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Behavioral-medical treatment of pediatric toileting refusal

M C Luxem1, E R Christophersen, P C Purvis

  • 1Children's Mercy Hospital, Kansas City, Missouri, USA.

Journal of Developmental and Behavioral Pediatrics : JDBP
|February 1, 1997
PubMed

Insights

This study explored behavioral and medical treatments for toileting refusal (TR) in children. A combination of dietary changes, medication, and behavioral strategies effectively resolved TR in all participants.

Area of Science:

  • Pediatric Behavioral Health
  • Gastroenterology
  • Child Psychology

Background:

  • Toileting refusal (TR) is a common challenge in preschool-aged children.
  • Existing treatments often lack comprehensive, integrated approaches.
  • Effective interventions require addressing both behavioral and physiological factors.

Purpose of the Study:

  • To evaluate the efficacy of combined behavioral and medical interventions for toileting refusal.
  • To assess the impact of additive treatment phases on TR.
  • To determine long-term outcomes and parental satisfaction.

Main Methods:

  • A multiple-baseline design was employed with 11 preschool-aged children.
  • Treatment B included dietary modifications (fiber, liquids), mineral oil, and positive reinforcement.
  • Treatment C involved suppositories for daily bowel movements and negative consequences for accidents, applied after a bowel clean-out.

Main Results:

  • Treatment B alone resolved TR in 3 boys and reduced it in 1 girl.
  • The combined Treatment B + C resolved TR in 6 children (2 boys, 4 girls) and reduced it in 1 boy.
  • All 11 children achieved accident-free status and regular bowel movements at 3-4 month follow-up.

Conclusions:

  • A phased approach combining behavioral and medical interventions is highly effective for toileting refusal.
  • The additive nature of the treatments allowed for tailored interventions based on individual response.
  • The intervention demonstrated sustained positive outcomes and high parental satisfaction.

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