During the potty training process, about 20% of children go through a phase of refusing to use the potty at all, or refusing to poop in the potty. For some the phase lasts a month or so. For others it can be a year. This is called “Toilet Refusal for Stool Only.” One scenario is a child that asks for a diaper at nap time or bed time, go in their room and poop in the diaper, and then asked to be changed. Clearly, they have bowel control, and are making a very conscious choice about when and where to poop. It’s just not the choice you wish they were making.
An important note here: I’m not talking about “stool holding” here. That’s a child who refuses to poop at all, anytime, anywhere. That’s a different issue and it’s a medical issue that can cause constipation and bowel impaction and requires different treatment (see here).
I’m talking about kids who have regular, normal poop once or twice a day, just not in the potty. And I’m especially talking about a child who you know is developmentally capable of pooping in the potty because they’ve done it in the past… they’re just not doing it anymore.
So why does a child do this?
There are lots of proposed reasons. Most won’t make sense to you as an adult, but they may be what your child is feeling.
- Fear of Pain: They may believe pooping in the potty will hurt. This sometimes follows an episode of constipation, when it did hurt. It’s hard for them to understand that the pain won’t always happen when they poop on the potty.
- Fear of Falling In. Fear of being Flushed down the Toilet. Using a small, non-flushing potty rather than sitting on the big toilet may help with this one.
- Fear of Losing a Part of Themselves: Some boys fear that if the poop falls out of them and into the potty, then maybe their penis could too. I also know of a girl who was terribly frightened the one time she saw the poop coming out while she was on the potty and then getting flushed down – she feared that part of her was gone forever.
- Hate the sound of flushing. Some children are very frightened of a loud flush. Sometimes it helps if they are in charge of flushing so they know when it’s coming. Sometimes it’s better to let them leave the room / the stall before you flush. On auto-flush toilets in public bathrooms, you can cover the sensor with your hand or a post-it note until they’re done.
- Desire for privacy. If you’re always with them in the bathroom, and they always poop when they’re alone, try just giving them a little privacy on the potty! (On the other hand, some kids want company in the bathroom and if you’ve been trying to send them in on their own to give them privacy, maybe they’d rather have you there.)
- Sensory issues. They’re used to the poop staying next to them as it fills the diaper. Feeling cold air on their bottom and feeling the poop fall away from them may be uncomfortable to them. An intermediate step may be to have them sit on the potty with their diaper on until they can poop there, and then remove the diaper.
- Shame. They’ve been taught that poop is disgusting and are ashamed of it. In one study, they encouraged parents to never use negative terms for feces, and – before they start potty training – to praise children for pooping successfully in their diaper. These children might still go through a period of refusing to poop in the potty, but it was a shorter-term problem than it was for the control group in study.
- Power struggle. Many children go through periods of rebellion, and if they learn that this really pushes your buttons, they may keep doing it to get a reaction.
- Autism, developmental delay, or physical challenges can lead to this issue.
- Emotional trauma or sexual abuse.
- Temperament or Personal Preference. Some kids just like to use their diaper and see no reason to change.
Which one applies to your child? You may be able to guess, or if your child is old enough to talk about it, then ask them in a really non-judgmental open-ended way. “I notice that you always poop in your diaper and you won’t try pooping in the potty. Why is that – tell me more.” They may be able to tell you.
How NOT to respond…
Don’t punish. Don’t scold, shame, or publicly humiliate them.
Don’t show a lot of emotion about it. Be very matter-of-fact. “It looks like you pooped in your diaper again. Remember, I’d like you to use the potty. Let’s go get you changed.” Be bland and boring during the diaper change.
How do you get a child to poop in the potty?
It’s hard to make someone poop on command! And no, threats don’t work either, because when we’re scared, our sphincter muscles tighten up and it gets harder to poop.
What can you do? Here are some suggestions – don’t feel like you have to try them all. Some will feel right for you and your family’s situation. Others won’t.
- Ask them why they don’t want to poop in potty. Address their fears. If they have any of the fears listed above, talk it over with them. Don’t expect to be able to just say “that’s a silly irrational fear” and have it go away. Take it seriously, validate it, ask them to help you figure out a plan for preventing that thing from happening.
- Give them some motivation. Consider a reward system. Stickers? Big kid underwear? A cool toy they only have access to on days when they poop in the potty?
- Withhold diapers. “Oops, we ran out of diapers. I guess you’ll have to use the potty.”
- Or combine those two: say something like “This Sunday is our Happy No More Diapers Day. From then on, I want you to always poop in the potty. And hey, check out this cool doll house I got you. As long as you remember to poop in the potty, you can have it. If there’s a day when you ask for your diaper back, that’s fine. I’ll put the dollhouse away for a while.”
- Give up for a while. Give control back to them. Say “When you’re ready, you’ll poop in the potty. Until then, I will change your diaper when you poop.” And then just go on with your life without fretting about the potty. Once a week, check in with them to see if they’re interested in giving it a try. If they say no, say “OK, I’ll ask again in a week.” Try to just relax and let the worry go in between those checks. In one study where parents “gave up” on potty training, then 24 out of 27 kids started using the toilet spontaneously within three months.
Your child may have some short-term issues with constipation. You should expect to see at least one stool a day, about the size of a small banana, and fairly soft. If your child is only passing small hard stools that hurt to poop, that’s constipation. Make sure they drink plenty of water, eat plenty of high fiber foods, and get lots of physical activity to help making bowel movements regular and easy to pass. If constipation persists or recurs often, check in with your child’s doctor.