10 year old won't use toilet

[Katiemonkey15]

We are at our wits end now with 10yo dd who has fairly frequent accidents in her pants because she just won't go to the loo.

She eats a good diet, no food allergies (we tested), no learning or behavioural issues and nobody else in the family has any issues. We have a 3yo who just toilet trained like a dream yet were dealing with this with a 10yo. I do try not to get too cross or overly embarrass her about it but it's really tough because she will literally sit on the sofa and poo her pants rather than take herself to the loo. Sometimes her sister will tell me that she's doing it cos she can tell by her body language (and the smell and somwtkmes noise) but dd herself just sits there and shows no urgency to get herself to the loo. Unless I frog march her and make her sit she won't go to the loo at all.

Have tried incentives, punishments and nothing seems to work. GP thought she might be constipated so we tried laxative drink sachets for a while but only made it worse as gave her diarrhea.

Anyone any advice on how to basically re-toilet train a ten year old?

Unfortunately it needs the diarrhoea to flush out the backlog.

There was a boy in one of my classes at school who used to withhold. name-calling by pears didn’t help. it was only when he got a girlfriend overnight it stopped.
what’s her sense of smell like?

The best advice ever OP.. Definitely worth digesting that info.

Our bodies are complex it seems and we often take so much for granted re: it's day to day function.

Just to add, thinking about it, we have a fair few young people at school, who often struggle with toilet habits, so don't rule out some kind of neuro/ sensory issue there.

Nurse here. If she was constipated before or is holding her stools the bowel can be stretched and after a while they stop being able to feel when there's poo waiting. She may also be scared to poo if it's hurt before. She's not doing this deliberately. As people have suggested GP referral to continence team. Blaming her with not help in any way infact it will probably make her more fearful and resistant. Please ignore those advising punishments.

But that’s isn’t what op said. She was at a party of her peers and op could tell by body language she was wanting to go, had to take her by the hand and take her to the loo.
If she is showing signs of needing to go but doesn’t take herself off to the toilet then it’s something else going on.

Just that your idea that children do not choose to do this is entirely wrong. I’ve met more than one child who has chosen to do it - they got a sensory pleasure. Not saying at all this is happening with original O P.

@commonsense61
Like I said she says she didn't think she needed to go or that she 'forgot' to go. She doesn't use the toilet anywhere

The diarrhoea is inevitable. And necessary.

Hi OP,

I am a psychologist and work regularly with my colleagues in a continence clinic. I think given your child’s age you should see your GP again to ask for onward referral.

In the first instance medical causes need to be ruled out. It is unusual for a 10y/o to still have problems. It is possible your child is extremely constipated (which can cause overflow or upset stomach when using things like movicol). Some children also don’t develop a hormonal response which alerts them that they need to use the bathroom. There may be another medical reason. If this is ruled out you would be thinking more about your child’s developmental stage and whether they may have some other underlying difficulties which would include neurodiversity. In the absence of any other indicators for this that feels very unlikely, although it is more difficult to see with younger girls. Having said that we (and schools ect) are much better at picking up on that in the past couple of years.

If both of these things have been ruled out (or even if your child is neurodiverse) you would be looking more psychologically or behaviourally at the problem. There doesn’t need to be trauma, although if there was you may well not know about it. Sometimes there is a reason why children want to continue to do a behaviour, even if it is a negative one- it may benefit her in some way. I’ve worked with young people who were keeping their family from separation by continuing with continence issues- it was pulling her parents together to work with each other. I’ve also seen youngsters who get a little bit stuck in a younger developmental stage (toileting) if there has been adversity Such as parental separation around the age when they were learning their toileting.

I don’t know how you are responding to this now. Whatever the reason I would caution against shaming or becoming angry as much as possible, that is a reflection of your emotional response as opposed to a helpful way to support her through a problem. I would advise a consistent plan of response between home and school, very close monitoring and filling in some ABC charts every time it happens over a number of weeks to look for patterns and a real push with your GP for further investigations. ERIC is the best resource on the internet.

You need specialist support. This is not an annoying habit like not brushing her teeth, or something you can address through usual parenting techniques of encouragement and sanction. It's an unusual and life impacting problem, all the more concerning due to its lack of physical cause, that must be addressed with specialist support. Go back to your GP as many times as necessary until you recieve an appropriate referral, or if its within your means go privately.

@Psyc2366
Thanks. In your opinion is it OK to make her sit on the loo for a while to try to avoid the accidents or should I just leave it totally up to her for now?

@Todaywasbetter Maybe OP's DD IS choosing to do it, who knows. Bodies and brain are complicated, but what is important, is that the behaviour is dealt with appropriately and effectively.

That sounds very difficult for everyone in the family! If it’s within your means, you might want to consider taking her to a child psychotherapist. It sounds like there is something that needs to be worked through.

Have you kept a diary to see if there is any pattern to the soiling? Record time of day, what she was doing before, during and after each BM and whether she made it to the toilet independently, with direction or whether it was an accident. I’d also use the Bristol stool chart to record the type of BM passed, Sometimes when you see things written down there can be a pattern you miss in the moment and it could also help to anticipate the most likely times of day or activities that lead to soiling and try and put a toilet routine in place at those times to see if it may help. Having a detailed record will hopefully also help in terms of getting referrals from your GP.

I would probably keep a food diary alongside as well just in case it’s related to her diet in some way.

Laxido is an option, it's very gentle.

My son had a very mild version of this - he'd hang on and hang on and often end up with skid marks. He goes ok now. It was very odd but it was never bad enough to go to the GP about. He wasn't easy to toilet train though.

Another vote for the ERIC website too.

The fact this has come from nowhere is very odd. Is there anything different like a TV programme she gets particularly engrossed in? I think some kids, boys in particular, get so involved in gaming that they don't want to go. Getting engrossed at a birthday party would relate to this too.

I did use to tell my son to go and sit on the loo if I'd noticed he'd not been for a day or two. He usually went then. So yes I think sending her to sit on the loo at certain times in the day is a good idea - her body might get used to going at a certain time.

Sorry I haven’t read through the full thread but I just wanted to ask - does she often tell you when she is feeling anything else? Does she express hunger? Tiredness? Pain?

is she able to communicate this articulately?

look up alexithymia - aka emotional blindness. This has recently been flagged to me as part of an ASD diagnosis for my 10yo.

she is ok with toileting (in that she never has any accidents) but often has to run at the last minute as she hasn’t noticed / felt the signs until almost too late. We only really noticed this when alexithymia was highlighted to us by the psychologist. It transpired that my daughter doesn’t feel hunger and I never noticed that she has never told me she is hungry. Seems incredible to believe but when you have a child eating three meals regularly and accepting food and snacks when offered, it never really becomes a problem. Likewise doesn’t seem to really feel pain but we’ve always just thought she was ‘brave’ for not crying when hurt.

anyway, there’s obviously a lot more to it, but worth looking it up as this potentially could be something which affects your child.

I'm sorry if it's upsetting you to hear this, but you need to consider sexual abuse. If I were you, I would make an appointment with the GP, initially see him/her without your dd present (they would be unlikely to do any kind of physical examination at an initial appointment in any case, so there's no real need for her to be there). Explain the exact problem (how often it is happening, how heavy & what type the soiling is, the circumstances around it - timing, watching TV etc.) and ask for it to be dealt with simultaneously as a potential physical or potential psychological issue, with referrals for both.

In the meantime, try to observe your daughter to see whether there are any other signs of abuse, and talk to her alone to remind her that she can always trust you if there's anything that's upsetting her. Go over the messaging about not keeping secrets, even if another adult has told you that you musn't tell. Even if it's nothing to do with abuse, it never hurts to have that chat at regular intervals.

I’m not convinced it’s constipation. My son once had very bad constipation (screaming in agony and he’s not a complainer or drama queen). He was put on Movicol and it just started to help it come out. Soft but controllable. If your daughter is doing poos, just not in the toilet, I would suspect it’s totally unrelated. I‘M not a medical professional though!

If it coincided with your other child being toilet trained (sorry if I’ve misunderstood timing) could it be something to do with attention seeking or challenges at school making her want to regress?

In your shoes I’d make a plan and give it a time limit, say a month.
Take her to the loo after every meal and before bed. On school days after meals at home, when she gets in from school, and before bed. No rewards , no punishments it’s just a routine. Then you’ve done all you can without professional help.
If after a month things are no better then you go back to GP and ask for referral to incontinence clinic and a psychologist. If whichever you get to first resolves the issue then you can cancel the second.

have you looked at the ERIC website? This is pretty common with children who are constipated and the poo that is happening accidentally in pants is overflow that they cannot control. I’d take her to the GP, call the ERIC helpline and plan a disimpaction.

It can be a sign of a safeguarding issue, not to worry you. It must be very stressful for everyone involved

I would give prompts at set intervals but I would avoid it turning in to a massive or aversive thing. If she’s finding it too much and getting upset by it at all I would take that as a cue that I need to reduce the demands and focus my energy on working out what is causing it as opposed to stopping it from happening for now.

I noticed that this has only started recently. I wonder whether something has triggered it but you’d need to see someone to think about what that could be. Psychology wouldn’t accept a referral unless an underlying medical cause had been ruled out so that is the first step.

Im also thinking about how this feels for your child and how you are speaking about ‘the poo’ with them. Sometimes with things that are more shameful to talk about it can be helpful to separate the problem from your child in order to talk about it. An example of this would be using crafts/ recycling to make a giant ‘sneaky poo’ and start by talking about the sneaky poo, that it lives in everyone’s tummy and pops out sometimes but sometimes he wants to hide too. You could play hiding games with the poo. After a while you could talk about how everyone has a sneaky poo and talk more about your own sneaky poo, asking your child about theirs too. It might help you to understand what sense your child is making of it all- you can get a lot of information from things like this- how the sneaky poo makes her feel/ when he comes out to play/ if he is annoying/ how does he tell her he’s there. You would need to model this chat to your child by talking about your own sneaky poo/ the rest of the family at home too. If you saw a psychologist they might be doing some similar activities with you and your child.

I'd do this tbh. If you are certain she can control it.