Case study - toilet training 4 yr old

4 yr old boy who has never done poos in toilet (identical twin brother toilet trained ok):

• Recently experienced severe constipation that required osmolax cleanout

• Usually soils small sticky blobs in undies in varying amounts each day

• Hates being made to sit on toilet

• Usually go quiet and often hides behind a couch or under a table when passing a stool

• Anxious personality and loves routine

• Good understanding and use of language and seems to have above average intelligence

Treatment 

• Seen 5x in therapy

• Advice given about correct dosage of stimulant laxatives in addition to osmolax

• Additional information provided to mother about behavioural management

• Education regarding digestive system provided to parent and child to help reduce anxiety

Outcome

• Able to take self to toilet independently

• No soiling

• Laxatives to be continued as necessary to prevent constipation recurring

• Cooperative when made to go to toilet

• Anxiety greatly reduced and calm and confident