It’s ridiculous how many expectations and conventions exist around childbirth and parenting. But over the course of writing two books about this time of life, I’ve come to appreciate that there are some things you simply cannot anticipate: things people don’t talk about, sometimes because they are sad, sometimes uncomfortable, sometimes just plain weird. I think we should talk about them—and, more than that, we should use data to really understand them. (I’m an economist; I love data). Acknowledging the data can often relieve a lot of the pressure on parents, either by reflecting experiences that feel isolating in the moment or by presenting us with a greater range of choices than we might have thought we had. In that spirit, I have a series of pieces in Slate this week about how data helps illuminate childbirth and parenting’s most underdiscussed topics.
There are few things in pregnancy and parenting that are a complete surprise. You’ve likely been dimly aware of the possibility of, say, vaginal tearing, and you know that children walk at different times. For me, however, “STR” was not something I had ever imagined. When my daughter was an infant, I recall talking to another mom who said it casually—“Oh, everything is great, other than we are dealing with an STR issue.” I didn’t want to pry or seem like an ill-informed parent, so I looked it up later. Stool toileting refusal, i.e. STR, i.e. a situation in which an otherwise potty-trained child refuses to poop in the toilet.
STR may be little known, but there is perhaps nothing else that so encapsulates the challenges of a toddler relative to a baby. Infants are tiring—they cry a lot, they eat all the time, they don’t sleep—but they are easy to manipulate. Most of the time, they do not actively resist you. Parenting them is a bit like being the dictator of a small, poorly functioning country. Not so with a toddler. Before I had children, I never dreamed I’d start preparing to leave the house 15 minutes before it was necessary, just to leave time for the inevitable fight over the horror of socks. Welcome to toddlerdom. Along with choices about discipline and early education, the great question of these years is potty training. When you come to potty training, you will likely run up against the stubborn resistance for which toddlers are so celebrated. Enter STR, a common battleground for toddler self-determination.
Despite the fact that people without children have probably never heard of this, it is quite common. You can see this in anecdote—I mentioned writing this piece at a friend’s house for dinner recently (I’m a great guest), and they told me, “Oh, of course. But doesn’t that happen to everyone?” But we do not need my dinner party friends; we can rely on data.
Consider one study, run in a suburban pediatric practice, that enrolled 482 children before potty training and followed them through their potty training adventures. One hundred and six of the children, or almost a quarter of them, had some degree of stool toileting refusal, which the authors here defined as peeing in the toilet but not pooping for at least a period of one month.
The exact mechanics differed across kids in this study. In most cases, it seems the children would wait for a time they were wearing a diaper—for example, during a nap or in the middle of the night—and then poop in the diaper. In some cases, they would, as the authors politely put it, “soil their underwear.” This all sounds fairly remote until you are the one scraping poop out of the seams of Finding Nemo underpants.
Adults may wonder why on earth this behavior happens. Certainly older children and adults do not long for the days of pooping in a diaper, so why is it so appealing to some toddlers? The answer is we do not really know. Some kids seem to find the idea of something dropping away from their body uncomfortable and weird, or even scary. Some argue that in a world almost wholly out of their control, pooping is a small area toddlers can have some agency over.
Even little kids have a lot of control over bowel movements. If they want to hold it, sometimes they can really hold it. Second, even if they are not trying to hold it, most kids do not poop more than once a day. This means that if you’re trying to (say) potty train your child using a three-day method or similar, you’ll get just three tries at this pretty essential life skill. If you miss the window and they have an accident, you do not get to try again 15 minutes later.
Also, stool withholding can actually be unhealthy, and parents rightly worry about it. The main issue is that withholding poop can cause constipation. This can lead to painful bowel movements, when they finally arrive, which further exacerbates the problem. Now the child associates using the toilet with pain and really doesn’t want to do it. Chronic constipation can also lead to problems with urination if it rises to an extreme level. It’s also just flat out scary. If your child is resistant to the point where they’ve gone three or four days without pooping, they’ll be very uncomfortable, and you may start to worry they could do real damage.
So, if you find yourself experiencing this particular wonder of parenting, is there anything you can do? The answer is that we do not know much. There is some work studying how to address this issue in older children—stool withholding is also a common issue in school-age children, so that’s something to look forward to—but virtually nothing systematic in younger ages.
One study of 400 children, published in 2003, showed that the length of refusal (i.e., the number of months this goes on) decreased with a child-oriented intervention where, among other things, parents made a big deal about the child pooping in the diaper before potty training started. This means saying things like, “Wow! You pooped! That’s so great!” and so on. The kids in this treatment were no less likely to have the problem at all, but it lasted for less time.
A common piece of advice to address this issue is that the child be given a diaper to poop in, perhaps in the bathroom. Although it may seem like a step backward, the theory is that it lowers the chance of constipation and subsequent negative feedback. There is not much evidence on this in either direction. In the first study I talked about above—the one that aimed to document how common this problem was—the authors report that putting children back in diapers temporarily worked for some kids, and most were trained within three months after that. But the truth is that, with time, pretty much everyone uses the toilet, and without a control group, it is difficult to learn much.
This last point is perhaps the most important of all. Like many experiences of early parenting, this too shall pass. It might take a month—honestly, it might take six—and in the moment, it will be frustrating (trust me, I know). But eventually your child will poop in the toilet. And you can move on to other worries.
By Emily Oster. Penguin Press.
Adapted from Cribsheet: A Data-Driven Guide to Better, More Relaxed Parenting, From Birth to Preschool by Emily Oster. By arrangement of Penguin Press, part of the Penguin Random House company. Copyright (c) 2019 by Emily Oster.
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