Behind on Potty Training?

Q.Our son is nearly 4 and is still not potty trained. We have tried every technique in the book, including giving him time outs, ignoring his accidents, offering incentives, and giving positive reinforcement. He will often wait until we are in a public place like the mall or church and then poop in his pants, which makes me think that he's willfully disobeying us. I'm concerned that we haven't been firm enough with him and now he's learned that he can control us. At what point do we put our foot down?

A. It sounds like you have put a great deal of effort into the situation, and I can understand your frustration. It's time to change course. Time outs do not work well for this problem, and the pattern is too defined to ignore the accidents as you would with younger children. Let me suggest a few alternatives:

1. Check with your pediatrician. Make sure there is no physical reason for your son's problem. Sometimes diet and other physical problems can be behind the trouble you're seeing. For example, some children have chronic constipation, which makes bowel movements painful. The child avoids the bathroom out of fear of pain. The child eventually has a movement in his pants when there isn't time to get to the bathroom. If this is the case with your son, dietary changes could help. There are a few other medical conditions that could be contributing to the problem, so have your doctor rule these out first.
   
   
2. Have him clean up. If you're not doing this already, try having him clean himself up after the messes. Set up a little drawer with a change of underwear and pants in the bathroom. Include a package of wet wipes and a bucket for the soiled clothes. He is a little young to put them in the washing machine by himself, but if you have a step stool and feel he can handle it, premeasure the detergent and mark the place on the dial with a sticker. Walk through the entire procedure together and then let him know this is his new responsibility.
   
   
3. Continue the rewards. Keep up the positive reinforcement for successful pottying and let him know a big reward will come after three weeks straight of handling his poop in a "big boy" way, on the potty. This reward could be a special family outing or something else you know would motivate him.
   
   
4. Do a conflict inventory. Often, but not always, when kids are deliberately pooping in their pants, the child is angry and feels out of control about something in the family. Double-check your family environment for marital discord (even if you argue in private, your son may sense tension between you and your spouse) or other family conflict or changes. These issues can cause children to act out in a search for reassuring attention.
   
   
5. Seek professional help. You have worked extensively to try to correct this problem on your own. I think it is time to get an outside perspective on your son to help you gain clarity and get some answers. A Christian counselor who specializes in children's issues can help. Your family doctor or pastor can refer you to someone you can trust.

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