Hi Barbara,
I have two boys. My older son was potty-trained when he was 3.5 years and was done in about 10 days. Nights, poops everything. It was remarkable. My younger son who is almost 4.5 has been training for a little more than a year. He was in early intervention from age 12-18 mos for motor delay and is still a younger 4 than his brother ... but is deemed age appropriate in his skills and is on target per his pediatrician and preschool for motor, language etc. He wears underwear during the day and remains dry but wears pull ups at night and they are wet every morning.
Our big problem is poops. He will go days or sometimes even 2 weeks without a poop accident and then will have several a day for several days. It's usually solid so I don't think it's from an upset tummy. I can't deny that sometimes I get extremely frustrated and yell. Then he cries. Today we had 3 poop accidents inside of 4 hours and I put him back in a pullup and he freaked. I don't want to torture him obviously and I feel like the worst mother in the world but I have no idea what to do. He's starting a prekindergarten program next month and if he has accidents there they will send him home. (PS- he rarely has accidents at his current preschool that he attends twice weekly). Any advice would be appreciated. Thank you--

Hi J,

I'm so glad you asked this question because here's a news bulletin: A preschool cannot send your child home because of a toileting accident.

State regulations enacted in 2010 (specifically, reg #606 CMR 7.04(g)1 ) stipulate that "toilet training status is not an eligibility requirement for enrollment." In fact, it's considered discrimination if a school has a toileting policy. David McGrath, deputy commissioner for the state Department of Early Education and Care, said in a phone interview yesterday that programs are required to have a change of clothing for each child in anticipation of accidents.

Have you just assumed the school will send him home or has it actually stated that that is the policy? If it's the latter, McGrath urges you to report the school to his department.

I hope that information takes a little pressure off you!

As far as the accidents your son is having, I asked Alison Schonwald, a developmental pediatrician at Boston Children's Hospital, to weigh in on this. Here's what she wrote:

"Constipation is the most common issue underlying stool accidents. When children have so much stool output, constipation may seem counter-intuitive. However, when children are backed up with stool they lose coordination of the rectal/anal feeling that they have to go, the ability to hold it in, and then to get to the toilet to push the stool out. Instead, backed up constipated stool can stretch the rectum allowing stool “from above” to leak out around it. The days when he has accidents may very well be times when he is constipated, so that softer stool sneaks out into his underwear. If this is the case, he truly does not feel the need to go and lacks the opportunity to get to the toilet in time.

"Often, the periods of accidents are preceded by a few days without any accidents, but without any stool at all! Days without any stool output are probably his stool becoming backed up, but before any leakage occurs. He may be wet at night if he has a belly full of poop pressing on his bladder. He may just not be neurologically mature enough to be dry at night either. A behavioral component often comes along in the situation you describe; children become overwhelmed and frustrated and ignore the issue or refuse to use the bathroom. The magnitude of importance and emotion parents display can be mirrored with equal and opposite energy in response from the child.

"So, what to do? Talk to your pediatrician about your child’s current toileting status. On days without a poop into the toilet, be sure he gets plenty of fluid and fiber, and that he tries to sit on the toilet to make even if he doesn’t feel he needs to go. If he becomes constipated anyway, talk to the doctor about other treatment options. Also, eliminate the power struggle by responding with consistently neutral and pressure-free comments. Limit conversation about the accidents as much as possible, and praise clean underwear and expected toilet use.

"If constipation and overflow leaking are not the explanation, several less common scenarios come to mind. Some children react to stress with regressive behaviors, so consider what else is going on during the days when he has his stool accidents. Abuse is a rare but obviously highly concerning stressor that needs to be considered as well. If the pattern continues, your pediatric provider might refer you to a specialist, such as a developmental pediatrician or gastroenterologist."

For more help, read this article by Dr. Schonwald in Pediatrics for Parents; learn about the Toilet School at Children's; or follow this thread in my blog.

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