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Toilet training and toileting refusal for stool only: a prospective study
1University of Pennsylvania School of Medicine, Department of Pediatrics, Philadelphia, USA.
Pediatrics
|January 1, 1997
Summary
Stool toileting refusal affects 22% of children during toilet training. Pediatricians should monitor for constipation and delayed training, offering support for families facing challenges.
Area of Science:
- Pediatrics
- Child Development
- Gastroenterology
Background:
- Toilet training is a developmental milestone.
- Stool toileting refusal is a common challenge during this process.
- Child-oriented approaches are increasingly used.
Purpose of the Study:
- To determine the incidence of stool toileting refusal in children undergoing toilet training.
- To investigate the outcomes and associated factors of this behavior.
- To provide guidance for pediatricians and parents.
Main Methods:
- Prospective study of 482 healthy children aged 18-30 months.
- Parents completed questionnaires on toilet training.
- Families were followed via office visits or phone calls.
Main Results:
- 22% of children experienced at least one month of stool toileting refusal.
- Younger siblings and parental limit-setting issues were associated with refusal.
- Stool withholding occurred in 61 children, with 80% being refusers.
- Interrupting training and returning to diapers resolved refusal in 24/27 children.
Conclusions:
- Stool toileting refusal impacts approximately one in five children.
- Pediatric intervention may be needed for stool withholding/constipation and delayed training (by 42 months).
- Late-stage untrained children can cause family stress, requiring professional support.