My pre-schooler insists on using a nappy
Is his refusal to use the toilet attention-seeking behaviour?
In helping him learn how to use the toilet a gradual step-by-step approach can work best. Photograph: Getty Images
Q Our son is four since May and will use the toilet to urinate, no problem. However, he point blank refuses to use the toilet for number twos and insists on a nappy. I have tried to get him to use the toilet and he will sit on it sometimes but refuses to do anything.
To give you some background– he has a younger brother and sister and his father works abroad and is home for only a few days each month. So most of the time I am a lone parent.
My parents visit and my mother thinks perhaps he is jealous of his siblings as he will also occasionally refuse to dress himself or do other simple tasks. Any advice would be welcome as he has just returned to playschool and the expectation is for him to be toilet trained.
A Despite what they might say in parenting books, the road to being fully toilet trained is often marked by many setbacks. Though people tend not to talk about it, many children continue to have accidents or problems at preschools and even after school starts.
Learning to urinate in the toilet is generally much easier for children as it is something they tend to have direct control over and they can try on demand. However, bowel movements can prove more difficult for children, as this requires children to be relaxed and to be able to “let go”.
Over-trying or forcing a bowel movement can be counterproductive, particularly if a child is constipated. Many children have an experience of passing a bowel movement as being painful and then “hold on” and avoid it the next time.
This can lead to further constipation and further avoidance – in serious situations the child can be become impacted which results in them losing control over their bowel movements resulting in frequent accidents.
If you think your son is constipated or you have any concerns like this, you should visit your public health nurse or GP to rule out any physical cause and to gain treatment as appropriate.
Adopt a gradual approach
In helping him learn how to use the toilet, a gradual step-by-step approach can work best. First, take time to observe your son’s current awareness and routine around his bowel movements.
Is there a particular time of day when he is likely to go? Does he have an awareness of when he does it or does he have a particular ritual around it (eg where he goes)?
Once you have a sense of what he does already, then you can encourage him to make the next step. For example, if he hides when he does it, really encourage him to tell you or if he only tells you after the event, try to teach him how to notice the signs when he is about to go (perhaps by reading a children’s book on getting to the toilet quickly).
If you notice he needs the comfort or association of using the nappy before he can go, think how can you reproduce these positive associations when sitting on the toilet. One mother I worked with made a breakthrough when she let her child overcome his fear of the toilet by letting him sit the first few times in his nappy before gradually weaning him off this.