Dear Dr. Rene,
My daughter will be four years old in January and will not pee or poop on the potty. She wears underwear all day long and very rarely has an accident. However, whenever she has to pee or poop, she asks for a pull-up. She puts on the pull-up herself, goes pee, takes the pull-up off, puts it in the trash and puts her underwear back on. If we are out, she only likes to change into a pull-up to go to the bathroom in the car. Sometimes I have to help her take her pants and shoes off, but she is self sufficient with the pull-ups. She is terribly afraid of the potty! We have two different potties, we’ve watched the movies and read the books, and she has a dollhouse with a potty to play. I don’t know how to physically make her pee where I want her to. A couple of times I have said that we have no more pull-ups for during the day, and both times she has held it all day until she is too uncomfortable to sit down – at which point I give her the pull-up. I don’t want to do this again unless I’m really going to stick to it. I just didn’t feel right having her in so much discomfort while trying to force her to pee on the potty. We also have a baby due in January, if that makes a difference.
Erkia, mother of one and one on the way
There are two answers here. First, the potty training answer. Second, the answer about managing fears and anxieties. I would start with the low key way of addressing the first while you learn about the second.
You are already on the path of the potty training answer. A more common related concern would be the child who will pee but not poop in the potty then has an accident or needs a pull-up to poop. The overarching suggestion there is to stay calm emotionally and allow the child to change into a pull-up as needed and then clean them as you would if they were not yet potty training. All of this while expressing, you know they are potty trained for pee (not in your case) and you know they will poop on the potty when they are ready.
There are several additional potty training things you can do to move forward. I would encourage her to be in a bathroom for the process. At home, move the stack of pull-ups to the bathroom and talk about how that is the room where people go when they need to potty. Carry a pull-up in your bag and guide her to a bathroom when you are out. With a silly tone you can remind her, “the car is not a bathroom, silly. When people go potty they go to a bathroom.” A next step, once she is comfortably going in the bathroom, would be to have her sit down when she is in the pull-up, either on the edge of the tub or on the can be closed potty. This is getting her into the sitting position which can feel different, but it’s necessary for eventually going on the potty.
Give her choices about which bathroom and if you help her or not. When she does at least make it in the bathroom, give her a bit of descriptive praise, “you knew you had to go, and you got yourself into the bathroom!” I would also give her language of ownership. This means saying every few days, and not on the heels of a pull-up, “you so know when you need to go potty. Your body knows soon enough that you can even get yourself changed to a pull-up. I know when you are ready, you will sit on the potty.” This is meant to be encouragement without pressure. Continue to mix in the story books and the video tapes. Continue to play with the dollhouse bathroom set.
If all that doesn’t lead to progress, you might take a consultation with the WASH Clinic at Children’s National Medical Center. They are specialists in potty training issues and may have additional answers to encouraging the process when there are specific concerns.
Your description of her being “terribly afraid” of going on the potty and her complicated answer to avoid it of changing, even in the car to go to the bathroom suggests while she is able, she has unknowingly convinced herself that is a scary thing. The more you just push or “force” her to go on the potty, likely the more she will push back. When there is an anxiety, the underlying idea is the thinking causes the feelings which cause the behavior. To help the child move beyond the avoidance behavior, the trick is to figure out and address the thinking to change the feelings to change the behavior. There is a good book titled Helping Your Anxious Child: A Step by Step Guide for Parents by Rapee, Wignall, Spence, Lyneham and Cobham. It is an activity book for parents and children to work through together to help children help themselves to calm the anxious feelings and outcome behaviors. I would start reading this book yourself, and, if they potty training suggestions don’t move the system forward, you can go back and start working through these activities together. This is a long term effort to your concern, but a healthy way to go. There are also area specialists who can work through this with you if you prefer a person to a book.
Sincerely, Dr. Rene