Because there is no "Operator's Manual" for raising your individual child, sometimes a parent has to do some detective work.
This is a difficult post to write, not only because my first draft had me reliving all of the challenging events that might have delayed potty training for my daughter. Ultimately, I don't really like to share my daughter's personal information with the world. In fact, I don't even use her real name when I talk of her anywhere online, whether it is Facebook or my blog. Still, if there is a chance that my experience will help other kids and parents, I feel compelled to share.
My daughter, AJ, still poops and sometimes pees in her pants. At the age of four, I could no longer just call her problem delayed potty training. She had recently started full time daycare and had been pooping her pants several times a week. The thing is, she had really never successfully potty trained. The accidents made it difficult to go to church, shopping or even the zoo. When she was home, she usually pooped large amounts in the potty with ease. I often had to encourage her to use the potty, but she sometimes went on her own, especially if she was wearing a dress or skirt without panties. Though potty training was progressing, she was having increasingly frequent accidents at school and whenever we left the house. On top of this, she often didn't seem to even know or care that she had poop in her pants. She would come home from daycare or her father's house with a red bottom and crusted poop all over.
Seeing a Gastroenterologist
At age four, I took AJ to see a gastroenterologist. He examined her briefly and diagnosed encopresis. Encopresis is a fancy word for soiling. Now I had a name for the symptom. The doctor told me that it occurs when a child has a hard stool that is painful and then starts refusing to use the potty. This withholding results in harder stools and more constipation, which eventually leaks out to cause soiling. The description didn't seem to fit my daughter at all. Her stools were never hard. She pooped easily at least once a day and often more than once. I told the doctor this, but he dismissed it. He said that encopresis is always caused by constipation and the only treatment is laxatives. He said that if she was going poop every day, it was just overspill that was leaking around blocked poop. He prescribed laxatives, including a clean-out procedure that used huge doses of laxatives to remove the blockage. He also suggested regular times to sit on the potty throughout the day. I didn't want to give my daughter synthetic laxatives, but the doctor refused to work with me unless I did the treatment.
Still, I complied with the treatment. I was willing to try anything at that point. I also read some more about encopresis. From my research, I learned that sometimes kids will withhold stool because they are afraid of painful stools. Other kids withhold out of a desire for control. Certainly my daughter, who has experienced the pain of divorce, a father with mental illness and the death of a baby brother would have plenty of reasons to try to control something in her life by holding her poop. Still, I couldn't find any descriptions that exactly matched her behavior.
I wanted to follow the doctor's advice to have her sit on the potty after every meal. If it was a control issue, wouldn't my forcing her to sit three times a day make things worse? I set aside three days at home to give her the suggested high doses of laxatives. The "clean-out" did not produce any impacted stool and did not improve her soiling the rest of the week. I also gave her the prescribed daily dose of laxative, which produced very loose stools and even more frequent accidents. I tried for a few months to regulate her stool consistency with laxatives. I finally got tired of constantly washing poopy pants. AJ and I were both miserable with the prescribed treatment. We saw a naturopath who helped us with food sensitivities and suggested ways to manage her stress and anxiety.
In the past two years I've tried rewards. I've tried punishments. I've tried being more involved. I've tried backing off and letting her do what she will do. I've tried making her clean her own messes. I've tried a regular schedule. I've tried sending her to a private school with private potties. I've tried keeping her home with me. I've removed allergens from her diet. I've tried both increased and decreased fruit, fiber and probiotics. Interestingly, forcing her to sit on the potty three times a day produced the best results. She responds well to any kind of structure and regular schedule. Still, she was having several accidents a week.
Recently, I went back to the gastroenterology department. We saw a much more respectful provider. She took the time to get to know us and thoroughly examine AJ. AJ even produced a successful poop in the potty while we were there. Ultimately, however, this practitioner also suggested laxatives. She hypothesized that AJ is really good at withholding and doesn't empty her bowels completely when she does use the potty. As I was describing AJ, I mentioned that she has an unusually sensitive scalp. The specialist looked at me funny and commented that a sensitive scalp wouldn't be related.
Finding A Different Answer - Sensory Processing Disorder
Though the experience was not as traumatic as my first gastroenterology experience, it left me wanting more answers. Luckily I found the book Cure Your Child With Food by Kelly Dorfman, MS, LND. This valuable book offers dietary solutions for a wide range of childhood disorders. The first time I paged through the book, I didn't find anything about soiling. I found another description of constipation that didn't seem to apply to AJ. I also found good reasons to avoid laxatives and wean your child off them. I found some descriptions in other chapters that seemed to fit my daughter better, such as being overly anxious and sleepless. I thought about how hard it has always been to get AJ to sleep, even when she was a newborn and should have been getting lots of sleep. In fact, it wasn't until recently that AJ finally learned to go to sleep on her own. I have to say that it is still not an easy transition for her.
It was her sensitivity to chemicals and food colors, however, that prompted me to read the chapter about "The Overly Sensitive Child." Here was a description of my daughter! Apparently most children can fall asleep on their own after about a year and most children are potty trained after three years, but some children have difficulty with sensory processing. These kids may also have speech issues (I've been meaning to get her to a speech therapist), over-reacting to minor things (AJ cried for an hour when she dropped a penny between the floorboards), under-reacting to pain (I only found out about a major ear infection because she woke up a lot during the night) and anxiety (asking the same questions over and over).
Sensory Processing Disorder is a little understood and much debated condition that affects untold numbers of children and adults. The name of the condition rang a bell for me right away because it is one condition that AJ's father will admit to having. After all these years, I'm finally piecing together my daughter's puzzle and coming to a better understanding that will ultimately help me to help her. I think it's very possible that she inherited the condition from her father. I recently read The Mood Cure by Julia Ross, which describes the ways that we can inherit neurotransmitter deficiencies and other brain-related issues. The book also explains how stress can further deplete people who have inherited tendencies. My girl has unfortunately had her share of stress, though life has become much more fun and less stressful in the last year.
Is it Helpful to Have a Name for the Behaviors?
As I examine the behavioral and nutritional protocols that help children with SPD, I can't help but wonder if I have only found another diagnosis that describes a symptom without getting to the bottom of the problem. It's not an easy answer or a diagnosis that allows us to just pop a specific pill. Unlike the name encopresis, SPD includes a huge variety of seemingly unrelated symptoms. The only way to really diagnose it is to look at your child in a holistic way. You have to see that there can be a connection between an oversensitive scalp and toileting difficulties. There is a connection between over-reacting to minor incidents and having trouble falling asleep. There is a connection between picky eating and chewing on non-food items. With this holistic perspective, you can start to understand your child's unique needs. You can also stop blaming yourself or your child for a variety of challenges. This may help you to start the healing process and the process of adaptation that is required to live with special needs.
Since I began to look at the toileting issues as mild Sensory Processing Disorder, I have become more compassionate as a parent. I've given AJ a more regular schedule and gentle encouragements to use the potty when the need is obvious. AJ's counselor suggested the book The Out of Sync Child by Carol Stock Kranowitz. I've only just begun reading the book, but it has already helped me pinpoint some of my girl's specific sensory processing issues and how to help her manage them. I've learned that wheat and dairy allergies are common in children with SPD. I've even gained some understanding of her need to always have something in her mouth, be it fingers, hair or even clothing. Instead of constantly nagging her to stop chewing on non-food items, I am planning to make or purchase a necklace specifically for oral stimulation.
In addition to the schedule and behavioral adaptations, I've started to implement the nutritional recommendations in Cure Your Child With Food. I suggest finding a practitioner who is familiar with dietary supplements. This could be a nutritionist, naturopath or even a chiropractor. Fortunately, though my girl is picky about much of her food - especially with regard to texture and temperature, she will beg for and devour fish oil. Kelly Dorfman, author of Cure Your Child With Food says that some children with SPD crave these good fats because their brains need them so much. Other kids are so caught up in a cycle of picky eating and empty calories that you will have to be a good "food whisperer" in order to gradually make the dietary changes that are so important to help a child grow and heal his or her sensory processing abilities.
I am excited to report that after only three weeks of the above-mentioned changes, AJ is down to only one or two potty accidents a week. This is a huge improvement from one or two per day. She is also playing better by herself. She seems to absolutely crave playing for hours with her tiny dolls and animal toys. She is still having melt downs over minor issues and transitions. I'm learning that we need to give her consequences for bad behavior only after she has recovered from an emotional meltdown. Consequences and time outs at the peak of her meltdown seem to only escalate her behavior.
As a parent, I'm starting to recognize and understand that my intelligent and high functioning child has some minor special needs. My bedside table is piled high with books that I must find time to read. Each of these books contains some insight and suggestions that will resonate with my own situation. Nobody has written the specific operator's manual to parenting AJ. Instead I must be her detective, advocate and scientist.
I have been lucky to see benefits quickly as the puzzle pieces start to fall together. Ideally SPD is discovered at an earlier age when the brain is even more able to grow and heal quickly. I have to forgive the things that I didn't know back then and start where we are. My hope is to help AJ be a happy, well-adjusted child who is able to independently use the potty. I remind myself that two years ago I thought that she would never fall asleep on her own. Now she falls asleep with soft music and a sheet tucked tightly around her. SPD doesn't mean that she will poop in her pants forever. It simply means that she is slower to learn to recognize and interpret her body's signals. I can help her by providing healthy foods and brain-nourishing fats, a regular schedule and gentle coaching. Before I discovered SPD, my daughter and I were often at odds. Now, with this new understanding, we are a team working together for a common goal.
Stephanie Aegerter is a wife, farmer's market manager and mother. She has a six-year-old daughter here on Earth and a baby boy in Heaven. She writes at Stephafriendly Foods, where food is just part of the journey. stephafriendly.wordpress.com. She is studying to be a Health Coach at the Institute for Integrative Nutrition.