MONDAY, June 7, 2004 (HealthDayNews) -- If you're having a hard time getting your youngster out of diapers, a new study offers some reassuring news -- your parenting style probably isn't to blame.
Constipation and your child's temperament are more likely culprits, conclude researchers in two different studies in the June issue of Pediatrics.
"We see a huge number of children who have problems toilet training," said an author of one of the studies, Dr. Alison Schonwald, an instructor in pediatrics at Harvard Medical School. "The vast majority of kids with difficult toilet training are constipated," she added, but it wasn't clear from her study whether the constipation or the resistance to toilet training came first.
In the other study, researchers from Children's Hospital of Philadelphia addressed this issue and found that constipation often precedes toileting difficulties.
Schonwald said that difficult temperament traits, such as being easily frustrated or not easily adapting to change, were also likely to contribute to toilet training problems.
In her study, Schonwald and her colleagues compared 46 children who were "difficult toilet trainers" to 62 youngsters who didn't have problems learning to use the potty. The average age of the difficult toilet trainers was 5.1 years old and the average age in the comparison group was 4.5 years.
The researchers defined difficult toilet training as either being between 3.5 and 4 years old and not toilet trained after six months of trying or being over 4 and refusing to use the toilet or not consistently using the toilet in the daytime.
Parents of the children were asked to fill out toilet training history questionnaires and completed a questionnaire to assess their parenting style, because the researchers suspected that the way children were parented might have something to do with their toilet training difficulties.
Surprisingly, they found no such association. Instead, Schonwald said the biggest factors were constipation and difficult temperament traits.
Seventy-eight percent of the children with toilet training difficulties reported being constipated, while 55 percent of the control group did.
Some of the difficult temperament traits that may have contributed to difficult toilet training included: difficulty adjusting; withdraws from new situations; easily distracted; excess energy in response to stimuli; negative demeanor; easily frustrated; and highly sensitive.
Schonwald said a good approach for these types of children might be to take them through the toilet training process slowly and step by step. For example, she said, start by just having your child practice sitting on the potty with no expectation of urination or defecation.
The second study followed 380 children for three years as they mastered toilet training. The children were between the ages of 17 and 19 months at the start of the study.
The average age that children were completely toilet trained in the daytime was nearly 37 months. There was a wide range, however, between 22 and 54 months.
Almost 25 percent refused to have a bowel movement on the toilet at some point during the study. These children were more than twice as likely to have had frequent, hard bowel movements than children who didn't refuse to have a bowel movement.
Ninety-three percent of the children who refused to have a bowel movement on the toilet and had hard bowel movements experienced constipation before they started to refuse to use the toilet.
Dr. Michael Wasserman, a pediatrician at Ochsner Clinic Foundation in New Orleans, said he was surprised by how many of the children were constipated in both studies.
"Constipation is a big issue," he said, adding that parents and their children's physicians need to make sure the child's diet is appropriate and, if necessary, to use stool softeners.
Wasserman said he suspects that a lot of the constipation may be due to dietary issues and recommended that parents provide their children with plenty of fluids and a high-fiber diet that includes whole grains.
He said that peer pressure -- seeing other kids using the potty -- works best for training children, and that parents should be low-key. If your child doesn't pick up toilet training quickly, he suggested backing off for a little while until your child is ready and motivated.
"You can't make children eat, pee, or poop, so don't fight about these issues because you're going to lose," he said. "When they're ready, they'll do it."
To learn more about toilet training, visit the American Academy of Pediatrics.