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Avatar linda...
My 4 year old keeps pooing in his pants.

It's been a couple of months now that my 4 year old has been doing poo's in his pants. I watch for signs that he needs to go and encourage him to sit on the toilet but he throws tantrums and refuses then 5 minutes later it's in his pants. I've tried bribery, taking his favourite toys away from him and rewarding him when he does the right thing but it seems to be a persistent issue. He will start school next year and I'm worried for him.

Jane ...
Answer: Regular toileting and sitting him on the toilet after meals, lots of praise and rewards such as sticker charts may help. Ensure he can readily access the toilet and can get there easily. One common issue in this age group is constipation and something called "retention with overflow". This is when there is hard impacted poo in the bowel and the child frequently soils their pants because the more liquid poo behind the impaction leaks around it. Some kids need a course of laxatives to clear the impacted, hard blockage and to regain muscle tone in their bowel and relearn the sensation of needing to go to the toilet and empty their bowels. I'm not saying this is the case with him, but just be aware of this. Try to avoid him becoming constipated by ensuring his diet is high in fibre and not too much refined foods. Ensure he has plenty of water to drink. Role model the behaviour you'd like him to demonstrate and praise him lots and lots when he does poo on the toilet. For now, involve him in the clean up process and try not to invest too much emotional energy into this. With time he will improve. Perhaps he's also using this as a means of gaining attention, so a matter of fact attitude from you may help. Cheers Jane
Answered: 03 Aug 2013