How Toilet Anxiety Develops
Toilet training is a big deal for children. Developmental psychologists often refer to it as one of the most fundamental and hard-earned victories that children acquire in their lifetime. As soon as children’s muscles and awareness of their bodies develops, they quickly start learning how to walk, how to talk, and how to control their bowel movements. Each one of them is a huge test for their basic sense of control and self-worth. These processes, even when they follow a basic structure, often take different directions and show multiple variations among children. Every child deals with it differently. That is why it is essential to understand every child’s unique journey. So that we can provide the kind of support that they would require as they undertake their very own battles for autonomy.
Between the ages of 2½ and 3, a child’s toilet training journey sometimes takes on a strange course. However, by this age, most of the time, the parents have already removed the child’s diaper, a step sometimes initiated by the child herself. Soon, the parents notice that everything is going great in terms of peeing. In other words, the child asks to go to the bathroom, sometimes even going there without asking, and can use the toilet proficiently. But when it comes to pooping, it is quite the opposite. The child can’t poop on the toilet, and is often unable to even sit on the toilet to poop. So, what’s preventing her? The cause of her behavior is down to a simple factor, albeit a really powerful one: anxiety.
Profound anxiety, often means that she just cannot poop in the toilet. So, in the child’s own experience, it’s a disaster. That’s why she starts making every effort to avoid it. But there is no choice. Her body must release the waste. As a result, children show how smart and creative they can be. They can’t poop in the toilet, don’t want to do it in their clothes or at an inappropriate setting. So, they find a classy solution: they regress to the safest and most convenient place. Therefore, when they need to poop, they ask for a diaper to poop in—a different kind of toilet.
Although they can’t poop in the proper place, they still get to control both the situation and their bowel movements. Most importantly, they do it at the right time, in the right place, discreetly and privately, neither embarrassing themselves nor soiling their clothes. They learn to co-exist with their problem. When parents understand and allow that kind of adaptation, children get along fine with their problem—they poop every day without constipation or holding in. It is important to understand that the child at this point is overwhelmed by a powerful anxiety, one that needs to be dealt with. However, many parents don’t realize this. Consequently, they continue with the same approach to encourage potty-training. They keep using rewards and keep repeating the same lectures and reminders.
You’ll probably recognize some of these scenarios from your home…
“Where do we poop?”
The child, of course, answers automatically, “In the toilet.”
“Where will you poop next time?”
And the child says, “the toilet, of course.” He promises. Really, totally promises.
“And when you need to poop…?”
“I’ll ask Mom or Dad to take me to the bathroom.”
“Look at David. He’s younger than you and he’s pooping in the toilet. Aren’t you ashamed?”
“You know you’re a big boy already. And where do big kids poop?”
“In the toilet, of course…”
Subsequently, a highly experienced aunt suggests an awesome idea:
“Tell her you’ve run out of diapers. There just aren’t any more.”
If you’ve tried it, you know exactly what happens. The child reacts and says, “no diapers? Okay, I’m going straight to the bathroom.”
Well, not exactly…
Therefore, he starts developing terrible constipation, and doesn’t poop at all for over a week. He cries, develops powerful tummy aches and can hardly move. Moreover, he lies on the sofa, miserable and helpless. Subsequently, in the best-case scenario, you catch onto what’s happening and you hand him a diaper. On the other hand, the less optimistic scenario? You rush him to the emergency room.
In addition, some theories maintain that this is a power game for control and that the child starts behaving like that to send you a message, to show you who’s in charge. However, the problem with these ideas is that they don’t lead to a solution. The fact remains that the child is controlled by a terrible anxiety. He did not initiate that behavior, neither consciously nor unconsciously. He’s simply a victim of anxiety. We need to internalize that fact and start thinking about how to set him free of it.
Try comparing the child’s situation to a kid with an eyesight problem. Imagine offering rewards to a kid who cannot see well, saying that he must make more effort, and comparing him to younger kids with 20/20 vision. Sounds strange, if not cruel, right? But that’s what a child with toilet anxiety goes through when no one close to him is able to understand.
Subsequently, you may feel like crying at that point—it happens a lot in my clinic. Do not blame yourself. Yet, mistakes happen, particularly when raising kids. Constructive self-criticism encourages us to see where we went wrong and make changes.
In these circumstances, the child is between the devil and the deep blue sea. On one hand, there’s anxiety that won’t allow him to poop in the toilet. On the other hand, there are his parents’ demands, social norms, and his own expectations, which forbid him from pooping anywhere else but the toilet.
In short, physically and emotionally the child is trapped in a really tough place.
So, what do we do?
Firstly, you need to seek professional help. Further, contact your pediatrician and describe your child’s problem. After hearing a description of the problem, she’ll decide whether to run tests (like stool and blood tests), and whether she needs to refer him for a gastroenterological evaluation. Meanwhile, after ruling out any medical cause, apply a Cognitive Behavioral Treatment.
Here, we start dealing with your child’s anxiety directly. Helping her change the negative thoughts she associates with the toilet and helping her find better ways to cope with and to overcome, her feelings of stress. To sum up, slowly, we help equip the child with the tools she needs in order to win her very own personal battle, so that she eventually learns to take full control of herself and of the situation.
Preliminary Bowel Cleanout: The First Step to Behavioral Therapy Pediatric constipation is more widely common among children than many parents think, and it can be