Q
Dear WholeFamily Counselor,

My oldest son (he will be five-years-old next month) refuses to use the potty, he won't go near it. I have tried different things, such as rewards, potty-time videos, potty books and nothing has worked. He is in preschool three days a week and, of course, he was supposed to have been trained before entering this preschool, but he just wears his pull-ups and so far hasn't had any accidents. When asked why he doesn't want to use the potty, he just says he's not ready. I have never forced the issue -- but I'm losing patience.

He has no physical or other developmental problems. His pediatrician had suggested that we take him to a child psychologist, which we did, but she didn't even have any kids!! Needless to say, she didn't help. My gut feeling is that he will use the potty when he's ready -- but yikes!! How much longer should I wait? Or should I try another child psychologist? Do you know of any other parents who might be able to help?

Thanks.


A

The fact that your son wears pull-ups to school and has not had any accidents, indicates to me that he is physically toilet trained, but psychologically is not ready to take off his diaper. It is great that you waited and did not push him to toilet train when he was too young, but by age five, for a child with no physical difficulties, toilet training should no longer be a choice. Sometimes, toilet training can turn into a power struggle that has little to do with the actual ability to use the toilet. Your son may be testing you to see how long you will be patient. Another possibility is that your child is fearful of the bathroom itself or of the responsibility of needing to go to the toilet. I would suggest the following program. I know this program may be drastic for some children and if you feel strongly it is not for your child, do not try it. On the other hand, do not underestimate him. He may surprise you.

1. Tell your son that he is a big boy and that during the day, big, almost five-year-old boys need to use the bathroom and not pull-ups or diapers. (Nighttime training can come later.) Point out that he will be five soon and that he needs to wear only underwear by the time he is five.
2. Pick a day that you will put all the diapers/pull-ups away. I would suggest a Saturday so you will have two full days to work with him before you need to return to a regular schedule. Give him a one week warning before you put all the diapers away. Talk about this step consistently during this time. Make a calendar for him, showing how many days are left. Each day cross off the day, so he knows how many days are left. Encourage him to start using the toilet so he will be ready.
3. I know you've tried this, but try again to think of a prize that he will enjoy for sitting on the toilet. If he uses the toilet, then give him a small prize and lots of encouragement. Also discuss with him a "big" prize that he will get when he uses the toilet regularly. Try and build this moment up as a wonderful, important step that you know he is ready for.
4. Discuss his fears with him during this time. If he is willing to discuss it, ask him how he feels about it. If he does not want to discuss the topic, then simply tell him how you feel. You can say that you are proud of him because he is such a good, big boy and that even if he does not feel he is ready, you will be there to help him.
5. Discuss what kind of underwear he wants and go buy it for him. Show it to him the night before and remind him that tomorrow he will be wearing underwear.
6. During the week, try to pay attention to his schedule. If you see a pattern, then that will help you know when to suggest he uses the bathroom.
7. When the appointed day comes - take the diapers away! If he is upset, then tell him how much you love him and that you will help him as much as you can, but do not give in. Hopefully he will have taken you seriously and at least psychologically be ready for this step. If you saw a pattern in his needs to go to the bathroom, try and keep the pattern in mind and remind him to go to the bathroom at appropriate times.
8. If he has an accident, do not get upset with him. Tell him that it's okay to have accidents and that everyone has accidents in the beginning. Even if he repeatedly has accidents in the beginning, encourage him and tell him you know he will remember next time. Each hour give him a friendly "reminder." Once he uses the toilet or if he has an accident, then wait two or three hours before reminding him again.
9. The first few days may be difficult for him, but if he is physically ready you should see improvement shortly.
10. If you see an improvement in his willingness to use the bathroom for urine, but a continued difficulty in using the bathroom for bowel movements, then I would consider allowing him the choice of a pull-up only for bowel movements. The drawback of this approach is that you may someday have to use the same program again, this time for bowel movements. However, you do not want to set up a cycle that may lead to constipation. If you see that urine training is going well, but bowel movements are a problem, consider this option.
11. At night, continue to allow him to use a pull-up. Night-time training is a later step and is not nearly as socially important.
12. You mentioned that his fifth birthday is in a month. Discuss with him that you hope you can have a big party on his birthday and he can get a present both for his birthday and for wearing only underwear. This gives him a concrete goal to work for.

If you have any concerns about trying this program or if you try it for several days and your son seems extremely upset, then I suggest consulting with another child psychologist. There are many wonderful child psychologists. It may be that the first psychologist was a bad match for your family.

Another option you can consider is going directly to a child psychologist and discussing this program before implementing it. Different approaches work with different children and it will be easier to ask someone who has met your child if he feels this approach will be effective.

Remember, sooner or later your child will be toilet trained. Your son is lucky to have a mother who is sensitive to his needs and together you and your son will find the right approach.

Good luck!

Esther Boylan Wolfson, MA
Director, Early Childhood Development Center
WholeFamily.com

Response: Thank you so very, very much for responding so quickly to my letter. I truly like your plan and I will let you know what happens. The part about testing my patience' really hit home!
We shall see...
Again, much thanks