Nelson's textbook of pediatrics by Richard E. Behrman

By Richard E. Behrman

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Children need to be taught to wipe, and keep on wiping until they are clean. Remarkably, there are some children who do not grasp this. They will wipe themselves once and then finish, regardless of how much poo is on the paper. I have seen a number of children, even teenagers, who are said to be soiling but actually are simply not wiping properly. 39 The Holy Grail – Sensible Use of the Toilet Ideally, we want pooing to be no big deal. This means it won’t bother your child or you. There should be no more tummy aches, hard stool, pain or bleeding on passing.

If he were allowed to eat, but not open his bowels for 42 days, that would have been a real challenge. Stool withholding can present differently depending on the child and their age. It seems that children who start withholding as very tiny babies know of nothing else and so have fewer obvious signs of distress. They tend to just not go to the toilet and will often only be really noticed at a much later age if they start soiling due to overflow. Babies will usually appear unsettled. They will wriggle around ‘stretching their backs’ to help keep the poo in.

If the target is too high the child will think he has no chance of reaching it, and so may not even try. In this situation, he needs to be encouraged gradually, without being pressurised to do too much too soon. For example, initially he may get a reward for just sitting on the toilet. Once he can do this comfortably, this may change to getting his reward only for opening his bowels. 2. The rewards have to be reasonable. If you promise the holiday of a lifetime for one poo, what will you give for the second one?

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