Stool Toileting Refusal
A Prospective Intervention Targeting Parental Behavior
Bruce Taubman, MD;
Nathan J. Blum, MD;
Nicole Nemeth, MD
Arch Pediatr Adolesc Med. 2003;157:1193-1196.
Objective To evaluate the effect of an intervention targeting parental behavior on stool toileting refusal.
Methods This study population comprised 406 children aged 17 through 19 months from a single suburban private practice. Children were randomly assigned to receive 1 of 2 written toilet-training instructions. Both groups were advised to use a child-oriented approach to toilet training. In addition, those in the intervention group were requested to avoid using negative terms for feces and, before training began, to praise the children when they defecated in the diaper. Follow-up telephone calls were made every 2 to 3 months, and 381 children were followed up until they developed stool toileting refusal or completed daytime toilet training.
Results The incidence of stool toileting refusal was 23% in the control group and 26% in the intervention group (P>.10). The mean ± SD duration was 5.2 ± 4.9 months in the intervention group vs 7.6 ± 4.9 in the control group (P = .04). Children with stool toileting refusal in the intervention group trained at 40.0 ± 6.4 months vs 43.0 ± 6.5 months in the control group (P = .04).
Conclusions The intervention did not decrease the incidence of stool toileting refusal but did shorten its duration, leading to earlier completion of toilet training. This should help to ameliorate some of the negative consequences of stool toileting refusal.
From the Department of Pediatrics, Divisions of Gastroenterology and Nutrition (Dr Taubman) and Child Development and Rehabilitation (Dr Blum), University of Pennsylvania, Philadelphia; and the Children's Hospital of Philadelphia (Dr Nemeth).
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