3 year old won't use potty

Dear Jenny,

I had to laugh when I read your comment "Maybe we didn't spend enough time with her when she was little, I don't know. "

It's actually very common for a 3.5 year old not to want to use the potty chair for BMs. If we can figure out the reason, we can address it. Here are the most common reasons (and of course they don't include not having spent enough time with her!)

1. She's afraid she'll fall in. We can cross this one off since it is usually a reaction to the toilet, not the potty, and you are using the potty, right?

2. She's had some bad experience at preschool. This raises the question: What happens when she has to go #2 at preschool? Do they change her diapers? If they ridicule her, it is possible that she is having a power struggle with them and therefore doesn't want to stop using her diaper. Worth checking out.

Also, if they don't have a small potty and the alternative is the toilet, then she might well be nervous about sitting on the big toilet if at home she only sits on the potty. I have repeatedly heard that kids at preschool get frightened when they see some kid "fall in" the toilet at school. Again, worth checking out. (Unless she does use the toilet at home and you know she is fine with it.)

3. Her body is accustomed to the position of squatting to move her bowels. This is the most common reason. On the toilet, many kids just can't get the leverage they need to push, because their feet dangle, which tightens rectal muscles and makes defecation difficult. But even on the potty, little ones aren't in their usual position to defecate, because instead of squatting, they are sitting back. This takes some retraining of their bodies.

So if she is indeed using the potty at home, I would try getting one of the most simple potties, that she can squat over. Baby Bjorn makes some very small ones -- I think one is called the Smart Potty. You want one low enough to the ground that her knees are higher than her bottom, and of course her feet flat on the floor, so she feels like she is squatting.

(If she is using the toilet, you might want to consider a stool like this: http://www.thepottystool.com/index.html. I know it might seem excessive to buy a special stool, but it gives kids the support and security they need, as well as the leverage.)

4. She wants privacy. It's normal for little ones to"hide" when they have a BM. Where does she usually go in her diaper? One option is to put the new potty there and tell her she can squat over it with her diaper on. But then you will have to pursue her there to be sure she actually squats over the potty, so it sort of defeats the purpose of privacy. A better option, if she goes at a regular time of day, is to make a big deal about the new potty you got her, and how she can have some special alone time with it, and can even keep her diaper on, you can do it, and have privacy, but she has to squat over her potty in the bathroom. (With the diaper on, to start. More on that in a moment.) And with incentives...

5. She needs some incentive. When you think about it, your daughter has no reason to want to use the potty; this is for your benefit (or at least that is what she assumes.) She is in this habit, and changing a physical habit is hard, even scary. You might have to provide some incentive, like a small basket of wrapped small gifts that she can choose one to open and play with as she squats over the potty. I don't generally recommend "rewards" beyond parental hugs, but I have heard so many stories of kids having a hard time making this transition, and then "holding" so they get constipated, and it becomes a vicious cycle. I think making it worth their while to "try" to change this entrenched habit is probably worth it.

This doesn't really taking buying many small toys, since she opens a toy and successfully uses the potty for her BM, she is allowed to play with the toy for the next two hours, but then it goes back in the basket and she can look forward to playing with it then. Sometimes that is a great motivator to get her back on the potty.

I know one family that used a hand-held video game that was only available to the child during potty time. Apparently, it was very quick and effective in solving what had become an intransigent problem in which their son adamantly refused to use the potty.

6. She is used to the feeling of her diaper and is frightened to have a BM without it on. Again, VERY common. Tell her she can go in her diaper, no problem. She can wear it while sitting on the potty. Once she does this, change her in the bathroom and let her help you flush the contents of her diaper, reminding her that "BMs go in the toilet." (WARNING: Only do this if she is not afraid of the toilet, obviously. And let her be the one to flush.)

Give her a couple of weeks of this to solidify her habit of going into the bathroom to have her bms on the potty, in the bathroom, in her diaper. Then start loosening the diaper, so it is on/under her still but not as tight. Just gradually loosen it, day by day, until she is finally having her BM ON the diaper, but it is not even attached to her. Then it is just a small step to take it off her as she sits down, and lo and behold, she is using the potty!

This may seem like a lot of trouble to go to, and it is. On the other hand, she's already 3.5 and set in her ways, and you really want her potty trained. Fighting with her about her body is a fight you won't win. So far you have shown terrific restraint, and that is great, because you have side-stepped any kind of power struggle. But maybe it is time to give her some incentive?

I will tell you a story. When my son was your daughter's age, he also would pee in the toilet but needed a diaper for BMs. One day when I was changing him, I said "I'll be glad when you decide to use the toilet for BMs. " He was shocked, and asked "Why?" Clearly this had never really sunk in, even though I had been telling him that some day he would use the toilet, and that BMs go in the toilet. "Because I love you, but I don't love changing poopy diapers" I told him. He never used his diaper for BMs again! I think it is ok to express your preference, as long as it isn't a power struggle, and doesn't involve punishment.

I hope this is helpful. Please let me know how it goes. Good luck!
Dr. Laura