Make Your Son Do The Dirty Work

Q. Our bright, well-adjusted 4-year-old son has a full bowel movement in his underwear four or five times a week. He knows how to use the toilet and is not, like some children, afraid to use the toilet. Nor, according to his pediatrician, does he have a physical problem. He’s just lazy. We’ve tried everything we know to try, from rewards to taking away special activities, but nothing has worked for long. Do you have any suggestions, including ideas as to what might be bothering him?

A. At this distance, I’m able to offer no idea as to what might be bothering your son, if anything. Why some otherwise well-adjusted children soil themselves well beyond toddlerhood is a mystery. Psychological theories, of course, abound, all amounting to educated guesses. My experience has been that it usually is a behavior problem, as opposed to one that’s emotional. In other words, there’s nothing wrong with the child in question.

To reinforce what you’ve already done, any child who has passed his/her third birthday and has demonstrated bowel competence but who continues to soil himself/herself should be evaluated by a pediatrician or family practitioner. Certain physical dysfunctions — most notably one known as Hershspring’s disease — can cause diminished bowel control.

Once the possibility of a physical cause has been eliminated, one is left with the mystery: What could possibly be driving such obviously self-defeating behavior?

In the absence of outstanding family pathology, my general explanation/finding unfolds as follows: The parents waited too long to toilet train. By the time they initiated training, the child was perfectly content with messy diapers. The child’s failure to “catch on” caused the parents’ anxiety level to rise. They began making a big, big deal of using the toilet. The child, being a typically obstinate human being, became less and less cooperative as the parents slowly lost their cool.

My most successful “treatment” involved making sure the child became bothered — and big time! — by his laziness. Keep in mind you can’t make a child use the toilet. You can, however, make the “cost” of not using the toilet so great that the child doesn’t want to pay it.

Buy a large-diameter bucket or galvanized tub. Show your son how to wash stains out of his own clothing. If you still have him in diapers or those rip-offs known as “pull ups,” inform him that he will not longer wear anything but “big boy” underwear and that you will no longer, ever again, ask him if he has to use the toilet.

From that point on, every time he messes his pants, his life stops. As soon as you discover his lapse, he must proceed to wash and rinse his soiled clothing until it’s free of stain and smell. Then he takes either a bath or a shower, cleaning himself thoroughly. (You are not to stand over him while he performs these tasks. You simply approve or disapprove of the outcome. In the latter case, he must try again.)

Once clean and smelling as fresh as a flower, he gets in his pajamas, spends the remainder of the day in his room (yes, even if the “accident” occurs at 9 o’clock in the morning) and goes to bed immediately after supper.

Parents who’ve followed the above plan — consistently and dispassionately — have never reported to me anything other than success. Don’t expect miracles, but if you’re willing to make your child harmlessly miserable every time he has one of his lazy spells, this should — if history does indeed repeat itself — be history within a few weeks.