Some 4 year olds cannot poop in the toilet

Dr. Ann,
My 4 year old daughter is very bright; she wears panties and is completely potty trained for peeing, however, requests diapers for pooping.

Over this past year, we have tried various methods, bribery, pooping on the potty, making her responsible for the process. She has accomplished pooping in her little potty on 5 different occasions–twice last year (she then would not do it again) and three times in a row this past week. We praise and celebrate–she is proud of herself and calls everyone she knows.

Now she is refusing–and withholding and then ultimately when she withholds she has thrown up.

She says she is scared, but will not give a reason to why she is scared. Obviously this is a control issue.

We start preschool in the fall.
I know she will withhold as she needs to for the three hours she is in school, but don’t understand that for as advanced as she is in all other areas, she is behind in this one. If I am this confused on how to handle this, I know she must be even more confused!! Will mine be the first kid in college to still be in diapers???
Sincerely, Laura

Laura, you are so not alone; developmentally some 4 year olds cannot poop yet in the toilet and want a diaper to do so.

The reason the diaper helps is she can feel when to contract her rectal muscles and knows the right amount of pressure in order to release the poop as she pushes down on the diaper. The hollow toilet seat doesn’t give her this advantage.

Standing & moving on her ‘tippy toes’ helps the stool move through the intestines and out. Respect her technique, after all, Italian women never even sit on the toilet, they always stand!

Don’t ask her why she thinks it is scary. Instead, just remember to help her differentiate between unrealistic fears and realistic fears. An example would be to tell her, “If you are not holding mom’s hand in the parking lot of the mall that is scary.

But pooping in the toilet is not scary, because you are in a safe place, our home or a private bathroom when you are out in public”.

You are obviously a thoughtful, caring parent who has recognized that accomplishing this task is never about bribing your child; it is about her owning this accomplishment. It is her body and she controls this for herself. So give her lots of other places to get control, like making placemats for the whole family or feeding the dog, so she doesn’t feel like she has to hold on to the poop to get control.

Thank you so much for taking the time to call and talk. I have already spoken with my husband and he and I both agree that your advice makes so much sense. I “got it” when you used the comparison of other developmental stages such as walking or rolling over. Definitely an “A-ha!” moment!