Posted on: Saturday, November 30, 2002

PRESCRIPTIONS
Toilet-training woes may have medical causes

By Dr. Landis Lum
Special to The Advertiser

Q. I've been trying to toilet-train my 4-year-old forever, making him sit on the toilet and lecturing him, but he still soils himself. What can I do?

A. Your keiki may have constipation and may even be blocked up (impacted). See a doctor to find out.

Another alternative: Kids older than 2 1/2 who never seem to 'get it' may be trying to resist you, and you'll need to radically change your approach.

In a wonderful book called "Instructions for Pediatric Patients," Dr. Barton Schmitt explains how: Transfer all responsibility to your child. He'll decide to use the toilet only after he realizes that he has nothing left to resist. Tell him you'll have one last talk with him about the topic, and then you won't bother him again. Tell him his pee and poop want to go in the toilet, and his job is to help the poop come out. Tell him you're sorry you punished him, forced him to sit on the toilet, or reminded him so much. Then stop all talk about the subject.

Let your keiki decide when he needs to go to the bathroom. Don't make him sit on the toilet against his will. And when your child stays clean and dry or uses the toilet, give him praise, smiles, and hugs. Take time to play a special game. If he's clearly holding back, you can say "The poop wants to come out and go in the toilet. The poop needs your help." Make sitting on the potty fun — some kids need treats for simply sitting on the toilet and trying.

If your child soils himself, tell him to clean himself up immediately — he may need your help. Don't punish your child for accidents, and don't allow siblings to tease him.

For impaction, your doctor may try mineral oil, enemas or both. Try chilling mineral oil and hiding it in juice, ice cream, chocolate syrup or oatmeal. For constipation, have him sit on the toilet for 10 minutes twice a day, 20 to 30 minutes after eating.

Increase his intake of fluids, fruits, and vegetables. Have him drink prune, pear, and apple juices — orange juice doesn't work. Dairy products and cooked carrots are constipating — avoid more than 2 glasses of milk a day. And using daily laxatives like mineral oil, magnesium hydroxide, lactulose, or sorbitol cures constipation sooner.

Treatment of constipation will take six to 12 months, and your keiki WILL have relapses, so be patient, and don't give up!

Correction: Contrary to what I wrote in my Nov. 9 column, the "tennis ball" technique is NOT adequate for sleep apnea. CPAP, or continuous positive airway pressure, is the best treatment option.

Dr. Landis Lum is a family practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine.

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