From the desk of Doc Smo: A Constipation Conversation (Article)

How many ways can constipated children come to the doctor?
I am totally amazed at the myriad of presentations that constipated children present to their doctors. I remember listening to MANY complex lectures in medical school and residency about recurrent abdominal pain and trying desperately to memorize the LONG list of conditions that present as recurrent abdominal pain in children. After all these years of clinical practice, common sense has finally taken precedence. Hold onto your seats for this DocSmo pearl: “Common things are uncommonly common.” In other words, don’t look for exotic illness when, most likely, everyday maladies are probably at work. Humans have two “common” reasons their stomachs hurt:

1. A lower intestine that is not completely emptying (Constipation)
2. An overly acidic stomach that doesn’t empty well and may actually reflux (send contents backwards) into the esophagus.

Let’s take a moment to talk about the first cause, constipation. Little kids—and even big ones—sometimes find pooping unpleasant. At some level they avoid it, and it catches up with them. When it does, they come to the doctor complaining of cramping pain (hollow organ trying to empty), feeling sick after eating (nowhere for food to go from the stomach), gas (excess fermentation in the colon), burping (slow gastric emptying), back pain (referred pain), vomiting (no room in the Inn), bloating, leaking stool, rectal pain, prolapse of the rectum… and the list continues. I am sure that another 30 years will bring many new variations on the same theme.

I really think we may have been better off when we lived outdoors, pooping wherever and whenever. I doubt children growing up in those conditions ever had stomachaches for the reasons we do now. Everything has to be so perfect for our children. They need to poop at the right time (when an adult says it’s ok), only in “approved” places, and quickly and cleanly: the so called Demand Poop. No wonder all the fuss!

 

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Potty Training- “Let’s get started right” (Pedcast)


Transcript:

For those new listeners, Pedcast are podcasts where we discuss parenting topics ranging from the basinet to the boardroom; they are informational in nature and not intended to give medical advice about a specific child.  For that, see your child’s doctor.

 

In today’s Pedcast, we are going to discuss the burning parental questions “When can we stop buying diapers?”  “When should I potty train my child?”  “Are pull-ups useful?”  I’m going to give you the DocSmo view of potty training young children.  I think I am going to convince you that success with potty training is more about your child than about your parenting skills.  Hopefully I am going to give you an understanding of where a child needs to be developmentally to master potty training.  Finally, in this episode, learn from the experience of generations past.

 

Most parents start thinking about potty training when their toddler gets to be about 18 months old, when language starts to emerge.  Once it is clear that Johnny can talk, it is logical to think that he can be coerced into urinating in the toilet.  Physiologically speaking, he does have control of his sphincter muscles by this age; they are under his control!  So, if he can control his muscles and can talk, why not be potty trained?  Well, lets think it through.  What does he have to do in order to be trained?

 

 

  • Step One: notice that his bladder is full, stop what he is doing, and be motivated to take action.
  • Step Two: tell someone that he needs to go pee.
  • Step Three: have the physical skills to pull his pants down (undress)
  • Step Four: now he gets to control his sphincter muscles
  • Step five: resume play as before

 

I don’t know about you, but this doesn’t sound like many of the toddlers that I know or have lived with.  Developmentally this sounds more like a 2 to 3 year old.  I counted 7 things Johnny had to do to have success at the potty. Remember, most 18 month olds barely have any expressive language, very short attention spans, have great difficulty transitioning between activities, and are not concerned about the consequences of their actions…but they do have control of their sphincter muscles!

 

Let’s let history be our guide on this one.  There was a time when children were forced into potty training around 18 months.  Until the invention of the modern disposable diaper, children were expected to master the “potty thing” by 18 months.  Most actually did to some degree but many either couldn’t, refused, or rebelled.  These rebellious children used the potty for a while and then began refusing, much to their parent’s dismay.  Think about it: after using the potty for a while, these children just refused to take over responsibility for this function.  Their parents at this point knew they were capable but unwilling.  The child was mad at being made to do something they were not ready to take responsibility for, and the parent was mad that the child “could” but “wouldn’t!”  The perfect recipe for friction.  And boy was there friction.

 

I have been told that famous pediatrician Dr. Benjamin Spock (no, not the Star Trek character, but the most famous pediatrician of the 20th century) came to the conclusion that many children were simply not ready to potty train at 18 months.  He thought that too much training by 18 months in many children put too much stress on the parent child relationship.  I happen to agree.

 

Conclusions and advice: should parents wait until 2 to start?  Toddlers have the physical skill to control the muscles of pottying.  They often do not have the other “READINESS” things necessary to be successful at taking control of their bodily waste:

 

  • Awareness of the need and willingness to stop what they are doing when bathroom time is needed
  • Language to tell someone they need help
  • Physical agility to take off their clothes
  • Judgment to limit their toileting to the toilet
  • And the ability to transition back to play

 

Once your child has reached the proper developmental level as described, potty training is usually easy.

 

During the training process, remember:

  • Reward not punishment is best.
  • Praise any and all success…your attention and approval is the ultimate prize
  • Provide them with some cool underwear to get started
  • Once you have decided that they are ready and training has begun, don’t go back and forth between underwear and diapers….bad message.  Stick with the underwear even when they are having accidents.
  • Don’t force your child to sit on the toilet if they are fearful
    • Provide a low toilet if they prefer it …toilets are high for young children.  Let them play with it or sit on it and even pretend with it.
  • Potty should be their friend
  • Teach them the vocabulary of potty
  • Bath time is a great time to begin learning
    • Most bladders empty every 3 hours, so try every 2-3 hours to have your child visit the toilet during the daytime.
  • Don’t over-react to accidents no matter how much you love that oriental carpet.
  • I have to tell you, I am not a fan of pull ups…diapers with a different design.  Useful for overnight dryness but in my opinion, not for training.
  • Finally, relax: keep in mind that all developmentally normal children will eventually be trained…be patient.

Thanks for joining me today.  Feel free to check out any and all of the other Pedcasts on Docsmo.com.  It is my privilege to spend a few minutes with you today giving you my perspective on child health issues.  If you have insights or comments you would like to share, feel free to join the discussion at my blog, DocSmo.com.  This is Dr. Paul Smolen, your host, broadcasting from studio 1E in Charlotte, NC.  Hoping your child feels free… to have success controlling his or her  pee!

 

Until next time

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*By listening to this pedcast, you are agreeing to Doc Smo’s terms and conditions.

 

© All Right’s Reserved.

 

The Lunchroom Lowdown: Bathroom Boot Camp (Article)

I was telling my partners about Bathroom Boot Camp at lunch last week. The topic of potty training comes up regularly for pediatricians, and they were happy to share their experience for this blog. I posed the question, “What have you found are important things for families to remember when training and maintaining continence in their children?” Their answers were very informative. Here is a glimpse:
 

Dr. Monica Miller, one of my young “GenX” partners, felt that reward and a positive attitude are important. Parents need to set the correct ambiance and mood. She feels that the bathroom experience should be slow, not rushed. She also emphasizes highlighting success. She recommends a “Potty Parade” after each success: “Let’s celebrate! The toilet success is so important that we need to have a party!” Her approach emphasizes patience, praise, and fun. Dr. Miller thinks that the most difficult children to train are those who are very intelligent or those who have difficulty adjusting to uncomfortable sensory experiences.

 

Dr. John Plonk, on the other hand, is one of the older doctors (mid fifties) that I work with. He is definitely a boomer. He grew up on a farm with days full of hard farm labor. His young life was dominated by work, dirt, and animals, so his attitude is “let’s get the job done.” He suggests letting children observe animals around them, learning through imitation. “Everyone pees and poops,” he says, “even animals. Children just need to observe what is happening around them and do as they do.” Being outside most of the day facilitates training since the deeds can be done anywhere; this method encourages children to take charge and be the masters of their own domains. Also, it’s hard to mess up too badly outside. Dr. Plonk recommends celebrating success with what he calls Flushing Fiestas: “Kids love to flush toilets, so make that their reward for cooperation when indoors.” Dr. Plonk also feels that a diet rich in “P” fruits promotes success: pears, plums, peaches, pomegranates, and popcorn. A great suggestion, and easy to remember. He recommends avoiding bananas and limiting dairy and cheese during the training process, for obvious reasons.

 

Dr. Kimberly Riley“If your stomach hurts, you need to poop, it’s that simple.” No wimpy poop for her patients, they need good volume. To achieve this, she emphasizes the relaxed bathroom, much like Dr. Miller. She recommends taking advantage of the gastro-colic reflex, the reflex that empties your child’s colon just after eating. “Routine toilet sitting is important, and don’t rush.” She encourages the parents of her patients to allow videogame use only in the bathroom. Dr. Riley declares, “Finally a good use for a video game!” Amen. Dr. Riley also points out that the school setting is particularly bad for regularity for many children since they do not have free access or adequate time in the bathroom while at school. Be aware of this fact as a parent, and make the necessary adjustments when possible. Dr. Riley feels that the strong willed child is the most difficult to train.

 
I hope some of these insights are helpful to families as they deal with the often-difficult task of potty training. I think the main thing to remember is that all normal children eventually master the entire bathroom experience. Be patient and don’t go negative. Remember, your child is the only one who can actually control their sphincters, both rectal and urinary; to have ultimate success, your child needs to take control. I recommend creating an environment that cherishes success and encourages independence. Good luck.

 

For a complete list of this week’s potty content, check out the topic of the week!

 

*By reading this post, you are agreeing to Doc Smo’s terms and conditions.

 

© All Right’s Reserved.

Announcing Bathroom Boot Camp, May 30th-June 3rd! (Article)

Hold your nose, it’s all about poop and pee next week on DocSmo! Every day, DocSmo.com will feature informative articles and Pedcasts related to potty training your little ones, including answers to parents’ frequently asked questions. Have a question you’d like addressed by the Doc himself? Submit them here or to docsmopedcast@gmail.com.

Come join the conversation, and let’s help your child’s potty training experience be positive from the start…“It’s alimentary, my dear Watson!”

 

For a complete list of this week’s potty content, check out the topic of the week!