Dear Jan,

We are at our wits end and need immediate advice on this problem. We've practiced attachment parenting, at least have tried our best, since our son's birth and in most ways, our son is a happy and healthy six-year old. Toilet training has been a major issue for years. We've always felt if we gently guided our son to use the toilet and didn't put too much pressure on him that he would simply become "toilet trained."

Although he's urinated in the toilet for years, he still resists having a bowel movement on the toilet. He will refuse to sit on the toilet without a diaper and if we withhold the diaper and ask (and sometimes in desperation, demand) that he have a bowel movement, he'll withhold the bowel movement for days, which leads to constipation and a huge, uncomfortable stool. When I've asked him why he doesn't want to poop in the toilet, he says it hurts. I do recall an attempt a long, long time ago when he sat on the toilet, strained, cried and gave up. But at this point, however, I feel he's taken this fear to an extreme and we've on the verge of seeking professional help.

In the past, I've tried encouraging him with charts and rewards and that at least got him to go into the bathroom and sit on the toilet with a diaper on (he wouldn't do this for the longest time). Now the sitting on the toilet has stopped and he's reverted to simply pooping in his diaper. I've withheld the diaper at times and he simply withholds his bowel movement for days on end. And ultimately, we have to give in. Since he's homeschooled, there's been no compelling reason to pressure him to toilet train. However, at this age, I feel it's time to find a way to help him use the toilet normally. As far as seeking professional help, you are my first attempt. I don't know how to go about finding a counselor in our area who would understand how we've raised our son so far and work with us within the framework of attachment parenting. Our son still sleeps with us and was breastfed until he was five years old. We don't spank, time outs have never worked so we don't practice them and we deal with behavior problems often times by trying to reason with him, by physically holding him and sitting with him. We set limits with him and he usually respects them but there are times when he refuses to do what we've asked. Major power struggles. We try to use natural consequences for inappropriate behavior but this doesn't always work.

I could provide more background if you need but at this point, our main concern is the toilet training. I know people say to just wait and he'll eventually do it but I don't think this is the way to go with him at this point. There's some physical discomfort and fear mixed in with the act of his having a bowel movement and it's now become a major issue. I'm making sure his diet has enough fiber to hopefully encourage more frequent bowel movements (pear juice, more bran and whole foods, less cheese) but I've only begun to seriously focus on his diet in the last few days (he's mainly vegetarian with some occasional dairy in the form of cheese, no milk). Also, I'm going to try and encourage him to simply sit on the toilet every day at the same time and reward him with a surprise. Since he refuses to sit on the toilet with his pants pulled down, I thought I'd allow him to simply sit on the toilet for a few days and work into pulling his pants down.

My son hasn't had a physical checkup in a few years but is due for one. So I'm not aware of any physical disorder that might be causing him pain. I feel that if he's experiencing some discomfort, it's probably because he's a little constipated. He has no problem whatsoever eliminating in a diaper. There's no strain or pain involved at all. I think he's so comfortable doing it that way that trying to move him over to using just the toilet seems like a big challenge to him. Just me thinking out loud.

Please jump in with advice. I'm at a loss here. I feel like I'm back where I was about two years ago!! Perhaps you have an entirely different idea of how to proceed.

Thanks in advance for any help with this problem.

- C. M. Davids

Hi,

Since you mention constipation, take a look at this advice reply: "Constipation Problems for Toddler". It may be that even a little straining is hurting him - after all he says it is, so this should be taken seriously. If painful straining is the problem, it would be more comfortable to use a soft cloth like a diaper, rather than a cold toilet seat (have you tried a heated seat? I've seen them recently in stores here in Canada). You could also try a padded seat, or make a soft cloth covering for the seat - he could pick out the fabric. That way it will feel like a project of his rather than another demand being placed on him. When I had a painful back problem a few years ago, sitting on the toilet seat was my most difficult task of the day, even when the pain had subsided. I later read that toilet seats put pressure on the sciatic nerve, at exactly the worst place.

Sciatica or something similar, or simply the pain of straining, are possibilities and reason to get another physical exam. And definitely reason to watch water intake! I read recently that nearly everyone in our society is dehydrated to some degree. This is dangerous, because water allows the best transport for nutrients to travel in the blood to all the various parts of the body. The common recommendation is 6 to 8 glasses of water/day for adults, and as much as is comfortable for children. To make it easier to add water to the diet, start with a very small amount and work your way up - you could even have a graph on the fridge to keep track. Be sure to present this as something fun and interesting to do, and explain, perhaps with a diagram of the human body, why water is so important. Another possibility is that he was somewhat traumatized by the previous incident. It may seem irrational for something like this to last so long, but with children, it certainly can happen.

Re the emotional possibilities, it might be helpful to validate his statement about pain, especially if you've been questioning it - or he feels that you are (children readily pick up on our nonverbal cues). Even just a quick acknowledgement may be helpful - "I'm so sorry this is hurting you." Also on the emotional side is what I call "the issue of issues". When a parent and child, for whatever reason, find themselves locking horns over a specific issue, it can create a real dilemma and a vicious cycle, with the parent demanding, the child resisting, the parent demanding more strongly, and on and on. Meanwhile the real concerns and solutions can get lost.

Here is my own story. When I was a child, I was very thin and my parents worried about my weight. After a while, I felt rather put upon, between my parents' insistence and my brother's teasing. To save face, I would refuse to eat. It became a matter of winning this unfortunate game that had developed, in which (at least so it seemed to me) the only way I could win was to starve! I even remember once refusing to eat even though I was very hungry, then I sneaked food after my parents left the room! The only way around this sort of thing is to stay on the child's side so it's clear that the only "winner" will be all of you, on the same side. It's about the importance of being on the child's side and letting him know this. That's where validation and empathy are so important.

If you've gotten into a vicious cycle where you are finding yourselves insisting (or even just "watching and waiting" expectantly, in a foot-tapping way) and he is resisting more and more, you might try getting him off the hook by turning the tables. The surprise may be enough to at least change the situation. Tell him that you want him to forget the toilet and just use a diaper for a month! Or even better, if circumstances allow it, tell him to forget the toilet and use the diaper until he no longer wants to use it - at that point, he can let you know when he's ready. It would of course be extremely important for you to be consistent with this, and give him the time that he needs or the time that you have promised. It may well be that he just needs to feel allowed to make this decision - especially if other things have been happening around him that are out of his control. As Naomi Aldort wrote, "Every stage in a child's life is there for a purpose. If we can respect and respond to her needs fully during each stage of her life, she can be done with that stage and move on." Of course, all of the above are just possibilities - you know him best.