Tuesday, March 30, 2010

10 tips to Toilet Train an 8 year old.

Yes I said an 8 year old.
In the world of older child adoption toileting issues are very common and not something that is talked about very much. It is very real and very challenging for many adoptive families because it is not something that they can really talk about with other parents. We have been through this, we have worked hard, we sought medical interventions and although we are not free of the issue we are well through the worst of it. I thought I would talk about it here because I know that there are a lot of parents who are dealing with the same issues and after a lot of mistakes I have learned a few things.

When we first learned about our boys one of the first things that we heard was that Calvin had "soiling" issues and Fudge rarely made it to the bathroom on time and had a lot of "accidents", (those were the terms that were used by the social workers who presented the boys file to us). We did not think that it was a significant issue but we would soon discover that we were wrong. Because the boys had very different issues and for very different reasons I will discuss them separately.

Calvin came into care when he was 5. He had been neglected, his biological father had bowel issues (which we only just found out) and he had experienced a lot of trauma. When Calvin was apprehended it was discovered that he was a "poop holder", meaning he would not got to the toilet when needed, instead he would hold his bowel movements until they began to leak out. This is a common behaviour among traumatized children and one that often leads to more trauma because the issue is not understood or openly discussed.

I was pretty sure that I could handle this, I had toilet trained a lot of little kids and I was sure this was just an issue of time and love - HA, I was so wrong. Calvin wore pull-ups every day in an attempt to control the mess and one of the first things we did was get him out of them. Then we used them as a threat when he did not comply with the toileting routine. That was a mistake. He also had a lovely habit or putting feces on his hands and wiping it on whatever was closest. It was awful. I began to understand that this was not something that was going to go away with a little love and training.

Here is what has worked  for us in regards to the challenge of encopresis (poop holding) in older children

1.  Buy them a large supply of underwear and keep multiple pairs in the bathroom where they are easily accessed by the child. Do not put your child is diapers or pull ups.

2. Create a schedule for sitting, in the summer it was after each meal and during the school year it was breakfast, after school and dinner. We always had to come straight home from school because Calvin had held it all day and was usually desperate.

3. Talk to your doctor, get your child on a daily stool softener, it may need to be given for as a long as a year. Prolonged stool holding causes damage to the bowel and the nerves of the anus, it is a medical problem and it often gets to the point that the child is unable to maintain any control because they actually do feel the urge to go. Chronic constipation becomes a secondary issue.

4. No Consequences for toilet issues. When your child soils their clothes have them clean up but do not assign any other consequence ( it does not work, trust me). Be vigilant, do not let them sit in soiled clothes because they will happily stay in them thinking that they are going to get some attention, negative attention is attention to a traumatized child. When I even thought that the odor in the room might be from Calvin he was escorted to the bathroom and his underwear were changed. Praising Calvin got us no where, if his underwear were clean I would apologise for making a mistake and move on.

5. Clean up is his responsibility. We used facecloths for clean up, underwear were washed out by Calvin and put into a bucket or washer with the rinsed out face cloths. This was supervised activity as he could not be trusted to be in the bathroom alone but no comments were made ( well not once I learned better), I just stood there. When he was finished I released him to go back to his task.

6. Talk to them about how your body feels when you have relieved yourself and about how that feels. Do not be shy, this is not something they understand and they need to learn it.

7. Teach them how to wipe their bottom. We had a lot of success with flushable wipes, it was easier for him to get himself clean.

8. Diet makes a difference. High fiber, whole grains, little refined sugar and lots of water. If the stool is softer it is easier to keep it moving.

9. Remember that many children who have experienced trauma use this as a coping strategy, do not be surprised when you have a week of good days and then it starts happening again. Sometimes anxiety or anger can cause a child to begin soiling again after a long period of success.

10. Be Patient, let me say that again Be Patient. It took us well over a year to get to a place that we had a lot of success and even then there were still steps backward. We came very close to major surgery in an attempt to correct the issues. It will 2 years this summer and we still use stool softeners everyday and probably will for some time to come.

Fudge was a different story, he held his poop to but not like his brother did and it was easier to deal with because it had not become a medical issue with him. Fudge was mostly just to busy to stop playing and go to the bathroom. Dealing with a boy who won't stop to go pee is a lot easier. He was having fun and frankly he just did not care if he was wet. Do numbers 1,2 4,6 and 10 from above and then buy a watch with an alarm. Set that watch to ring every hour. Put it on. Each and every time that it beeps you send that child to go to the bathroom. In summer we let him go outside which was a huge incentive for a little boy. Make him go all the time, make him be successful because he has no other choice. Carry lots of extra clothes when you are out of the house and when he says he has to go drop everything at find a toilet.

And here are things that I did that I regret because they did not work and I am sure that I will hear about them later when the boys are telling the world about all the mistakes I made.

1. Do not punish them for accidents/soiling/doing it on purpose. They clean it up, where ever it is and move on. Sometimes things get ruined, throw them away, explain it, talk about, pitch it and move on.

2. Do not shame them by saying that no other kid there age does this. No other kid they know has had the life they have had.

3. Do not lose your temper because they have had an accident at a friends house and you are embarrassed.

4. Do not put them back in diapers or pull ups or threaten to do so.

5. Do not expect that this going to be quick process, it may take years.

6. Do not let siblings shame one another about toileting issues at home or in public. In our house that results in consequence for the child doing the teasing.

7. Do not let your child manipulate you into believing things to distract you from the issue - oh well it happened because so and so was in the bathroom and I could not get it in - this was usually a lie in our house and attempt to distract the adults from the poop on the wall.

8. Do not let your guard down, it is an invitation for them to walk all over it.

9. Do not use a reward system, it is to hard for them to be successful in many cases and they just get discouraged.

10. Well I think I only made 9 mistakes because I can't think of another one.

Hang in there, be patient and know that you are not alone.


Corey said...

I wish I had had you 20 months ago. I was a major fail in this department.

MomInTheTrench said...

Well thought out and well written. This is hard on families whether the cause is organic or behavioral.

Kerrie said...

I have a seven-year-old who will not use the toilet to pee. Right now, I ignore it mostly and she does her own laundry (kept in a rubbermaid box) and takes extra baths. I think I'll try the scheduled sitting again this summer. Thanks for the post.

GB's Mom said...

Great post! This information should come with every older child adoption.

Diana said...

BTDT!! So not fun. What worked for me was a combination of a lot of what you wrote, except the doc stuff. Every doc we talked to just kept throwing more and more and more miralax at it, even though I told them over and over and over again it wasn't working. Then they added mineral oil to it as well. Ok, what don't you understand? NO amount of miralax you prescribe will work and I use mineral oil to seal my wood cabinets and lubricate small motors. You're going to have to work really hard to convince me that having my son injest 2 bottles a week of the stuff is actually healthy.

So, I told them to hang it and I did my own thing. I went on the internet and researched constipation. I found all sorts of groovy home remadies like prune juice and "dynomite" - equal parts orange juice and olive oil...in fairly large quantities of each. My son hated them, but he took them. That was also about the time he started believing me that all that poop inside of him was making his body very sick. Once we did those for a couple of weeks, I put him through a gentle, but adult strength colon cleanse (just pills, basically) that I picked up at the health food store. After more than a year of horsing around with doctors and getting no results, what I did on my own finally did the trick...and did it in about 3 weeks, too. We haven't had any problems since.

Now, about the pee... Got any great ideas on that one?

Essie the Accidental Mommy said...

Excellent post! We have had the rare poop issue here and putting the kid in charge of all the clean up has done the trick. It actually has happened less than a dozen times in almost 3 years.
I put her in the shower dry, with a pail of water and all her poop clothes and she comes out when it is all cleaned up, she washes herself at the end. Then, we bleach the shower.

Acceptance with Joy said...

Thanks for writing this for me. :-)

You are the only one I "know" who understands what we are dealing with X's 2.

I keep having to remind the girls not to make comments about the twins being too big to poop in their undies... It's a trial for all of us and it takes ALL 5 of us to keep up.

Anonymous said...

This is the best and closest advise to my situation I have found, and I am so glad I've found it. Although my son is not adopted or a foster child he does have this same problem to the t and it kind of worries me. You said these children are like this due to some type of trauma, should I have him checked for something else? I am very grateful you have posted this THANK YOU

Anonymous said...

I would be interested to hear how things are going now, four years after you wrote the article. We just started on this road about a year ago and have found this article extremely helpful, thank you! Ours are now 10 and 11, and the issues are many, but we are making slow, fairly steady progress. Thank you for sharing part of your journey.

Kelly Mazzola said...

Thank you for your post. I have a 7 year old girl who is still not potty trained. She did not have a traumatic background, but did have encopresis. We seem to be done with that, but she still pees her pants everyday. We've been to several doctors, including a psychiatrist who currently has me punishing her each time she has an accident. Even that doesn't seem to be working. I really don't know what else to do. At what point is it something besides behavior?