliative.

With respect, this is where the phrase "common sense" would apply, were it possible to invoke anymore. There is something wrong, whatever the therapist says. His parents have given up? The "patient" is a 10 year old kid about to enter middle school. The diaper is probably close to adult size, as is the bowel movement. It is just cruel to offer a "palliative" measure at this point -- that might have made sense when the boy was 5 or 6 years younger. I'm not sure what I would do as a parent, but I would take loving, gentle and kind action of some sort, including a Big Bribe.
posted by thinkpiece at 3:59 PM on March 11, 2012 [5 favorites]


His parents have given up. They figure he will eventually just figure it out for himself.

Did they ask for your help on this? Sounds like they found a solution they're happy enough with.
posted by liketitanic at 4:01 PM on March 11, 2012 [2 favorites]


I am absolutely gobsmacked that some people are characterizing this as a "chosen social difference" or something that is anything other than extremely abnormal for a 10-year-old. This problem should be fixed rather than allowed to go on. It's not only a problem if his peers find out. It's a problem that his parents have to continue buying pull-ups for their TEN year old (!), it's a problem hygienically (because pooing in a diaper makes much more of a mess and requires more than just wiping; I seriously doubt he's carefully cleaning the entire area with antibacterial wipes), and it's a problem in that even if he is able to keep it from his peers, he now has A Big Secret That Makes Him Different and Not Okay. There is no mentally-able ten-year-old who would just be completely ok with shitting in a diaper. This *has* to be wreaking havoc on his self-esteem. I don't know what the answer is, but it is certainly NOT to just let the behaviour go on and hope it will self-correct. It hasn't self-corrected in this many years. This child needs help. Sure, help him without shaming him, but do help him. It would be very interesting to know why he says he cannot poo on the toilet, I'm sure there's a clue there as to how to resolve this.
posted by parrot_person at 4:14 PM on March 11, 2012 [23 favorites]


What does he say about why he won't poop in the toilet and only in a pull up? That seems relevant.
posted by Maisie at 4:14 PM on March 11, 2012 [1 favorite]


Uh, this is pretty embarrassing, but I had some gastrointestinal problems as a child (younger than 4th grade but they persisted), and they were mostly caused by constipation. Again, very embarrassing, but I had to come up with specific "rituals" that would allow me to not get anxious/tense and take my mind off the pain. If he's chronically constipated, it might be that he needs the "ritual" of the pull-up, and prunes and mineral oil will make the experience much less terrible. What the link above said about not knowing when you need to go sounds accurate to my situation. (I had to take a lot of mineral oil, tried to "mix" it in with orange juice and it wasn't so bad.)
posted by stoneandstar at 4:19 PM on March 11, 2012 [3 favorites]


parrot_person, you said it better than I did. "Chosen social difference"? At some point years ago -- 5, 6, 7 years ago -- this kid was done a disservice in that whatever the issue/challenge/event/trauma was, it was allowed to be his "choice" as to how/when to resolve. He was too young to "choose" then, and he's too old to wait and "figure it out" now.
posted by thinkpiece at 4:20 PM on March 11, 2012 [6 favorites]


I'm not a parent and have very little experience with children. But I was a late bloomer when it came to pooping in the toilet. Granted, I was 5 when I finally picked up the habit. I realize 9 is an entirely different matter, but...

I have so many memories of my toilet training experience being riddled with anxiety, mostly due to my parents who were so frustrated with my hesitation and who didn't know what to do about it. It simply came down to Toilet = Anxiety for me. I wasn't afraid of the toilet, but when I was 4/5 and honestly trying to go on the toilet I just couldn't do it. My body just automatically tensed up, and I was flooded with memories of the pressure my parents put on me to just go all of those years previously, that my bowels refused to budge. The only way I could go was to put on a diaper and stand barefoot on a tile floor. That was the only way I could get my body to relax and go. Couldn't do it in shoes, couldn't do it sitting down, couldn't do it barefoot on carpet. I remember being rewarded, at the age of 5, the first time I pooped on the toilet afterward. I remember the trip to the toy store, I remember the toy I picked out, but that didn't matter as much as the fact that I knew my parents would get off my back and stop stressing out so much over it, which just continued to stress me out and make it harder for me to go.

So I'm tossing my two cents in with the "No Pressure" camp of suggestions, here. I would really advise NOT taking away the pull-ups right away and avoiding anything that is going to cause the kid more tension/anxiety/etc about pooping. Encourage him to try going on the toilet, definitely! I don't think it should be left alone to "self-correct." But it could be a matter of him simply needing to learn how to relax his body enough to go.
posted by Squee at 4:20 PM on March 11, 2012 [6 favorites]


The parents talk about this with me a lot and it is straining their relationship, so I thought I would AskMeFi just to give them some additional options that they might not have thought of yet. I was planning on just sending them this thread and letting them sort through the various suggestions.

I do not know exactly why he won't poop in the toilet. They have asked, but the child doesn't seem to have a specific reason that can then be addressed. I do know that a few years back he was just holding it in, for days and days. His mom would have to take him to the hospital every 4 days or so to have him flushed out. It was absolutely horrible. The poor kid was visually sick because he wasn't pooping. That went away as soon as the pressure to use the toilet went away. So he has that history and the fear is that if the pull ups are taken away, he might fall back on that option.
posted by Seymour Zamboni at 4:20 PM on March 11, 2012 [1 favorite]


Also, by rituals I mean rituals that would actually allow me to "go." They were totally mental, and kind of like games I had to play with myself. Going to the bathroom really hurt, and I was afraid something bad would happen every time (like a hernia, or my organs would fall out, as my cousin once shared with me). I can see how having something close to your body would make that less frightening, as arbitrary as it is. But if the child doesn't share any experience of pain (and he's not afraid to), maybe it's something else.

Don't say "this kid was done a disservice." It took me a long time to get to normal (though I didn't have conspicuous rituals like a pull-up to deal with), and my parents took me to plenty of doctors. The solution was not exactly one hour of talk therapy for anal-retentive personality disorder.
posted by stoneandstar at 4:25 PM on March 11, 2012 [2 favorites]


When I was 12-16 years old, I was obviously gaining a ton of weight, and it was deeply distressing to my parents. They each tried various random tactics to try and fix it - the one thing I wish they had done is make me a partner in the process. It wasn't "their problem" - it was "our problem," and really mostly "my problem."

Give him options - lots of options, at least five or six of them - and talk it over with him. Explain all the things that his parents are willing to do to help him, but that it's really up to him to make the change. Make sure that he understands the social difficulties he might face in the future (imagine what a week-long residential soccer camp will be like,) and that they're willing to help him do [X] and [Y] and [Z] to deal with this, but that the decision pretty much has to be his, because the work is his.

The options should absolutely include things like talking to the nurse at school (or some other solution that doesn't involve him making a lifestyle change,) but it should be clear to him what the consequences of that choice are. Same goes with choosing to increase his prune intake - information is really important. A reasonable consequence would include cost-sharing for the pull-ups, in my opinion, probably in something like a year.

Also let him know that the topic will be revisited periodically - no matter which option they choose - and that they can change course at any time if things aren't working for anyone. He can help them decide how often they should meet, within certain limits (something like every two weeks to every six months seems reasonable to me.) Limits can also be placed on how often this will come up in conversation: a promise not to talk about it every time you buy pull-ups at the store, or whenever you're grumpy, may go a long way.
posted by SMPA at 4:38 PM on March 11, 2012 [6 favorites]


Chronic constipation with a history of repeated impaction and medical intervention are a very reasonable context to give this child some time. It's also reasonable that the family may need a break from intervening, and in the meantime, he may start to gain a little confidence in his own pattern. He has a very significant history. I really do wish the family the very best as they figure out moving on from these issues, it sounds like they have been through a lot and are following their child's lead very appropriately--as well as already knowing where to go for additional help.
posted by rumposinc at 4:39 PM on March 11, 2012 [5 favorites]


Miralax and similar often work really well for kids, for whom prunes and/or mineral oil might just be too icky.

Have they considered putting grab bars by the toilet so that he can stand comfortably while shitting?
posted by Sidhedevil at 4:51 PM on March 11, 2012 [1 favorite]


I do know that a few years back he was just holding it in, for days and days. His mom would have to take him to the hospital every 4 days or so to have him flushed out. It was absolutely horrible. The poor kid was visually sick because he wasn't pooping. That went away as soon as the pressure to use the toilet went away. So he has that history and the fear is that if the pull ups are taken away, he might fall back on that option.

A hospital enema every four days is a seriously traumatic experience for a child to have had. I would really encourage you to think about what that would be like, from his perspective, to have that physical and emotional experience. Not just what it was like for "his mom [to] have to take him to the hospital," but what it was like for him to have all those enemas from strangers in a strange place, and all the drama and fear surrounding them.

My one-year-old daughter needed a urinary catheter to check for UTI a month or so ago. She still is not over it, breaking down into terrified sobs whenever we go into a doctor's exam room for follow-ups. Children get just as upset as adults when their private parts are intruded upon, even if it's for a medical reason.

It is huge progress, under these conditions, that he has a set of circumstances that he can create for himself and poop every day. Support this child's parents in giving him a little space to feel comfortable and confident about eliminating in whatever form he can manage right now. Don't encourage them to force the issue, or they could end up undoing that hard-won comfort, and just push further back any progress.

Pooping in a pull-up once a day is not that big a deal. It's definitely nowhere near as serious as the situation he was in a few years ago. It's a neurotic little quirk.
posted by palliser at 5:06 PM on March 11, 2012 [27 favorites]


I agree that, for the most part, this behavior is abnormal, despite the fact that he seems to be functioning well socially (from what the OP says). I agree that his previous pooping situation is much worse than it is now. So, he is clearly progressing.

The most important thing that has not yet been mentioned specifically is that within the next year or two, he is going to start going through puberty. If the behavior is not resolved before then (I think it will be, but who am I to say), I doubt it will outlast puberty unless something more serious arises like OCD or another anxiety disorder. The reasons for this should be obvious, but include the many social consequences and perhaps even hygienic consequences of no longer having Boy genitalia, but Male.

I don't think a "no pressure" scenario here needs to necessarily be a "hands off" approach. There are other, unspoken ways in which to encourage positive behaviors and unlearn undesirable ones. This is just an example, but if the parents know the child poops once a day, they could provide as many pull-ups at the child requires in that week (indirectly, like placing them under the sink), and if the child successfully poops in the toilet (and therefore avoids using that day's pull-up), the child can place the pull-up in a box in a discreet location that the parents will check when the child is not around. Then, the parents can provide some kind of reward of their choosing. It's important to note that in this scenario there is no anxiety producing result here; the adults check the box and if there is no pull-up, there is is no "punishment" or acknowledgement of a pull-upless box.

I think that, if this is a behavior caused by bathroom anxiety (seems like it is), perhaps some relaxation exercises or stretches might help with his ability to use the toilet. Even making the bathroom a more comfortable place to be; toilet seat cushion (I hate them, but it could help), dim lighting, a fan to muffle noises and diminish smells, maybe even some ocean sounds and unscented candles.

In conclusion, putting direct pressure on him will probably not help him to progress in this situation, but I think there are solutions that will help. Good luck!
posted by two lights above the sea at 5:26 PM on March 11, 2012 [2 favorites]


So long has the kid is handling himself hygienically, as we have been assured he is, there really is no actual problem under the current paradigm except for small ones of convenience, that is the kid having to work harder at cleaning and the parents having to buy the diapers. So long as the poop ends up disposed of properly, the path the poop takes to get there is precisely as relevant to the kid's life as the people around him make it. Chronic impaction issues are incredibly dangerous to healthy development and can cause irreparable complications that will follow the kid long after his poop strategies get more logical. There is nothing inherently wrong with the way the kid is pooping, just inconvenient. However, it is profoundly abusive to terrorize a kid to the point where they cause serious enough damage to themselves to require hospitalized care. That is especially if it involves clever ideas like withholding their only functional pooping strategy and telling them that they will be forced to clean soiled underwear if they adapt their current strategy in the 'wrong' way.

I think a lot of the aggression towards the parents in this thread is a reflection of the same kind of bullying and policing the kid could likely expect to come across should their habit ever come to light. That is, replacing YOU ARE POOPING WRONG with YOUR KID IS POOPING WRONG all the while those kids would only be mirroring the same policing behavior they would expect to come from adults. We don't need to take our behavioral cues from hypothetical middle schoolers, and we can teach our own kids better. I imagine that by the time rumposinc's kid gets to middle school age that they would react to this kid much better than many of the adults in this thread, having learned to from their mother.

When I in elementary school I had issues along similar lines, though no where near as dramatic, and I sympathize. I was potty trained with access to the wet wipes one of my parents needed to use for medical reasons, and thus the pooping ritual I naturally developed involved wet wipes rather than dry toilet paper. My parents must have figured the wet wipes used while I was in diapers would make the transition easier or something so long as they were around anyway. However, when they figured I was fully potty trained they started pressuring me to use dry toilet paper and I guess I had already past whatever developmental point that allows transitions like that to be easier and I resisted it more strongly than I had the potty training itself. I think they started to transition me to dry toilet paper before pre-K but I wasn't fully comfortable with using it until just after the age your friends kid is now. At least for the first couple of years, when I wasn't able to steal the wet wipes I would just hold it in until I was, which didn't always work and then that was terrible. After about 1st grade I was able to use dry toilet paper, but I hated it enough that I would not poop until I absolutely had to, which was still terrible. Some understanding and some adaptations to my strategies as they were would have gone a long way. I outgrew it, and I imagine your friend's kid will too shortly, the only question is how much medical and psychological damage gets done to him before that happens. Again, this is only as big of a deal as the people around him make it.
posted by Blasdelb at 5:27 PM on March 11, 2012 [8 favorites]


It's true that this is only as big a deal as the people around him make it, but there's no way on God's green earth that his peers are going to do anything but emotionally brutalize this kid when (not if) this info gets into circulation.

I certainly wouldn't recommend taking the kids diapers away, or shaming him, or anything else like that. Just gonna have to work towards bringing the toilet into the shitting ritual somehow, I reckon. Amazing that this has been allowed to go on this long, really.
posted by Sternmeyer at 5:32 PM on March 11, 2012 [3 favorites]


SMPA's advice to make this boy a partner in the process is right on. I know he's seen a therapist, but has he seen a therapist he liked? Maybe the parents could look at five different therapists, and let their son meet each one and pick a person to work with. The parents can help him come up with questions to ask the therapists to inform his decision.

Once he feels more in charge, and once he's working with someone he likes and trusts, they can do some of the exposure therapy that others have talked about.
posted by brina at 5:36 PM on March 11, 2012 [4 favorites]


When I was ten I started my period and began to go through other unpleasant aspects of puberty as well. Suddenly there was no more room for working bodily stuff out in my own special snowflake way. I needed to figure out how to manage a tampon if I wanted to stay on the swim team. I needed to wear a bra if I wanted to dress appropriately for ballet class. This was anxiety-inducing to an extent that I can barely conceptualize now even though it happened to me. My mother basically told me that I could comply with these baseline aspects of what it means to be a person, or I could sit at home while my friends did fun activities. Guess what I chose?

A four year old is not old enough to understand that holding in your poop is what causes the stressful hospital visits and the strangers touching you in uncomfortable ways. A nine year old is. A twelve year old is going to have to confront far weirder bodily stuff, so might as well start practicing now.
posted by Sara C. at 6:01 PM on March 11, 2012 [8 favorites]


Why would he be wiping with antibacterial wipes? Who the hell wipes their butt with antibacterial wipes?!

Any good parent will wipe a baby's butt with wet cleaning wipes. A swipe of just the anal area with a piece of dry toilet paper doesn't suffice when dealing with a butt smeared by poop from a diaper.

I think it's horrible that people want to shame this kid into thinking he's got a condition

I haven't seen a single suggestion in this thread to shame the child. On the contrary, people including myself have very specifically said the child should not be shamed. Not shaming the child and not doing anything about the issue are two different things.
posted by parrot_person at 6:03 PM on March 11, 2012 [3 favorites]


A hospital enema every four days is a seriously traumatic experience for a child to have had.

This is true, but those visits were the direct result of the kid making a deliberate choice of holding it in rather than going to the toilet normally. In short, he was repeatedly choosing to self-harm. Why this series of abnormal choices wasn't addressed by a mental health professional at the time, or by the current therapy just baffles me. The fact that he's being provided with pull-ups is just letting the self-harm issue go unaddressed while putting him at severe risk for being ostracized and bullied by his peer group.

The following analogy may be too strong, but from where I'm sitting, it seems like it'd be in the same ball park as letting him scratch up his arms with dull butter knives because it keeps him from using exacto blades and ending up in the hospital repeatedly due to blood loss. Sure, the butter knives might be preventing any serious damage, but it does nothing to address the behavioral issue.
posted by radwolf76 at 6:08 PM on March 11, 2012 [2 favorites]


Sometime ago I read about a kid who had this problem. The way it was solved was the parents whispering in his ears when he was asleep something to the effect of that they loved him and it was ok to poop in the toilet.
posted by brujita at 6:25 PM on March 11, 2012 [1 favorite]


radwolf76--withholding stool is actual medical diagnosis not uncommon to preschoolers and young gradeschoolers (the OP said "a few years back") that actually has nothing to do with choice. If he was going to the hospital to be disimpacted, then the procedure was being performed by the exact GI specialist interventionists who can best help with any etiology or supportive care. Stool withholding is part of an extremely complex feedback loop in very young children that is far and away from what we understand about self harm. What's more, people who engage in self-injurous behavior as a part of mental health diagnosis and challenges may struggle with your illustrations and comparisons. I appreciate your concerns, but pediatric intervention surrounding GI/GU and toileting is absolutely a speciality in and of itself and when families are working with these specialists (for procedures like disimpaction), there is absolutely a whole host of considerations taken into account (including behavior, mental health, and OT).
posted by rumposinc at 6:32 PM on March 11, 2012 [19 favorites]


In short, he was repeatedly choosing to self-harm.

This is so incorrect it hurts. Self-harm is a direct, intentional behavior. This holding behavior (called Encopresis) is not a choice, it's a cycle of anxiety and discomfort. The child is in NO WAY choosing this behavior, especially when he was 6 or 7 and ending up in the hospital.

With all due respect, the OP is looking for a solution, and your ill-informed lecture is really not helping.
posted by two lights above the sea at 6:44 PM on March 11, 2012 [24 favorites]


In short, he was repeatedly choosing to self-harm.

Respectfully, you have absolutely no idea what you're talking about.
posted by scody at 6:56 PM on March 11, 2012 [9 favorites]


This is sure a tough one, a 10 year old is so different a stage from when toilet training is normally done, and I don't have a clear opinion myself of what should be done. I can say, however, that one of my children was difficult to toilet train in the poop department and one of the things that helped this child finally be successful was us making THE CHILD solely responsible for the poop process. Us standing over the child and constantly fussing about how and when and why it should should be done was not helping the child. It was a long haul but the child did figure it out. So perhaps you could call this a vote for the parents giving up and letting him figure it out on his own.
posted by molasses at 7:52 PM on March 11, 2012


[folks, if you're not answering the OPs question please withhold other comments. thanks ]
posted by jessamyn at 7:55 PM on March 11, 2012


Yikes! Have they tried to bribe him to poop in a shallow tray or pan? He might feel safer. If he can manage this intermediary step, he could take a resealable takeout food container to keep in his locker, use it in a stall and dump it in the garbage. Now that I think of it, I don't member taking many dumps at school when I was a kid.
posted by bonobothegreat at 9:41 PM on March 11, 2012


Just gonna have to work towards bringing the toilet into the shitting ritual somehow, I reckon. Amazing that this has been allowed to go on this long, really.

Yeah... how? The OP stated that the parents have tried everything they could think of. That's what this thread is for.
I think it's amazing that anyone is so willing to blame the kid and parents, since this is a medical and psychological issue and there's no actual way to force a kid to do this.

I also don't see how it's a matter of "when" the kid will be exposed to his peers, since most kids have a bowel movement about once a day, and usually wait until they get home. It is a medical issue, and it would be great if it were cured sooner or later, but concern trolling about kids at school is not going to help.

It seems the worst thing that is likely to happen is that the kid would hold it in at a friend's house. Which is why I think Sara C. is right on-- the kid just might not be ready yet, but when they get older and realize that this means they can't go to summer camp for a week, they might be able to turn the gears mentally until they realize they have to physically overcome this hurdle. I had the exact same issue with tampons-- they are terrifying at first, but eventually I realized that I wanted to swim when I was on my period and got mentally comfortable with it. In fact, it's very similar, because you can't use a tampon until you're mentally relaxed enough to relax your body. The parents don't need to invent obstacles for the kid, obviously. Life will provide those. I joked about this earlier, but there's a reason Freud and other child psychologists delved so deeply into these early moments of learning one's relationship with the body. Pain and outside intervention create a huge mental block.

I'm kind of seconding the idea that the parents let the kid work it out to a degree (though perhaps seeking professional help when it seems necessary), because learning how to put things in or eject things out of your private body parts can be difficult/impossible when you know people are fussing about it.

Also, OP, you say "fear" of the toilet-- is he actually afraid, or just unable?
posted by stoneandstar at 10:00 PM on March 11, 2012


*sooner than later
posted by stoneandstar at 10:16 PM on March 11, 2012


I don't understand the "try" therapy. When did the parents decide that therapy "didn't work" and terminate it? How did they know how long the treatment was "supposed" to take and that, therefore, it "didn't work"?

I agree with choosing a therapist the kid likes and continuing with this until the problem is solved and even after it's solved. The behavior is a symptom of anxiety, and I would want to explore the anxiety (much) further.

Also agree that this is not a choice on the child's part. At all.
posted by DMelanogaster at 5:29 AM on March 12, 2012 [5 favorites]


It's astounding to hear people talk about this as being "no big deal". If only ONE kid at his school finds out about this, he's DONE socially. Finished. For chrissakes, I didn't have anything that weird going on, and the kids in JR high were MERCILESS towards me.

I know we all wanna be nice and inclusive here, but at some point you have to look at it objectively. This is a 10-year-old who still shits his pants, every day, regularly, as a matter of course. That is really not okay. Remember that one day at your school when they noticed that one creepy kid playing with a dead squirrel? And how everyone avoided him after that? This is like 10x worse.

I think basically any option would be better than "just leave him alone" or "work with a school nurse to give him a place to shit himself at school." I think the point is to NOT give up. Work with therapists, doctors, whoever. At this point, "just giving up" almost sounds like willful neglect.
posted by Afroblanco at 8:40 AM on March 12, 2012 [5 favorites]


Pees but doesn't poop . . . maybe he doesn't like water splashing on his ass when he poops. Try having him putting a wad of toilet paper in the toilet first.
posted by fimbulvetr at 8:58 AM on March 12, 2012


Let me get this straight: when he needs to go, he goes in the bathroom, poops in the way that's comfortable for him, cleans himself up, disposes of the poop, comes out again, and no one knows the difference except the person who buys the pull-ups? I'm struggling to figure out what the problem is, here. For a kid who has a traumatic history with elimination, it sounds to me like he's doing very well.

No one is more aware of the social repercussions were his secret to get out than the kid himself. I think a ten year old can be trusted to protect his own privacy in this area, and to conform to peer pressure as much as his present physical/psychological limitations will allow him to do. If the parents want to help, they should be helping him brainstorm strategies to maintain comfort and privacy around his bathroom habits as he transitions to a new school. Ask him what his feelings and goals are in this area and honor them.
posted by milk white peacock at 9:20 AM on March 12, 2012 [6 favorites]


This will get out in school--what will the child do, carry pull-ups with him when he needs to go to the bathroom? Wear them while he's at the gym? This is not something the child is going to be able to keep hidden even if they are 10. And unfortunately "Kid who craps his pants at 10" is going to have a lot more social repercussions than "Kid who threw up on themselves that one time" or "Kid with the funny glasses." I mean, if the kid stays in the same school system this is going to carry with him through middle and high school, unless he manages to develop into a charming, handsome, and athletic enough kid that his popularity quotient from that overrides the whole "Still uses diapers" thing. It isn't "concern" trolling to point out this is a very real possibility.

They have discussed the issue with child therapists who specialize in toilet-training and whatnot, right? Specifically behavioral therapists?

The Thomas trains of three blind mice may not work for a 10-year-old, but incentive-based behavioral therapy is a tremendously effective tactic that works on children and adults alike--you simply have to find a good system. Perhaps using a combination of ambrosia's gradual approach with incentive-based stuff. Set mini-goals (e.g. going to the bathroom sitting on the toilet in the pull-up), with incentives to reach each mini-goal, and the final reward for the last goal (pooping in toilet) being the best one. Maybe don't even tell him what the incentive for the last one is to not have that added pressure, once he reaches the first goal, say what the next one is.
posted by schroedinger at 9:52 AM on March 12, 2012


Does he flush the toilet when he pees? My thought is that he could be scared of the flushing sound for some reason. Did they ever flush his goldfish down the toilet? Did he ever lose a toy down there? If he did, did he stick his arm in there to try and retrieve it? Did he ever have a negative experience in a pool or lake or ocean?

I could not take a shower until I was around 10 because I was terrified I'd drown. My parents ended up physically forcing me (which was admittedly not the best approach, but I love showers now). I'm not sure what the parents should do in this instance, but the problem might not be the pooping or the pull-ups but the toilet itself.
posted by desjardins at 6:53 AM on March 13, 2012


    "This will get out in school--what will the child do, carry pull-ups with him when he needs to go to the bathroom? Wear them while he's at the gym? This is not something the child is going to be able to keep hidden even if they are 10. And unfortunately "Kid who craps his pants at 10" is going to have a lot more social repercussions than "Kid who threw up on themselves that one time" or "Kid with the funny glasses." I mean, if the kid stays in the same school system this is going to carry with him through middle and high school, unless he manages to develop into a charming, handsome, and athletic enough kid that his popularity quotient from that overrides the whole "Still uses diapers" thing. It isn't "concern" trolling to point out this is a very real possibility."
According to the information given to us by the OP, none of your discovery scenarios are real concerns. The diaper is put on immediately before pooping, disposed of properly immediately afterwards, and only at home. This kid has experience holding it in for 'days and days', and I did too once, it is perfectly doable. The current paradigm that involves daily pooping, while certainly suboptimally inconvenient, is perfectly healthy and more than sufficiently discreet. His habits being discovered by his peers is in fact extremely unlikely, much less an inevitability.

The kid is old enough to be managing his own relationships with his peers and doesn't need the adults in his life becoming like the bullies we can imagine that his peers would become. Patient attention to the issue, a steady supply of diapers, and meaningfully positive rewards for any progress are really all that should be needed. That and nixing anything like summer camps or sleep-overs until this is resolved.
posted by Blasdelb at 12:07 PM on March 13, 2012 [3 favorites]


[Folks, this is getting far afield from the original question which is about helping the parents of this kid. ]
posted by jessamyn at 12:15 PM on March 14, 2012


If he likes the squatting aspect of the pullups, there are removable platforms that fit around seated toilets to convert them into squat toilets, which are actually easier and healthier to use for many people. The platform can be slid away for people to use the seated toilet as usual.

If the whole ambience of the bathroom makes him anxious, he may appreciate a portable toilet he can keep in his room to use when/where/how he chooses. Not a cutesy potty-training toilet for little kids, a camping toilet as for adult hikers.
posted by nicebookrack at 9:03 AM on March 17, 2012


« Older Some people say: “If you have ...   |  My laptop needs a new hard dri... Newer »
This thread is closed to new comments.