Toilet regression

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Toilet regression

Postby Melmum24 » Thu 27 Jun, 2013 5:12 pm

Hi, I am having trouble with my 3yo son. Bit of background.. He is an ex 29 weeker who had bowel issues in hospital and suffered NEC but was treated with antibiotics. He was then in and out I hospital with urine infections, rsv, severe allergic reaction, asthma and bronchiolitis. We have no further neonatal follow up with King Edward due to him being fine developmentally and we do see a pediatrician for his asthma.

He started toilet training last July. He started well, using the toilet and potty, no accidents and some dry nights. After a few months he began having accident after accident with no apparent cause. We got some advice from the health nurse saying try give him a break and put him back in pull-ups. He would still ask to use the toilet and would go to the toilet himself even while wearing a pull-up.

It's now been almost 12 months since starting and we have gotten no where. He is having up to 10 accidents a day (soiling and wetting) and trying to get him to go to the toilet is a battle. He screams blue murder! Some accidents can be within 5-10 minutes between each other. I have also noticed he is wetting and soiling at the same time.

Some help or advice would be great! Do we go back to pull-ups, do we keep sticking with the jocks, could there be something underlining?

Thank you in advance!!
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Re: Toilet regression

Postby NgalaOnline » Fri 28 Jun, 2013 4:08 pm

Hi Melmum24

Thank you for your post. Regression or stagnation in toilet training is quite common and can be frustrating for parents. One common physical cause for frequent toileting accidents is ongoing constipation. This can cause the bowel to become stretched and the child can begin to lose sensations that alert him he needs to go to the toilet. This is temporary and the sensations will be restored once the child has had a period of time without the bowel being stretched when constipation is managed. Frequently the child will also experience some pain and discomfort when having the bowel motion which can cause the child to resist toileting and to hold onto the bowel motion. If a child has faeces in their rectum frequently they will have spillages of "overflow" faces that move around the impacted faeces but does not move the full faecal load - this can cause lots of smaller faecal accidents. Constipation can also cause urinary accidents as the pressure or sensation of a full bowel can cause the child to lose control of his bladder. If your child has occasions of passing hard motions that seem painful for him or difficult to pass, this would be worthwhile discussing with your doctor. Even if you have not noticed constipation, given your child has a history of bowel troubles in his early life and as the issue has been ongoing for a while, it would be worthwhile taking your child for a medical review at the doctor. Sometimes children can have an underlying urinary tract infection which can cause frequent wetting, so it may be worthwhile having your child's urine tested.

It does sound as though your child is feeling strongly about resisting toilet training right now. It is quite common for toilet training to become a source of conflict between parents and children, especially around the age of three. It is quite common for children to develop a fear of going to the toilet, particularly passing a bowel motion whilst sitting on the toilet or potty. Sometimes this is because the child has had a scary experience having a motion on the toilet (such as falling into the toilet or having water splash up and wet the child when the faeces falls into the toilet, which can scare some children, or if the child has had a bowel motion that was painful to pass). Often, however, there is no apparent reason for this fear. It is thought that children are not able to fully understand that the poo is not part of themselves and that they fear losing a part of themselves down the toilet. It is also thought that a lot of children do not like the sensation of the poo falling from themselves, but prefer the sensation of the poo passing when held close to the body by a nappy. Very occasionally children may be motivated by rewards or incentives in their "currency" (such as a special toy that is bought and the child is told they can have the toy when they pass a motion in the toilet or potty) but frequently when children have this phobia, the fear surpasses any interest in rewards and this does not work to motivate the child. The child will often strongly resist any types of encouragement to use the toilet or potty, and may become upset.

It is common for toddlers and preschoolers to not have many areas in their life in which they hold control, and for them to work out that there are two areas in which they do hold control - what goes in and what goes out. It is common for them to hold control over these two parts of their life strongly, and resist any attempts by parents to take any control over these areas. Studies show that with fussy eating, any attempts by parents to either get children to eat either through punishments and negative reinforcements, or through encouragement and praise, actually has the opposite effect and makes children more likely to resist eating new foods. Research shows that children are more likely to try new foods if parents approach food in a very neutral way, just repeatedly presenting the same healthy foods over a period of months and role modeling the eating of these foods, but making very little comment on whether of not these foods are eaten by the child or not. The same appears to be true for children who are resisting using the toilet. It appears that any focus or attention given to the issue of toileting exacerbates the feelings or anxiety that the child is feeling regarding passing bowel motions, and that the child often feels conflicting senses of pressure to pass a bowel motion in the toilet but acute fear of doing so. Although it is frustrating for parents having to deal with changing nappies on an older child who often may have the physical ability to control their bowel, commonly the most effective way of getting a child to make the move to use the toilet is for parents to completely drop the issue and not discuss the issue with the child for a number of weeks, or even a month or so. Frequently this results in the child reducing their level of anxiety over using the toilet, and the child often begins to go to the toilet on his own terms after a few weeks of the issue not being discussed and when he feels it is in his control. It is ok to briefly mention once or twice a week that one day he might feel like being a really big boy and using the toilet, but it is best to just change dirtied nappies matter of factly and briefly without any discussion or attention drawn to the matter. Keeping potties available, and letting him see peers using the toilet without too much discussion over this can be helpful.

If the child is happy to comply, some parents find that they can request their child gets a nappy on and then goes and stands next to the toilet to have their bowel motion. This can sometimes be progressed to having the child sit on the toilet to have the bowel motion, and even to having one side of the nappy undone whilst having the motion. It is common that children will resist this approach, however, and if your child does resist this idea it is best not to pursue this ideas as it may just serve to continue the child's anxiety over the issue or desire to have control over the issue.

It can be very frustrating for parents when their children are not toilet training easily and are getting older. It is common for it to feel as though though this issue is lasting a very long time and for it to begin to wear down the parent's feelings of patience with toilet training. It is also common for parents to feel isolated when they are experiencing this issue, and feel as though their child is the only one who has this issue at this age. You may be reassured to know that Ngala does, however, receive a number of calls about this exact issue every week from parents of three and four year olds. Ngala does also offer a workshop called "Successful Toileting 3.5 years plus" which you may find helpful to attend if you do not see any results after a few weeks of limiting attention given to the area of toileting. ... years-plus

I hope this information has been helpful. Please call the Ngala helpline if you would more information and support.
This information is general in nature and should not be used as a substitute for the personalized assistance that can be received from the Ngala Helpline by telephone.

For families residing in Western Australia you can also contact the
Ngala Helpline
Telephone 9368 9368 or 1800 111 546 for country access
Available 7 days a week, 8am to 8pm
or request a callback online

For helplines in other Australian states please follow this link
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