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How to Deal with Toilet Training Challenges: Constipation and Fear of Flushing

Angela Oswalt, MSW, Natalie Staats Reiss, Ph.D and Mark Dombeck, Ph.D.

Constipation

Another challenge to consistent potty training is constipation, or a reluctance to have a bowel movement. Constipation can by caused by many factors. Children may not be getting enough fiber or fluid in their diet, may fear pooping in the toilet, or feel an inhibiting sense of emotional pressure to use the toilet or to give up diapers. For some little children, the sensation of feces falling away from their body over a toilet (instead of staying close to their bodies in a diaper) is strange and scary. Furthermore, it might be difficult for some children to relax and sit still for the necessary amount of time while on the potty. As children avoid defecating, their feces becomes drier and more difficult to pass. If feces becomes dry enough, it can be painful to eliminate, which can lead to even more fear and avoidance.

The easiest way to prevent constipation and to make elimination physically easier to occur is to include adequate amounts of fiber and fluid in children's diets. Exercise also helps encourage children's bowel movements. Parents should consider letting little children use their shoulder or lean back on the toilet tank to help them stay in a comfortable position. Applying a little bit of petroleum jelly around the anus can help lubricate a painful bowel movement should one occur.

To help kids become more relaxed or emotionally comfortable, parents should encourage children to engage in relaxing, fun activities while on the potty such as singing songs, reading a book, or playing a game. Engrossing activities that help children almost forget they're trying to pass a bowel movement may be most helpful. And as always, parents' warmth, empathy, and encouragement help children feel accepted and comfortable.

If nothing else works, families should consult with a pediatrician or family doctor before using over-the-counter suppositories. As well, a doctor should be consulted if four or five days have passed without a bowel movement occurring, or if constipation is accompanied by abdominal pain, vomiting, or fever.

Fear of Flushing

Some children will be afraid of the toilet itself (afraid of the toilet's size and shape and the rushing noise that occurs when it flushes), and the possibility that they might get flushed away themselves. Adults shouldn't force children to remain next to the toilet if flushing terrifies them. Instead, parents should gradually desensitize their children to the flushing action over time. Mom might start by having Jimmy listen to the toilet flush from another room. Then, when Jimmy is comfortable with that distance, Mom can have him watch and listen to the toilet flushing from the hallway. Eventually, Jimmy will be comfortable enough to be next to the toilet while it is flushed. All the while, Mom should educate Jimmy about what happens when a toilet flushes in language he can understand, and provide him with support and encouragement.