Going Poop a Little at a Time

Hi Dr. Rene,
My son is 3 years and 8 months old. He has been totally potty trained for pee for six months but refuses to poop on the potty. He was constipated but that resolved. He holds it in and poops a little at a time in his pull-ups. When he does, he immediately wants me to change him which ends up being five or six times a day. He has only gone poop in the potty three times. Each time, we had a parade in the living room to celebrate. I have tried just letting go, rewards, stickers and a coin jar. What else can I do?
Sincerely,
LeighAnne
Mother of two, ages 3 and 10 years old

Hi LeighAnne,
I would argue that you are still dealing with constipation or at least the withholding that can follow a bout of constipation. Children who have been constipated often hold their poop so they won't again have the pain they felt from pooping. Unfortunately this just starts a negative cycle. The more they hold, the worse it can hurt and so on. The general idea is that this needs to move at their pace and without pressure.

There are many things you can do. Let's start with the easy, general ones

• Play the videos and read the books - There are so many good potty books and videos available. Mix them in with your other story or tv times.
• When you do change him, let him watch you empty his poop into the potty. Help him make that connection "the potty is where poop belongs."
• Change all diapers in or just outside the bathroom. Again sending the message about place and letting him know we have to stop and go to the potty each time.

Next let's address the ones related to the constipation

• Increase fluids, particularly water.
• Increase exercise, particularly walking.
• Check his diet. Think fiber, fruits and vegetables. Make fruit smoothies and add in a few prunes. Add raisens to all snacks.
• Avoid white bread, rice, bananas and too much milk.
• Talk to the pediatrician but you might try an over-the-counter remedy such as mineral oil.

Now for the specifics

• Let him know it's okay to poop in a pull-up but encourage him to at least stand in the bathroom while he does this.
• Once he is comfortable, encourage him to sit for poop. This can be with his pull-up on sitting on the floor or on the closed lid of the potty.
• Once he is comfortable, you could have him try on the open potty and then on the open potty with no pull-up.

All of your language and efforts should be encouraging him to take ownership. Out of the moment and maybe once a day say things like "You know you are the only one in the whole world who knows when you need to potty," or "You know that feeling in your tummy when you need to poop? I can't feel that, just you!" The idea here is to make it their job, to encourage ownership without pressure.

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