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During toilet training, constipation occurs before stool toileting refusal
Nathan J Blum1, Bruce Taubman, Nicole Nemeth
1Division of Child Development and Rehabilitation, Children's Hospital of Philadelphia, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania 19104, USA. blum@email.chop.edu
Pediatrics
|June 3, 2004
Summary
Constipation and painful defecation often precede stool toileting refusal (STR) in children. Early, effective treatment of constipation may help prevent STR development.
Area of Science:
- Pediatric Gastroenterology
- Child Psychology
- Developmental Pediatrics
Background:
- Previous research links constipation and painful defecation to stool toileting refusal (STR).
- The temporal relationship between these conditions and STR remains unclear.
Purpose of the Study:
- To determine if constipation and painful defecation precede or result from STR.
- Investigate the causal link between bowel issues and toilet training difficulties.
Main Methods:
- Prospective longitudinal study of 380 children (17-19 months old) during toilet training.
- Telephone interviews monitored bowel movements, painful defecation, and toilet training behaviors.
- Defined STR and frequent hard bowel movements based on parent reports and accident/soiling frequency.
Main Results:
- 24.4% of children developed STR.
- Children with STR were more likely to have prior hard bowel movements (67.7%) and painful defecation (41.9%).
- 93.4% of children with STR and constipation experienced constipation before STR onset; 74.4% with STR and painful defecation experienced pain before STR.
Conclusions:
- Constipation and painful defecation typically occur before stool toileting refusal (STR).
- These bowel issues are likely contributing factors to STR, not solely consequences.
- Earlier, effective constipation management may reduce STR incidence.