Toilet Training - Parent Consultation case study (3.5 year old)
written by claire burgess, family consultant
This family approached us as they felt that they had tried everything and needed some support. They were particularly concerned about their little one starting school and having toileting issues.
It had been going really well - the little one had:
· showed signs of being ready for toilet training at 2 years 7 months.
· done well moving from nappies to pants.
· said when they needed a wee or a poo and moved between using the potty and toilet.
· used the toilet at nursery and had very few accidents.
However, over the last couple of months there had been some regression. There had been change in the little one’s life - they had moved to the next age group room at nursery and they had a new sibling. More recently the child had started to withhold their poo. This had led to constipation, behaviour changes (agitated, not able to focus, reduced appetite), wee accidents and refusing to use the potty or toilet.
The little one was very resistant to use the toilet when asked to and this often led to wee accidents. They were going 2-3 days without pooing, clearly needing a poo and often having small poo accidents in pants due to not being able to hold any more. The increase in wee accidents were also linked to the poo holding.
There were more accidents happening at nursery where previously they were doing well.
What next..?
The parents had moved their little one back into pull-ups as the accidents were becoming very frequent and they didn't feel that there was any other option.
They also tried lots of different approaches such as stickers, food, praising, ignoring and many more! They then decided to contact us for more 1:1 support and advice.
Which parent consultation option did they choose?
They chose option 2 which includes:
Your guide to toilet training to watch before the 1:1 call
1 hour zoom call with a family consultant
A detailed personalised plan
1 x follow up 30 min call
We identified 5 main areas to consider and work on:
1. Constipation
One of the main issues was constipation where children have large, painful poos which lead to resistance to use the toilet/ potty. The first thing we needed to do was to relieve the constipation first of all by increasing fluids and foods to help soften the poo. If this didn’t work we would then advise seeing the GP to look at a laxative or stool softener to help and stop the large hard poos.
Even if a child is pooing everyday it is important to check their poo as they can still be constipated. Constipation can lead to wee accidents when the poo presses on the bladder and so healthy poos are essential for the success of toilet training.
We have a few blogs that give some more information on this:
Constipation in babies, toddler and older children…what can we do to help?
Why won’t my child do a poo on the toilet or potty?
2. Not wanting to leave what they were doing
It became very clear that the child didn't want to leave the activity that they were engrossed with at the time, particularly as they had a younger sibling who would often 'destroy’ what they were playing with if they did go to the toilet. This was also the case at nursery with other children. Our advice was to introduce ‘toilet time’ (both at home and at nursery) so rather than asking “do you need a wee/poo/toilet?” the parents said, “it’s toilet time” while also ensuring that the little one’s game or toys were 'protected' while they went to the toilet. Their younger sibling was kept away from the game or one of the parents / nursery staff 'kept watch’.
3. Spending enough time on the potty / toilet
Encouraging sitting on the toilet/potty for longer to allow time for pooing. We suggested activities to help getting the poo moving such as blowing bubbles, blowing up a balloon, and a toilet toy bag which was only for when they were on the toilet to give time for the poo to come!
4. Sitting position (to help with wee and poo!)
We explained how getting the right sitting position on the toilet is really important to help with weeing and pooing. Feet need to be supported on a flat surface with their knees slightly above their hips. It needs to look like a squat position, and their feet should be slightly apart.
5. Positive toilet talk
Ensuring that the little one had positive associations with weeing and pooing. This would be by talking with them about why we wee and poo, what a healthy poo looks and feels like, reading books about poo to normalise and help understand that it is not something to be scared of.
We worked with the parents on all of these areas, helping move the focus and taking the pressure off toileting.
Their little one responded well with all of the strategies we had suggested, in particular the toilet toy bag. They started to sit on the toilet and allow time to poo. Having their toys and games ‘protected’ also gave them the confidence to go to the toilet and not have to rush back. Regular fluids over the day helped with regular wees and non painful poos!
We had success!
You can find information about our 1:1 parent consultations here. You might also be interested in ‘Your Guide to Toilet Training’ - a step-by-step downloadable video guide as well as our toilet training blogs.
We also have a podcast - ‘Newborn to Teen and Everything in Between’– listen here.