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Published on: December 24, 2013
Behavioral characteristics of children with stool toileting refusal
N J Blum1, B Taubman, M L Osborne
1Division of Child Development and Rehabilitation, Children's Seashore House, University of Pennsylvania, School of Medicine, Philadelphia 19104, USA.
Insights
Children refusing to defecate on the toilet do not exhibit more behavioral issues than toilet-trained peers. However, they may experience more constipation and painful bowel movements, though the cause is unclear.
Area of Science:
- Pediatric behavioral science
- Child development and psychology
Background:
- Stool toileting refusal is a common challenge in pediatric toilet training.
- Understanding the behavioral correlates of stool toileting refusal is crucial for effective intervention.
Purpose of the Study:
- To investigate whether children with stool toileting refusal exhibit more behavioral problems compared to toilet-trained children.
- To explore potential differences in temperament and compliance between these groups.
Main Methods:
- A case-control study was conducted in a suburban private pediatric practice.
- Participants included children aged 30 to 48 months, with cases exhibiting stool toileting refusal and controls being fully toilet trained.
- Behavioral problems were assessed via parent interviews and standardized questionnaires (Child Behavior Checklist, Toddler Temperament Scale/Behavioral Style Questionnaire); compliance was measured in a room clean-up task.
Main Results:
- No significant differences in overall behavior problems or compliance were found between children with stool toileting refusal and toilet-trained controls.
- A trend suggested children with stool toileting refusal had more difficult temperaments.
- Parents reported higher rates of constipation and painful bowel movements in children with stool toileting refusal.
Conclusions:
- Stool toileting refusal in children is not associated with increased behavioral problems.
- Constipation and painful defecation are more prevalent in children with stool toileting refusal, but their causal role remains undetermined.
Objective:
To determine if children with stool toileting refusal have more behavior problems than matched children who are toilet trained.
Design:
Case-control study.
Setting:
Suburban private pediatric practice.
Participants:
Children 30 to 48 months old who had achieved bladder control but refused to defecate on the toilet were identified as cases. Controls were sex- and age-matched children who were fully toilet trained.
Measures:
Total behavior problems were assessed using a semi-structured behavior screening interview with the child's parents. The parents also completed the Child Behavior Checklist for ages 2 to 4 and either the Toddler Temperament Scale (30 to 36 months old) or the Behavioral Style Questionnaire (36 to 48 months old). Child compliance with adult instructions was measured during a room clean-up task.
Results:
Children with stool toileting refusal were not found to have more behavior problems than the matched children who were toilet trained. There were no differences between the two groups in compliance during the room clean-up task. There was a trend toward children with stool toileting refusal having a more difficult temperament, and these children were reported to have more problems with constipation and painful bowel movements than the controls.
Conclusions:
Children with stool toileting refusal do not have more behavior problems than controls who are toilet trained. Parents do report higher rates of constipation and painful defecation, but it is not clear whether this is a cause or effect of stool toileting refusal.
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