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Stool toileting refusal: a prospective intervention targeting parental behavior
Bruce Taubman1, Nathan J Blum, Nicole Nemeth
1Department of Pediatrics, Divisions of Gastroenterology and Nutrition, University of Pennsylvania, Philadelphia, USA. Taubman1@aol.com
Insights
A parental behavior intervention did not reduce stool toileting refusal rates but shortened its duration, leading to earlier toilet training completion for children.
Area of Science:
- Pediatrics
- Child Psychology
- Behavioral Science
Background:
- Stool toileting refusal is a common challenge during childhood toilet training.
- Parental behavior significantly influences toilet training outcomes.
- Understanding effective interventions is crucial for pediatric health.
Purpose of the Study:
- To assess the impact of a parental behavior intervention on stool toileting refusal in young children.
- To determine if modifying parental communication and reinforcement affects the incidence and duration of stool toileting refusal.
Main Methods:
- A randomized controlled trial involving 406 children aged 17-19 months.
- Intervention group received specific instructions on positive reinforcement and avoiding negative language regarding feces.
- Control group received standard child-oriented toilet training advice.
Main Results:
- No significant difference in the incidence of stool toileting refusal between groups (23% vs 26%).
- The intervention group experienced a significantly shorter duration of stool toileting refusal (5.2 months vs 7.6 months).
- Children in the intervention group completed toilet training earlier.
Conclusions:
- The intervention effectively reduced the duration of stool toileting refusal, not its occurrence.
- This approach can help mitigate negative consequences associated with prolonged stool toileting refusal.
- Targeting parental behavior offers a viable strategy to improve toilet training efficiency.
Objective:
To evaluate the effect of an intervention targeting parental behavior on stool toileting refusal.
Methods:
This study population comprised 406 children aged 17 through 19 months from a single suburban private practice. Children were randomly assigned to receive 1 of 2 written toilet-training instructions. Both groups were advised to use a child-oriented approach to toilet training. In addition, those in the intervention group were requested to avoid using negative terms for feces and, before training began, to praise the children when they defecated in the diaper. Follow-up telephone calls were made every 2 to 3 months, and 381 children were followed up until they developed stool toileting refusal or completed daytime toilet training.
Results:
The incidence of stool toileting refusal was 23% in the control group and 26% in the intervention group (P>.10). The mean +/- SD duration was 5.2 +/- 4.9 months in the intervention group vs 7.6 +/- 4.9 in the control group (P =.04). Children with stool toileting refusal in the intervention group trained at 40.0 +/- 6.4 months vs 43.0 +/- 6.5 months in the control group (P =.04).
Conclusions:
The intervention did not decrease the incidence of stool toileting refusal but did shorten its duration, leading to earlier completion of toilet training. This should help to ameliorate some of the negative consequences of stool toileting refusal.
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