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Column originally published May 27, 2014

Children Need Patience To Train Good Bowel Habit

Question: I am a frustrated mother. We have not been able to toilet train our three-year-old son. He started peeing in the toilet by himself after he turned two. However, he refused to have a bowel movement there. He asks us to put a diaper on him when he knows that he has to poop. Sometimes my husband gets angry with him, and he would hide in the closet to have the bowel movement. I have tried different techniques that I have read in magazines, but he is very stubborn, and nothing has worked. Otherwise he is a completely normal and healthy child. Please give us some suggestions.


You are not the only parents who are frustrated. Toilet training, especially with bowel movement, is probably the most difficult skill toddlers have to learn and master. Some children can grasp it overnight, while others have a lot of difficulty. This has very little to do with a child’s intelligence, although children with different temperaments may react differently to this challenge. Furthermore, different cultures approach toilet training differently. In North America, most children are toilet trained between two to three years of age.

There is no particular age when parents should start toilet training. Many physicians recommend parents not to start until they notice that their child knows when he needs to pee, or to have a bowel movement. Some children are aware of these earlier than others. Once started, the process of toilet training can vary from a few days to several weeks or occasionally months, depending on the child as well as the parents.

Many children are aware, at an early age, that they need to relax the anus and use their abdominal muscle to have a bowel movement. If the stool is not constipated, it doesn’t take a lot of effort to poop. Parents are often able to tell that their child is trying to poop in the diaper just by the way he acts.

There are a few important things that parents should consider in order to have successful toilet training. Calm and reassuring tone of voice as well as encouragement and praise work much better than stern and threatening voice. When they feel pressured or threatened, some children will withdraw and hide when they feel the bowel movement is coming. Others will hold their bowel movement as long as possible, which can lead to long-standing constipation.

Where a toddler has the bowel movement is also an important consideration. If you have a small potty beside the toilet, most likely he would feel comfortable using it. Some children, however, prefer to use the adult toilet because they want to imitate their parents. Unfortunately, the toilet seat cover is too big for their little buttocks, and their feet will dangle well above the floor. It is very difficult for them to use the abdominal muscle to poop. Some children are scared of falling into the toilet, or falling off it.

A few simple steps can make it easier for these children. There are toilet seat inserts which can support their little buttocks. You can also place a footstool in front of the toilet so that he can put his feet on it; this will give him security and make it easier for him to push.

You should also know that the intestines are most active shortly after a good size meal. Therefore, a child is more likely to have a bowel movement shortly after breakfast, lunch, and supper. Many parents put their children at the toilet within about half an hour following each meal. This will help the child to develop a good bowel habit. Most often, children will settle into a routine, and have one or two bowel movements a day, shortly after finishing one or more of the meals.

Developing a bowel habit is comparable to having a good sleep habit, both of them can be trained. Children go to sleep when they are tired; they should not stay up until they are totally exhausted. A bedtime routine including some quiet activities like reading stories can help them settle in bed, and then relax and fall asleep. This is most successful if bedtime is generally consistent. In the same way, bowel routine can be trained; if children are put at the toilet consistently and encouraged to have a bowel movement shortly after meals. If there is no routine, some children only have bowel movements when their rectum is packed with stool, and this can lead to constipation.

When faced with difficult toilet training, some families have elected to have one parent take a leave from work and stay at home to deal with this issue. It may sound excessive, but if you consider the importance of having a healthy bowel habit for the future of your son, this may be well worth the effort. There is no doubt that he will enjoy the presence of a reassuring parent. You should give him good amount of fruits and vegetables, as well as lots of water. If you work on the bowel habit as I mentioned earlier, he may finally relax and poop in the toilet instead of in his diapers. The whole process may not last too long, and for sure both of you will celebrate his success.