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Stool-toileting refusal in preschool age children: A follow-up study
Cansu Çobanoğlu Osmanlı1, Berkan Şahin1
1Department of Child and Adolescent Psychiatry, Giresun University Faculty of Medicine, Giresun, Turkey.
Insights
Persistent stool-toileting refusal in preschoolers is linked to constipation, enuresis, maternal psychiatric issues, and rhythmic temperaments. Lower activity levels in children also predict continued refusal behavior.
Area of Science:
- Pediatric Gastroenterology
- Child Psychology
- Behavioral Science
Background:
- Stool-toileting refusal (STR) in preschoolers presents significant challenges for children and families.
- Investigating factors contributing to the chronicity of STR is crucial for effective intervention.
Purpose of the Study:
- To explore the relationships between temperament, life events, parental characteristics, and psychological burdens in children with STR.
- To identify predictors for the persistence of stool-toileting refusal behavior.
Main Methods:
- A prospective, controlled, single-center study involving children with STR and age/sex-matched healthy controls.
- Evaluations included sociodemographics, parental psychopathology, child temperament, and life events.
- Follow-up assessments one year later evaluated the persistence of STR.
Main Results:
- STR persisted in 11 of 31 children after one year.
- Family history of constipation, comorbid enuresis, maternal psychiatric disorders, and rhythmic temperament were more prevalent in the STR group.
- Children with persistent STR showed significantly lower activity levels.
Conclusions:
- Associations were found between STR persistence and TSC rhythmicity, comorbid constipation/enuresis, and maternal psychiatric illness.
- Low TSC activity scores were notably associated with continued stool-toileting refusal.
- Clinical practice should consider these factors for tailored assessments and interventions in preschool children.
Background:
Stool-toileting refusal in preschool-aged children is a significant issue that strongly impacts both the child and the family, signaling a challenging period. We investigated the relationships between temperament, traumatic life events, parental sociodemographic characteristics, and psychological burdens and these behaviors. Our goal was to identify factors that may contribute to the chronicity of this stool-toileting refusal behavior.
Methods:
Conducted as a single-center, prospective, controlled design, the research involved children exhibiting stool-toileting refusal for at least one month, alongside healthy individuals of similar age and sex. Evaluation covered sociodemographic characteristics, parental psychopathologies, children's temperament features, and life events. Follow-up questionnaires, administered one year later, assessed stool-toileting refusal behavior.
Findings:
An evaluation at the end of one year revealed that stool-toileting refusal behavior persisted in 11 of the 31 children. A family history of constipation, comorbid enuresis in the child, maternal psychiatric disorders, and rhythmic temperament features were significantly higher than in the healthy group. Children with persistent stool-toileting refusal behavior exhibited notably lower activity levels.
Discussion:
The study's results indicated associations between the TSC rhythmicity score, comorbid constipation and enuresis, and maternal psychiatric illness in preschool-aged children with stool-toileting refusal behavior. A notable association was identified between the continuation of stool-toileting refusal behavior and a low TSC activity score. Advanced statistical methods did not reveal significant differences, highlighting the need for larger sample studies.
Implications To Practice:
Applying the study's findings to clinical practice involves considering factors such as a family history of constipation, comorbid enuresis in the child, maternal psychiatric disorders, and rhythmic temperament features as potential indicators of persistent stool-toileting refusal in preschool-aged children, guiding healthcare professionals in tailored assessments and interventions.
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