Hello! Our grandson (GS?) has just turned 4. He's reading and loves anything to do with numbers, patterns, puzzles. He's taught himself to write both numbers and the alphabet, and some words. Loves building with Legos. Carries on conversations that leave us struggling to catch up! We haven't had him tested yet.

My question concerns potty training. He has decided that he doesn't "like" having a bowel movement, so he won't. He holds it until I don't know why he doesn't feel sick. And then will sit on the toilet forever, not do anything, go play and then GO in his underpants. We've tried rewards, time outs, withholding toys, you name it. Even telling him that he can't go to school if he can't go to the bathroom. He tells us then that he doesn't want to go to school. So that doesn't work. Other than this he is such a bright, happy, loving child. It's very frustrating. Does anyone have any suggestions? Thanks!

Welcome!

You may wish to search the forums for "encopresis". Here is an example of one old thread on the subject.

Hi CSaw, I have no idea if this is more common with gifted kids but at the time, our DS5 decided that he wasn't going to toilet train until his 4th birthday. It was really strange, as nothing worked with him either until he decided it was time. Apparently there was absolutely nothing wrong with him (other than a serious stubborn streak!) because as soon as he decided he was ready, he started using the toilet and only had one or two accidents thereafter. Our boys can both be fiercely independent and have always wanted some degree of control over their own lives (around that age, our DS6 couldn't understand why we got to make the rules and he had to follow them). So maybe it could be related to control over his own body?

You need to see a doctor. He may be in control now but please don't risk him damaging his bowel - encopresis is a nightmare.

I have however met people whose kids wouldn't move their bowels without a nappy at that age. If you google it you should find a progression plan for training toilet use. I think step one is ask for a pullup and go to the bathroom or toilet room.

Welcome!

Perhaps you could clarify whether he retains bowel movements in general, or if he is reluctant to have bowel movements on the toilet, as those are two separate issues.

Just turned four is not too old to be using a pull-up for bowel movements. (There's no rule that says everyone has to be in underwear day and night at any particular age!) If he isn't comfortable with the toilet yet, I wouldn't push it to the point of retaining his bowel movements for excessive periods of time, nor do I view it as worthy of punishment if he soils himself because he doesn't like the toilet. Keep in mind that using a toilet is not a physically intuitive posture. (In fact, quite large portions of the world outside of North America and Europe find our sit-toilets rather peculiar and unsanitary.) He clearly is perfectly capable of using a toilet, but uncomfortable with this particular toileting convention.

The straightforward solution would appear to be to put him back in pull-ups for defecating. He still has time to get used to toilets.

Hello and Welcome!

My DD 7 (Highly gifted) potty trained at 3 and we are in the process of potty training my younger DD3.6(untested). My children have generally potty trained later than most of our family/friends kids. Like your GS, DD3 has taught herself to write the alphabet and loves puzzles. She doesn't have a problem urinating in the potty but we've noticed that she is not comfortable having a bowel movement in the potty. I've put her in pull ups the past couple of days because we believe she's been holding her bowel movements. She is also in pull ups at night.

I second aeh's question of whether your GS is holding his movements in general or specifically because he doesn't like the potty. If he's holding his movements in general, I would speak to your doctor. If it is potty related I would continue to encourage him to urinate in the potty and keep pull ups on for bowel movements.

Anecdotally, I have a friend whose little boy didn't go to the potty for bowel movements until just before he started kindergarten, and in the end everything worked out fine.

Is your GS able to articulate why he doesn't like having a bowel movement? Is he experiencing pain or is he uncomfortable? We are pretty open with our kids in terms of talking about bathroom issues and my DD7 is very comfortable talking to us if she's having difficulty. If your GS is not comfortable I would follow his lead. If he's in pain or generally avoiding bowel movements I would speak to his doctor.

We had issues with our older two. Our youngest trained late, but we sent her to a different day care than her older sisters - one that did not insist on being trained to move up to the preschool class - so we had a more relaxed approach with her (and she trained quickly when she did train).

Eldest refused to use the potty for bowel movements and rewards did not work. We solved that one by telling her she could not watch any kid shows or videos until she was trained. We did not cut off her TV viewing (my kids watch a lot of TV). We just told her she could only watch CNN or CNBC. She trained quickly after that.

Middle kid just did not care about the potty at all. She would hold it in all day at day care, then could hold it no more (at about 3.5 years). She would wet herself, with pants and socks soaked. We'd ask if she wet herself, she would reply "No" and walk away as if nothing had happened - she did not care. Promises of rewards or threats (such as withholding TV) did not help.

She finally came around and stopped wetting herself, but would not cooperate with bowel movements. Right before she turned four, and a week before she was going to her older sister's school where potty training was expected, we were on vacation. I told her they would kick her out of school and leave her sitting on the curb if she didn't use the potty. She finally did use it. Maybe it was the threat, but DH swears it was traveling to another country (we were in Canada), so not sure what clicked.

He will probably come around soon. Could be a control thing or a kid who just doesn't care. Middle kid (18 years old) still says she aspires to make a lot of money, retire early and sit on the couch watching TV,with mini-fridge beside the couch - and she'll wear a diaper so she doesn't need to get up.

Definitely go see a doctor. My DS had a brief stint with resisting BMs when we initiated potty training. He wasn't quite ready to begin at that time.

A week of PEG in a glass of water and a more relaxed attitude let the entire issue fade away. In Canada, the Canadian Pediatric Society has a good position statement on toilet learning:

http://www.cps.ca/documents/position/toilet-learning

Ultimately, what induced DS to use the toilet for BMs was an incentive -- something he chose that was highly motivating. I bought it and put it on a visible high shelf next to the entrance to the bathroom. DS knew it was his for the taking whenever he felt ready to use the toilet and could use it consistently for a week, and I didn't mention toileting once until he initiated the conversation a week or so later. 7 days later, the prize was his.

Note that the incentives most children choose might not be useful currency with a gifted child.

Thanks for your replies. Not a medical problem. A stubborn, control problem. It helps to know that others have had similar situations. I'll share this with his parents of course. We'll keep on working at it. This too, shall pass. (pun intended)

Our DS5 potty trained at around 31/2. We thought it was a bit late, but after making a potty available (an on the floor potty as opposed to a toilet with a seat) we just followed his lead. Once he decided to start trying the whole process was relatively quick and painless. However, with respect to bowel movements, he did okay when he transitioned from the on-the-floor potty to the toilet with a kid's toilet seat but then had a really hard time transitioning from a child toilet seat to just a plain old toilet seat. This was never a problem at home but it was a problem when we were out. We talked to him a lot about it and never punished him. It turns out that he was afraid of doing his business on an unadorned toilet seat because of stability problems and fear of falling in. To start with, we put a stool under his feet so that he could feel some stability from it and have something to push his feet against. And, although we never punished him for failing to do his business without a child's seat on the toilet, we did give him a choice of a "prize" for doing it without for a week. He selected a "talking telescope" as his prize, from which he has learned many wonderful facts about planets and animals. He had just started junior kindergarten at the time and we wanted to give him a little extra incentive to be comfortable on the toilet because we were afraid he would start holding in it while he was at school. He also eats a lot of fruit and fibre, so he has thankfully never had a problem with constipation from a food-intake point of view. He now 5 1/2 and has never had any problems since that first little confidence issue. In fact, some people may recall an earlier post of mine in which I confess to his particular affinity for the ugly blue toilet in our house on which he conquered his fears! LOL!!!

I obviously don't know your grandson, but I wonder if there isn't some kind of fear or other concern that is contributing to his control issues. If it is not a fear issue, could it be a food issue? I echo the suggestion of other posters to consult with a medical professional even if it is just to firmly count out any physiological concerns or maybe even to make a change in diet that might help.

Best of luck.

Just keep an eye on it. Holding can develop into a stretched bowel and ignoring signals you need to go to the toilet can result in those signals reducing to the point you get about 30 seconds warning - not good when you are out and about. After my experiences with ds9 I would err on the side of caution and check for medical or emotional reasons first.

It sounds like he's had a lot of external baggage attached to a natural act that is rightly within his control. Pediatricians are well aware of the psychology behind toileting for children, which is as important--if not more so--than the physical issue of encopresis.

Yes, it's a control issue, but it's also a trust issue. Does he feel his boundaries are being respected? Is he pushing back because he is being pushed? I would urge you and your GS' parents not to label your GS's behaviour negatively, and certainly wouldn't punish it, as that will lead to further toilet avoidance and compound the issue.

And as to whether this is a medical issue, if he's having impacted fecal matter, I'm sorry, but it is. Long term continence issues can stem from persistent encopresis. The first line intervention here in Canada is to assist in passing the mass gently, then assisting in toileting comfortably (physically) by giving the child water soluble PEG laxatives over the counter for a designated period of time. Only a doctor can provide the appropriate path for your GS given his experience, so don't delay.

we had a nightmare with our eldest - she could hold for weeks. Despite GP advice that she was fine medically it turned out she had a food intolerance. This had by the stage we discovered it evolved into a host of emotional problems associated with going. Please get a second medical opinion before labelling it a behaviour one.

Here is a link to several pages of information presented by Mayo Clinic on encopresis.

A person's willful withholding of stool, even when not due to a medical cause initially, can become a medical problem, as described on the Mayo clinic webpage of information on causes:
Each webpage of information presented by Mayo clinic on encopresis may be of interest, including preparing for your appointment.

Your GS is probably too smart for this, but when DD refused to potty train, I waited until she turned three then told her a big fat lie. I told her that 'the law' was that when you turn three you have to start using the toilet. I said it with such a straight face, and kept up the pretence with a trip to the shops to buy the insert seat, that she totally believed me and toilet trained in one afternoon. There were a few tears, but I just said 'I'm sorry honey, it's not up to me. It's the law. When you turn three you can't wear nappies anymore' and DH nodded empathetically. Not sure if it was great parenting or terrible parenting, but it worked!

Both my boys potty trained at 4.5 years old.

The oldest was a withholding nightmare resulting in constipation and problems. Anxiety and Developmental delays (later Aspergers dx) were a part of it. I try to block that out of my memory. But some things I found were scheduling a sit down on the toilet every night right after bath/shower. The warmth of the water helped relax him and then once he was in the habit his body responded to the routine. I will say that 12 years later I don't have to monitor his bathroom habits--thank god because I thought that day was never going to come back when he was 4-7 years old.

The second was just comfortable with the status quo happy go lucky not in any rush. He was easy once I finally said enough is enough. I put the older boy in spring break gymnastics day camp (both loved their gymnastics classes so he wanted to go too). Day camp didn't take kids not potty trained and I told him that he could have gone too if he would use the toilet and I would do a week of summer day camp for both if he potty trained over spring break. I bought a giant package of m&ms and tons of juices and drinks that I normally didn't buy. Older son out of the way we were able to potty train in three days. Easy peasy. Week of summer gymnastics camp reward in June and we were all happy!

CSaw, I presume you've tried potty training books? Most of them are really quite childish (because most children potty train earlier, I suppose), so we had a difficult time finding ones that would interest our nearly 4 year old at the time. He loved The Long Journey of Mister Poop. Maybe it would help for your GS to understand more about the process?

And by the way, I also sent you a PM.

Personally, I think this approach is abusive. Little children take things quite literally, and adults can traumatize them with ideas like this. I'm sure you meant well and thought you were doing a good thing, but try to see what you said from the perspective of a tiny little kid who might have been thinking she'd go to jail for wetting her pants.

Agreed. Quite cruel.

Good lord, she didn't think she would go to jail for wetting her pants! It was done in good humour, with smiling faces. There was no fear. It was just easier to make her think it wasn't our decision. Whenever something is our decision, she'll argue black and blue about it. If it's a rule set by an external authority, she'll take it on board much better. We've only ever used the 'fake law' trick that once, and it was because she needed to potty train to start daycare. She's a very well loved little girl and we're very easy going parents.

When my daughter was 3, an adult we know would tell her that the police were coming for her whenever sirens sounded. It was all done with good humor and smiling faces, too. She spent a year in fear of sirens, and only explained it to me a few months ago. Our friend had no idea that he'd traumatized her and feels lousy about it.

Adults can tell lies in jest, but the fear in the child is real.

There's a big difference between telling a child that police are coming for her, whenever she hears a siren, and telling a child that a law is set by someone else and it's not your discretion whether she follows it. There are plenty of other laws that DD follows, like standing up for less-able people on the train, or waiting to cross the road, and she's not afraid police are going to arrest her if she forgets one of those. She knows what police are there for, and she knows they don't arrest kids. Honestly, I know you mean well, but you've jumped the gun.