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Ask Dr. Sears: Potty Problems

Q  My 3-year-old son is refusing to have a bowel movement (BM) on the toilet, though he's done so in the past. He has no problem staying dry all day. What do you think the problem is, and what can I do?


A The keys to getting a reluctant little one to move his bowels are to make it easier for him to pass a bowel movement and to motivate him to do so. The problem with his holding his BM's is, of course, that he'll become constipated, which makes it even harder and more painful for him to go. This in turn leads to a cycle of constipation. How to break this pattern? Remember that what goes in at the top often influences what happens at the bottom. You can discourage constipation by offering your child a stool-softening diet - give him lots of fluids throughout the day, including four glasses of water and eight ounces of prune or pear nectar; increase the amount of fiber-rich foods in his diet, such as prunes, pears, and the A's and B's of fiber - apples, apricots, avocados, bran, beans, and berries. Also, serve your son a daily smoothie with intestinal-friendly, stool-softening foods, such as yogurt, fruit, flax oil, bran flakes, and his favorite nectar.

Once his stools are easier to pass, your next goal is to get your child to the bathroom. Make a sticker chart and place it on the wall next to his potty chair. Every time he goes to the toilet on his own, he gets a sticker. After several stickers, he gets a special treat, such as an outing with Mom and Dad. Or let him put a coin in a jar every time he goes on his own - it's cheaper than diapers.

Another technique that may help is losing diapers altogether. Going bare-bottomed encourages him to take more responsibility for his bowel movements. Start by setting a toilet routine; your best chance of predicting when he'll have a BM is around 20 minutes after a meal, often following breakfast.

Finally, and as a last resort, place his diaper in the bowl of his potty chair. Have him sit in the potty chair and go in it. (It'll at least save you from having to clean the bowl.) This trick is one we've successfully used in our pediatric practice for children fixated on having a bowel movement in their diaper.

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