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Potty Problems

Most children, when developmentally ready, toilet train themselves regardless of the strategies used by the parents. Children like having control over their bodies, and learning to use the potty is one of the great accomplishments of early childhood. Unfortunately, when children have difficulty controlling their urine or bowel movements, it causes stress for both them and their families. This stress usually causes avoidance on the child’s part, and anxiety on the parents’ part, which compound the problem.


Dr. Steven Tobias has developed a short-term intervention for children who are difficult to toilet train. Once a physician has ruled out medical problems, Dr. Tobias can meet with parents to develop an individualized program for the family. The program is for children from ages two (who are withholding) to early adolescence. Treatment is most often done in one session with follow-up phone contact.


Treatment has three phases:

1. Reduction in anxiety for both child and parent.
In this beginning phase, parents act a therapist for the child to reduce anxiety and teach the child how to use the toilet. Parents are given specific instructions about what to do and not do, which help them meet their child’s needs in a way that reduces conflict and stress within the family.


2. Disincentive to have accidents.
Often it is not enough just to reduce the child’s anxiety and teach them how to eliminate. It is also necessary to make accidents the child’s problem rather than the parents’ problem, and do so in a way that does not cause a conflict between parent and child.


3. Generalization.
Once the child is successful, it is necessary to maintain the behavior while fading the program. Usually, the intrinsic motivation to have control over one’s body leads the child to want to continue using the toilet. However, how the program is faded and setbacks dealt with are important to insure continued success.

Parents can call the Center for Child & Family Development to set up an appointment after seeing their pediatrician or pediatric gastroenterologist.

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