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Live Q&A Episode 12: Dr Cathrine Neilsen-Hewett

At what point do I need to get some professional help with toilet training my son. He is now 4 years old and he deliberately holds on to his bowel motion for ages and then goes off and poos his pants. I know he has the urge and that he recognises it , because he holds on to it. Help I'm going mad!

I understand your frustration. It is important to remember that successful toilet training can only take place with the voluntary co-operation of a child.  As you know all too well, battling with a strong-willed toddler or preschooler inevitably leads to certain failure and lots of frustration. Children hold onto their bowel motions for a number of reasons. For some it is a matter of control - this is often the case when other things in their world seem to be out of their control like during times of significant change, beginning a new preschool, the birth of a sibling, or moving house.  It is important to transfer the control back to your child so that he feels that it is his decision to use the toilet, just remind him that he will need to wear a nappy or pull-ups until he wants to poo in the toilet. For other children withholding poos can be induced by fear, it can be quite scary to watch something of themselves disappearing down a toilet. You can encourage him to help you empty his poo into the toilet so that he becomes more familiar with the process.  Some children need additional incentives beyond praise – sticker charts are good as they are a great visual reminder of their attainments.  He may be holding on because it hurts to poo – constipation can be very common among younger children particularly if their diet consists of little fibre or liquids.  If all else fails then it is certainly time to make an appointment to see your GP or get a referral to an occupational therapist or child psychologist.

I cannot even count on one hand the number of times that we have NOT had a tantrum after swimming lessons about getting out of the pool and getting dry  and into the car etc. Please give me some tips on what I should do to make it easier for both of us. I get so frazzled by the experience I almost dread going each week.

Toddlers have tantrums for many different reasons – frustration, tiredness, inability to communicate or feeling insecure.  In order to handle the tantrum effectively it is important first to try and identify the cause.  Your child may be behaving this way due to sheer exhaustion after a very active and demanding lesson - if this is the case it is important that you support and encourage your child by acknowledging how well they did in the lesson and how tired they must feel, don’t rush your child into getting dressed too quickly as this could result in frustration.  When your child is calm and the tantrum is complete (perhaps on the way home in the car) discuss the behaviour with them, ask your child why they were upset, helping them to find words for their feelings.  You can also explain to your child that you will no longer be able to take them to swimming if their behaviour continues.  Use lots of positive reinforcement on the days when your child behaves appropriately – tell them how proud you are of them when they get out of the pool and get dressed without tantruming.

I wish I could be a toddler and throw a tantrum every so often. But seriously what should I do when there is a public tantrum and I'm being tutted and scrutinised by the ever so helpful general public about my parenting skills. I know what I would like to do but I don't think it's considered polite, LOL :)

The public tantrum is the most embarrassing and testing of them all.  As parents we often feel as if our parenting skills and coping mechanisms are under the spotlight.  There has been many a time that I have felt like standing back and walking over to those judging from the stands and offering them the opportunity to handle the situation - go for it – instead I usually take comfort from one of the other mother’s shopping in my aisle, that knowing glance or sympathetic look usually does the trick.   In all seriousness, the best way to handle a public tantrum is to remove your child from the situation. Children often tantrum when they are over-stimulated or are prevented from getting something they desire – unfortunately shopping centres are a breeding ground for both.  It is a good chance that the behaviour will stop once they understand the consequences.  Try not to panic – although this is often our instant response, don’t cave in to avoid embarrassment because it will teach your child to perform in a crowd and ensure repetition.  If this has happened a number of times try to preempt it, avoid going shopping when your child is tired, sick or hungry, or prepare your child for what is about to happen – you could always offer a reward for afterwards if their behaviour is appropriate.

My son is now 16mths and he started throwing tantrums at 12mths. Should I be concerned at how young he has started as on the show it was stated that they normally dont start happening until 18mths. I pre warn him of everything we are about to do but even if I do something as simple as picking him up and if he doesnt want to be picked up he arches back and screams and when i put him down he starts to bang his head on the floor/wall. Ive tried just holding him until he calms down but this normally involves me getting scratched and headbutted so now I just put him down somewhere different to where I picked him up and ignore him. Is this early behaviour indicative of ADHD?

While most tantrums start around 18 mths and most common between 18 and 2yrs it is common for tantrums to start at around 9mths. Children’s temperaments vary terribly with some being more prone to tantrums than others. They are a normal part of development and are should not be seen as a negative. Tantrums happen quite frequently and occur most frequently when their verbal skills are inadequate to be able to express themselves. You are doing the right thing by putting him down till he calms down. This is the same way I handle my son’s tantrums as children do get more frustrated if you try to hold them. It is important he is somewhere where he can not hurt himself.
Occasionally they may have trouble stopping a tantrum in these cases it may help to tell your child you will help them calm down and give them cuddle. Rest assured this is normal toddler behaviour and you are doing the right things.

My daughter is 2.5 yrs. I should toilet train her early this year when the wheater is warm, so I though better late than never so I trained her 2 motnhs ago she nearly got it but then we when travelling overseas when we are back she was sick and now the wheather too cold to do toilet train. Now everytime I took her to the toilet she always cry while 2 months ago when we took her to the toilet she did a wee but not poo yet. Should I back her again into training this winter? Will they change automaticly just like talking one day and say "no nappy today please, I'm going to toilet for wee" something like that? Tia - Gold Coast

It's not unusual for children to regress when toilet training,  particularly when there has been particular changes to their lives ie travelling overseas. Starting Pre School, moving house. It is important to let your child to determine when she is ready to toilet train. If she is feeling too pressured or stressful the process will only take longer or she may with hold wee or poo. The best thing to do is wait till she is ready and she shows interest again. Take your cue from her behaviour.

Dear Cathrine, My name is Ira and I have a 15 months old toddler. I have questions about Tantrum. When I am going out, eg. in supermarket, with my toddler, sometimes his tantrum come. What should I do??? I try to ask him stop, gave him water, hold him for a while but sometime it still doesn't work. In that situation what should I do? It's worry me, don't know what happend to him (he only speaks a few words at the moment) One big tantrum happend before when I was in supermarket, I tried many things to comfort him but still didn't work, finally I gave up and ignored him, but still mad(cry) 'till about 30 mins and then stop. But during the 30mins I ignored him, I felt so misserable coz didn't know what happend. What should I do?? Can you explain me step by step what I should do when the tantrum come? Thank you very much for your time and suggestions. Regards, Ira

It's not unusual for children to have a tantrum in a public place – often because they are over stimulated, attention seeking. Very important not to reward behaviour by giving in. Remove the children from the situation even if it means leaving a trolley in the supermarket. Do not cave in as this will encourage the behaviour. Be aware once the tantrum has started it can be very rarely stopped. Do not try to reason with him, wait till he can gain control of himself again. If this happens often, you can pre-empt the situation – you can distract him – take advantage of his short attention span – ie something interesting. Avoid going shopping when he is hungry, tired or sick.

Remember you have the support of every other parent in the supermarket. You are not alone!!!!!!

Hi My son is 29months & tells me when he needs to go to the toliet but he refuses to use a potty or big toilet. What should I do? Thanks Sharon

Give your child time to get used to the potty before he uses it. We have some beautiful photos of my daughter on the potty, fully clothed watching videos.  Involve your child in the process – take your child when buying the potty. If he is disinterested put it away for a few months. You can  involve him in the discussion about using the potty – read books, tell stories and try to make it fun. Demystify the toilet by imitation – let your child watch you when you are on the toilet so he knows we all do it.

my 4 year old son who has been in childcare since he was 12months old, has decided he doesnt want to go, and hypervenalates when i let him know its childcare today. i am having another baby (im 27weeks) could this be a tantram related to jealousy?. he has also started 4 year old kinder this year, so he goes there 3 days and his childcare centre 2 days, im really finding it hard because im working fulltime to accomadate his wishes by him not going.

Many parents are taken aback when their easy going toddler turns into a clingy insecure pre-schooler. Anxiety is normal and an expected part of emotional development. Children become anxious for many different reasons.  Your son may be suffering from separation anxiety. It is important to acknowledge his fears and concerns. Assure you love him and will be there for him. Sometimes it may be easy to pick him up early some days.

It is not unusual for children’s behaviour to change in times of stress ie the birth of a new sibling and a new childcare centre. It is important to reassure him and praise him. Build his confidence and self esteem. Talk to the child care centre and see how he is responding during the day.

Hi, I have a 14.5 month old daughter and the tantrums have started already! I am trying to ingnore them but i wonder if she isn't to young to understand what i am trying to do? She has a tati if she doesnt get her own way or if i take a potentioall dangerous item out of her hand (like the remote or phone). I dont know the best way to tackle this - i ddnt think I would have to deal with ths untl she was at least 2!! Pleae help!! Thanks, Narelle

It sounds like your daughter is tantruming to get her own way. You can either respond by ignoring her or you can leave her alone if she is not too destructive. You can also redirect her behaviour if you think a certain event will send her over the edge eg remote control. Shift her attention else where by beginning a new activity to replace the forbidden or frustrating one, or simply change the environment. Take your child inside or outside or to a different room. Be creative with orchestrating life to minimise tantrums, keep out of sight items that cause frustration

Choose your battles wisely, like when she is refuses something unimportant like a nap or a snack, give your child an opportunity to assert her independence or control. If her tantrums are related to attention seeking, move away so she no longer has an audience. Most important do not give her negative reinforcement give her the positive attention she desires when she is calm.

Toilet Training My son is 3 in June & we have hit a brick wall with toilet training. He is happy to sit on the toilet or potty but will not pass any wee. He attends creche full time & wants to sit on the toilet when the other kids all go but does not do anything. We encourage him to go when Myself & my Husband go to try and show him what you do in the toilet - but still to no avail. We have stickers ready for encouragement & he has shopped with me to choose his new underwear. How do you teach a child to actually use his bladder when he is on the toilet?

There is no magic age to toilet train your child. It is not unusual for boys to not be ready to train until 3. Most importantly do not try until your son shows the necessary skills these include: being able to control an urge to go, having a dry nappy for more than 2 hours, having predictable bowl movements, emotional indicators include: expressing an interest in using the toilet or potty, imitating your behaviour, demonstrating independence (often by saying no).

Children ready to toilet train have a desire to please adults (give gifts, enjoy praise). Your child needs to be able to predict and indicate when he needs to go and is able to follow simple one step commands If you start too early or before he is ready the process will be stressful and will take longer. If you are feeling pressured to toilet train your child because of comments from friends and family, your anxiety within your self with provide anxiety within your child

Relax it will happen in its own good time.

hi my name is michelle i have a 4 1/2 yr old son whom i'm trying to toilet train but because he's only just started saying a couple of words it's extremely hard. he does go to daycare & they are helping with his speech, both the daycare & me & my partner all think he's just being lazy with his speech but it's delayed his toilet training. i put him in under wear every day & put him on the toilet at least 3 times a day but i feel like i have no idea & that i'm fighting a loosing battle but the thing he has to be toilet trained by the end of the year as he has to go to kindy next yr. what can i do?

Yes toilet training can be very difficult if your child is delayed in communication skills. In order to be able to toilet train your child must be able to let you know that he needs to go, going or has gone to the toilet. You don’t mention anything about his respective language, but it is important for him to be able to follow simple one step commands.

I think it is wonderful that you are working in partnership with your son’s day care and working on his speech which appears to be significantly delayed. Can I suggest you make an appointment with your GP to get a referral for a developmental assessment as they can rule out any problems that may contribute to learning/developmental delays.

Dear Dr Catherine, I found the show covering tantrums very helpful but wanted to ask your opinion on toddlers having tantrums when they are put to bed. My toddler keeps coming in and out of her bed for about 1 and a half hours from when she is initially put to bed. If we try and keep her in the room she screams and it wakes my 11month old in the room next to hers. My husband has taken to laying down in her room till she falls asleep but this is giving her the upper hand. She use to sleep from 7-7 until March this year and it all changed. This is turning our family upside down as by the time she is asleep we are having dinner so late and have to do chores and it is already time for bed. We have no time for each other. I was hoping Rachel might consider doing a show on this subject , as I know a lot of mothers that are suffering like me. Kind regards

I too have experienced exactly the same problem with my daughter (I used to sit with her for up to half an hour while she fell asleep playing with my hair). It is not unusual for many toddlers who used to sleep well to suddenly develop increased fears especially around bedtime. Toddlers have active imaginations and often find it difficult to differentiate between make believe and the real world.

You need to find out what is causing her fears and reassure that no matter how vivid it seems, it is not real. Sometimes toddlers benefit from having a night light or going to sleep to music. Introduce quiet time around bedtime. Reduce stimulation. Ensure she is not watching anything on tv that may scare her and reassure her you are not far away, but most importantly don’t take her out of her bed as this will only reinforce her behaviour.

You can maintain closeness initially by sitting outside her room until she falls asleep, I tried this approach and it worked a treat.

Hello Dr Neilsen-Hewett.....I really enjoyed listening to your advice about tantrums this morning. I was very interested to hear about toilet training, but unfortunately missed it, because me baby boy woke up and was bellowing! I just wanted to know when should I start toilet training my son and the bet way to do it. I hear all these horror stories of children experiencing trauma etc if pushed into it. But I would really like to encourage him earlier rather than later. Hope I hear from you. with kind regards, Sabina Belli

There is really no perfect age to toilet train your child. Readiness depends on each individual child. One of my children began at 20 mths while my son was not ready till 30 mths. The more ready your child is the easier the process will be.

First of all look for signs of readiness; Physical, emotional and communication indicators.
Physically – your child needs to be able to understand the feeling and can feel the urge to go, bowel movements need to be predictable. Your son needs to be able to move around independently and be able to take his pants down and up with minimal assistance

Emotionally – He needs to be able to imitate your behaviour, shows an interest in using the toilet. It is not unusual for a child when they are showing signs of readiness to go away in a quiet corner to poo.

Communication – he needs to be able to express a need to go to the toilet and follow simple instructions. The average length of toilet training takes about 3 to 6 mths. Watch for behavioural indicators like grimacing when they about to have a poo.  Sometimes children need to be given help with indicators like shifting their weight from one foot to an other, so they begin to understand that this is their bodies way of telling them what is about to happen.

Boys should learn to wee first while sitting down as they need to feel comfortable when sitting to do a poo. If your son attends child care make sure to co ordinate toilet training plans to have consistency. Good Luck!

Hi Dr Cathrine. My son is 2yrs 10mths (Ronan). I find it very difficult to go to the shops with him especially when I also have my 14mth old (Callum) with me. He refuses to hold my hand in the carpark or in the shops and usually just takes off. If I try to control him he throws himself on the floor and carries on like a banshee. He also throws tantrums when he doesnt get his own way. For instance one of the local shops has a cafe with stairs... he of course wants to just climb up and down the stairs (even if I am not a patron in the cafe). I find it extremely hard to control him... Even my husband has difficulty controlling him. We end up having to carry him kicking and screaming whilst pushing my younger child in the pram. We do have a wrist leash which he just takes off and a harness. When we put the harness on him he throws himself down and screams non stop. Please, please could you give me some advice. Thank you. Jodi

Hi Jodi, The best way to deal with temper tantrums is to avoid them in the first place. Unfortunately this is not always possible. Here are a few helpful hints that may help:

1. A trantrum is a way a child expresses feelings that they have trouble in controlling.
2. Pre empt his behaviour by telling him what is going to happen during the outing, but also talking to him about the consequences of his behaviour.
3. Try and anticipate. Lead and guide him into behaving properly rather than demanding, as this creates a battlefield.
4. He is at an age when he is trying to exert his independence. Don’t try for absolute control, be clever and orchestrate life so you both want the same thing most of the time.
5. Try avoid saying no to everything he tries to explore by distracting him and diverting his attention to something of interest. Give him a sense of independence by giving him limited choices. IE when you are going shopping, which shop would he like to go into first, deal with all misbehaviours immediately and remove him from the situation immediately when ever possible.
6. Lay on the praise when he behaves. So that he quickly learns that it is more fun to have praise from appropriate behaviour than disruptive.
7. Use positive reinforcement when they accept no ( thank you for being a good boy by not getting upset when mummy said no).
8. Introduce tangible reinforcement if appropriate ie a lolly etc if he behaves appropriately.
9. If the trantrums escalate and begin to interfere with normal life – you can always make an appointment with your local GP who can investigate any physical issues that maybe contributing.
10. If you are going shopping – if possible leave your child with someone else.
11. Take something to entertain him – food a drink.
12. Avoid going out when he is tired or when you can sense a tantrum is brewing.
    

Good luck