Posted tagged ‘constipation’

Grunting Baby Syndrome – A whole lot of show for very little poop

April 21, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

Lemelon wrote in:

“Grunting Baby Syndrome. Is this really a thing? My 6 week old son grunts, strains and writhes from ~approximately 3-6am every night. Most of the time he sleeps through it. My GP suspects reflux but ranitidine has not helped. Also, he’s very happy/calm all day rarely fusses or cries. My google searching came across Grunting Baby Syndrome. Is that a real thing? When do babies grow out of it on average?”

One of the fun things about writing this blog are good questions, or questions about things I had never heard of before. And, yes, Grunting Baby Syndrome is a real “thing”, and something I’ve talked with parents about for years. I’d just never heard this name for it. I think the name is mostly used in the UK (most of the sites I found referring to it come from across the pond), but it seems to be catching on here. Whatever you call it, it’s one of those things that makes sense with a little explanation.

Anyone who’s had a newborn knows that poop doesn’t always come easily. There’s often a big show, with grunting and a red face, and sometimes crying (this is the baby we’re talking about, here. Not dad. I think.) But the poo itself isn’t hard or even firm – it’s normal, ordinary baby poo, soft as applesauce or weird yellow pudding. So why the big show? Why all the grunting?

Two reasons, I think. One is that it’s genuinely difficult to have a bowel movement while lying on your back. Go ahead, try it yourself. We’ll wait here.

See? With nothing to push your feet against, it just doesn’t work. I’ll bet you were pushing and grunting and your face turned red too. Perhaps your behavior was puzzling to your spouse, who chased you out of the bedroom with a broom. You should probably go back and explain, later.

But there’s a second reason for the grunting. Have you ever thought about the steps you’re taking to poop? You need to tighten up your abdominal muscles to push, while simultaneously relaxing your pelvic floor and anus. Tricky! It’s like patting your head while rubbing your stomach – another trick that newborns can’t do well. Tightening one set of muscles while relaxing another isn’t easy. You can tell a baby’s having trouble coordinating this if you pat their bottoms while they’re grunting. Their little buns are squeezed together, all tense. It’s no wonder the poop can’t come out! And it’s no wonder that when it eventually does, it’s a noisy explosion that startles Junior and parents alike.

So: what should parents do? Relax. Don’t get anxious – that will not help your baby get through this. Gently bicycle his little legs, and hold him, and help him relax. When gas passes, and it will, make a little joke. “You sound like Daddy!” would be appropriate, or “Here comes Grandma!” if she’s not in the room. A bad thing to do is to get wrapped up in the drama, and add more worry. If it’s at night, and the grunting is keeping you awake, turn down the baby monitor. The poop will come, I promise.

This isn’t constipation, which requires hard stools. Giving a stool softener won’t work, and neither will changing formulas (though it will get you off the phone with your pediatrician’s office. I probably shouldn’t have told you that.) Rectal stimulation with a thermometer will work, but only in the short run—that won’t help Junior figure this out himself, which is the only long term solution.

If you’re worried that your child just cannot pass stools, talk with your child’s doc. There are some rare conditions that prevent poopage. But the vast majority of grunting, red-faced babies have this “Grunting Baby Syndrome”, which is another thing you don’t have to worry about.

Monica Seles

When a child refuses to poop

September 18, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Michelle wrote in: “We trained my 3 year old son approximately 3 months ago, and it’s been great. He’s been having virtually no accidents. The problem is that he’s terrified of making ‘dirty’ on the toilet. He does it in his pamper at night when he’s sleeping. He’s very verbal about it, and tells me that he’s scared to let the dirty come out. It’s really difficult to deal with because there are days when he holds it in all day, and misbehaves all day because he’s in pain. All of my friends tell me to give him laxatives to make him go, but my pediatrician recommended against it because he said he doesn’t want to mess with his muscles, and he’ll get over it eventually. I trust my pediatrician completely, but I wanted to hear your thoughts.”

Here are three parenting truisms: you can’t make kids eat, you can’t make kids sleep, and you can’t make kids poop. So issues around eating, sleeping, and the potty are often the biggest parenting challenges, a least for younger children. Parents wish they had a way to “fix” these issues, or “make” their child do what they know their child needs to do. It can be frustrating, but raising children doesn’t always work like that. Children really do have ultimate control over their own eating, sleeping, and pooping. Why do children sometimes hold their stool? Sigmund Freud felt that stool holding was part of the anal psychosexual stage, and that a children who rebelled against potty training would develop anal-retentive personalities. He also thought that boys in particular had a fear of castration, and that stool looked like a little penis, so boys didn’t want to even symbolically lose their little penises into a toilet. Fascinating stuff, Freud—though it’s worth remembering that his specific analytic theories were just about 100% wrong, even though he deserves credit for figuring out that experiences and subconscious thought affected our outward behavior. In other words, I doubt Michelle’s son is holding his stool because he’s afraid his penis is falling off, but I do believe that his fear could be related to other experiences he’s having a difficult time articulating.

Freud’s theories aside, I think the most common reasons for kids to hold their stool are more ordinary: (1) they like being in control; and (2) stools sometimes hurt. Whatever the initial cause, stool holding inevitably leads to larger, more-painful stools, which makes the child try even harder to hold the stool. I’ve called this the “constipation death spiral.” Fixing stool holding means interrupting the cycle of holding leading to pain leading to more holding.

One thing you can try that will not work: talking. I’m not saying you shouldn’t talk about this with your child, but honestly, once your child learns it hurts to poop, you’re not going to be able to talk him out of it. Sure, you’d love to crawl into his little brain and say “Relax, honey. If you let the poop out it will feel better and you’ll be OK.” Good luck with that. Instead, try all of these methods, all at the same time:

Don’t make passing stool any more uncomfortable than it already is. Don’t try to force it, and don’t punish any behavior that’s involved with stool. Don’t belittle the child or insult him. Avoid saying things like “don’t act like a baby” or “you’re making me mad.” Don’t show even with body language that you’re disappointed or upset, even after a stool accident—all of that just feels negative to the child, and will reinforce a holding habit.

Please, please don’t rely on enemas or suppositories. Maybe once every ten years I’ve suggested one of these, and I’ve usually regretted it afterwards. Almost all constipation and holding, no matter how bad, can be managed without sticking things into your child’s bottom. Believe me, once you start wresting with things down there, it will only get worse.

Make stools more comfortable by using an oral, daily stool softener. You can get exact doses and instructions from your pediatrician. The key here is to use a consistent daily dose to keep stools soft and painless, and to not stop using the stool softener until all memories of the painful stools have disappeared. This usually requires months of therapy. That may sound discouraging, but it’s much better than going on and off medications for years. The main medication you’ll use will be a softening agent only, though sometimes we have to add a laxative to get the bowel squeezing. Again, rely on your own child’s pediatrician for specific advice here.

Michelle mentioned a concern that medications might change the muscles of the bowel. While it’s true that with long term use some laxatives (including Exlax and Senokot) can cause changes in muscle functioning, the stool softeners (like Miralax) are not addictive in any way, and don’t permanently change anything. They just make stool softer. In fact, by relieving the pressure of a big retained mass of stool, softeners allow the muscle wall of the colon to return to normal. No one should be afraid of using these sorts of agents to help their child.

Encourage healthy eating, though don’t harp on it or make it a big deal. More fruits and vegetables, and drinking more water, can help. More dairy can make things worse. But, again, don’t harp on diet or punish your child because of food issues. That will lead to even bigger problems. You will not solve a holding habit by changing diet alone.

Set aside a “potty time” every day for Junior to go sit on the pot, to wait to see what happens. A good time for this is right after dinner. Don’t let Junior just sit there a few seconds and have a little tiny BM—encourage him to sit a long time, read a story, or play with your phone (I think some Samsung phones are water resistant!) Do whatever keeps him happy. This should not come across as a punishment. The idea here is to stop relying on whether Junior says he does or doesn’t have to “go”—just tell him it’s time to go, once a day. And don’t rush.

One final idea: add some fun with something called “The Poopy Party”. (Works best for boys over age 3)

By the way, as with many of my posts, all of this applies to ordinary, healthy, neurologically typical children. If your child has GI problems or developmental challenges, other approaches might be more appropriate. Please talk with the doctors who know your child best.

With time and patience, stool holding will stop. The approach needs to be gentle, non-judgmental, and consistent—and even with that, it takes time to develop new habits. Good luck, Michelle, and let us know how it goes!

Can’t feel his poops

April 11, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

Kathy wrote in about her son: “What can cause a nine year old boy to poop in his pants occasionally and not feel it? He was completely potty trained at age three. I have found dirty underwear, poop on the bathroom floor–and it just concerns me that he is unaware of it. It has been suggested at check ups that he may be constipated. My mother suggests he may simply not be paying attention until it’s too late and also if his bowel movements are soft (and they are) this might be part of the problem. I worry that there might be a congenital defect or the like and don’t want to overthink it, but also don’t want to ‘poo poo’ it.”

This is one of those problems that’s very, very common—as a pediatrician, I hear about this all the time—but parents don’t talk about it much among themselves. Parents sometimes think that their child is the only one who’s doing this. Believe me, he isn’t.

The name for what’s going in is encopresis, or fecal soiling. Kids with this leak soft stool, usually without noticing it at all. Very rarely, encopresis can be associated with an anatomic problem, like a serious anal malformation or spinal cord defect. But if your son is walking around and seems fine, and his pediatrician has looked at his spine and reflexes, there is no underlying anatomic or medical condition.

Encopresis is a complication of longstanding constipation. Kids hold their stool—often because it’s become hard and uncomfortable, or sometimes because they’re too busy to stop what they’re doing to have a good BM. Held-in stools become bigger and harder, and that reinforces the stool holding. Kids do not want to pass a painful stool! In time, they get so used to holding that they don’t even realize that they’re doing it. The distal colon becomes big and distended, and can hold an impressive amount of stool.

The poop, though, has to go somewhere. Eventually it will leak around the stool mass in the colon, and that’s when soiling occurs. The leaked stool is often soft—so parents may not believe us when we tell them there is constipation. Sometimes I’ll do a quick, one-view x-ray of the abdomen that shows the huge amount of stool that’s backed up.

Encopresis symptoms sometimes come and go. Some kids will eventually pass their huge backed up stool (often clogging the toilet), and then won’t leak for a few weeks. But the habits are still there, and they’ll usually get backed up again.

Treatment of encopresis begins with explaining to the parents what’s going on. Often there are some misconceptions and sometimes even some anger that that child is doing this willfully, or just doesn’t want to stop. Negative feelings and punishments never help kids with fecal soiling. If there is a lot of finger pointing, a referral to family therapy may be needed before much progress can occur to fix the encopresis.

Getting stool habits back to normal requires a comprehensive plan that everyone in the family must follow. There is no quick fix, and the longer the problem has been going on the longer it’s going to take to repair. Believe me, it is much better to face this head-on and fix it than to take halfhearted efforts that help for a little while, then back off and let the problem resurface again. The main components of therapy, in addition to family understanding, are:

  • A big clean out. Therapy will almost always start with relatively high dose stool softeners to get the old mass of stool out and let the colon return to a normal size. This is best done on the weekend!
  • Maintenance, ongoing, long term stool softeners. This is essential. Parents must keep their child’s stool soft and painless for many months or sometimes years to create a new habit. Backing off the stool softeners too early will inevitably lead to relapse and a more-difficult situation.
  • Reinforcing good stool habits. That means relaxed time on the pot, every day. Usually staying on the toilet for a set amount of time after a big meal is better than letting them go “until they’re done,” because at least at first these kids do not know when they’re done. Keep ‘em on the pot with a Game Boy or a new iPhone app. Those things are waterproof, right?

Dietary changes can also help, including more fluids and fiber. But changing diet alone will not fix the problem, and I don’t overly stress diet issues. Practically speaking, fighting with your child about bran rarely helps solve anything.

There are many good stool softeners out there that are not habit forming and can be safely taken long term. I try to stay away from enemas and suppositories unless they’re absolutely necessary. That’s a good rule of life: stay away from your child’s anus.

Encopresis can be fixed, but it takes time and consistency. Sometimes a referral to a pediatric gastroenterologist can help reinforce these instructions and help reassure parents. The most important thing: stick to the plan.

Constipation remedies

September 24, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

Li wrote: “I saw an article you posted about potential causes for excessive urination for children.  One of the mentioned problems involved constipation.  Do you have any advice on where I can find more info on ways to relieve this problem through diet?  I was told build up of old stool is the cause of my child’s urinary problems.”

Constipation is very common, and it can lead to urinary problems like frequent urination, wetting, and painful urination. It’s no fun to be constipated, and I think parents need to treat this aggressively. Untreated constipation leads to harder, even-more-painful stools, which leads to more stool holding, which leads to worsening constipation. It’s what I sometimes dramatically call the Constipation Death Spiral—it gets worse and worse until it’s treated correctly and consistently. Fortunately, all but the most severely constipated kids can be treated with a few simple steps.

What is constipation? Normal stools might be anywhere from three times a day to once every three days—so it’s not really a matter of how often kids go. It’s what it feels like. Stool that’s firm enough or large enough to be uncomfortable is a sign of constipation. If it hurts, it’s constipated. If Junior is holding it in because it hurts, that’s worse constipation. If Junior has gotten so used to holding it that he doesn’t even realize he’s full of stool that leaks sometimes, that’s really bad constipation.

Some kids with significant constipation don’t really complain of pain much. They might have an occasional belly ache (especially after eating), or might only have urinary symptoms or stool leakage.

Why is constipation so common? I believe it comes down to diet. Our guts developed through almost all of human history to digest minimally processed foods. Even people who pursue a very “healthy” diet these days are still eating in a way that dramatically different from what our ancestors ate for thousands of years. It’s not all bad—human nutrition, at least in the developed world, has never been better. For the first time in history we suffer more now from overnutrition than from undernutrition. Still, one cost of all of this abundant, easy-to-eat-and-digest food is chronic constipation.

The first rule of treating constipation is to treat it. Do what it takes to fix it, and keep it fixed, for long enough that new patterns develop and children forget that they used to be afraid of their painful stools. Often parents make half-hearted attempts for a week or so, then give up as things maybe start to improve a little. Take my word for it: if you want to get out of the constipation spiral, you need to be consistent, and you need to be in it for the long haul.

The second rule is to try to avoid relying on enemas or suppositories. Your children do not want you anywhere near their anus. Constipation can almost always be treated orally. If you’re needing to go from the back route, you ought to be doing so while working with a doctor (though, hopefully, not in the same room.)

What can you do to treat constipation? Start by setting up a time, usually after a big meal, where your child is expected to sit on the pot for a set amount of time. The bathroom break isn’t until the child thinks his business is done—it’s until a timer goes off. These kids will sometimes squeeze off a little BM and think they’re done long before they’ve emptied, so you need to reinforce a new habit of relaxing and taking one’s time. I encourage bringing a GameBoy or iPhone or book or something for distraction. Maybe a Wall Street Journal, if your child is into investment banking. Whatever it takes.

From a diet point of view, you ought to encourage more water, more fruits and vegetables, more whole grains, and less dairy. Having said that, it’s very difficult to get children to make big changes in dietary habits, and rarely do diet changes alone fix significant constipation in kids.

Almost all families struggling with constipation will need to use a stool softener of some kind. Natural ones include fruits and fruit juices rich in sorbitol, like prunes, mango, or pears. Apple juice is popular, but isn’t a very effective stool softener. Ground flaxseeds or other sources of bran or insoluble fiber can help soften stools only if the child also drinks extra water. Without extra water, bran products themselves are constipating.

The most popular medical treatment for constipation is PEG 3350, often marketed as “Miralax” or a generic equivalent. This is a white powder mixed in a drink. Once the crystals dissolve, Miralax is flavorless. It helps constipation by drawing more water into the stool. Miralax is FDA-approved only for the short-term treatment of constipation, but it’s routinely used as a long-term maintenance drug safely. Other medicines used to treat constipation include Lactulose, Senokot, and Dulcolax. If you need to use medications, you ought to get more-specific instructions from your child’s pediatrician, who can also screen for rare-but-important medical causes of constipation that might be present.

Constipation isn’t fun, and it can cause significant problems including discomfort, embarrassment, and urinary problems. Unfortunately, some kids learn early on that pooping hurts, and those kids often continue to have issues with stool holding for years. If your child is constipated, please fix it, and keep it fixed. Talk with your pediatrician for more-specific advice, and don’t give up or stop treating it until it’s fixed for good.

The Poopy Party

August 19, 2009

The Pediatric Insider

© 2009 Roy Benaroch, MD

Julie’s 3 year old son uses the potty great—at least for urine. For poop, well, he’d prefer to use a diaper. What she needs to know about is the poopy party, and how to create some fun and excitement to get her son to take that last step!

Keep in mind: there are three ironclad rules of parenting. You can’t make ‘em eat. You can’t make ‘em sleep. And you definitely can’t make ‘em poop. Kids will hold it and hold it, and will make themselves sick, if you try to force them to poop on the potty. Don’t try that. No forcing, no punishing, no humiliating, nothing at all negative is going to work if you want your child to be successful on the potty.

Fortunately, all kids inherently want to succeed and learn new things. As soon as they’re sure you’re not pushing, and they start to get an inkling that—hey, this is the way to go!—they’ll do it. For kids who are a little late to the party, here’s one way to jump-start the process.

“The Poopy Party”: A method to encourage using the potty for stool

This works best at age 3 and above, and seems more effective with boys than with girls. You’ll see why! It’s important to “ham it up” and really play with this to create a sense of fun and excitement about the potty. At no point should you be direct—never say “Don’t you want to use the potty now?” The point is to create excitement, but only to indirectly talk about what the potty is for.

You’ll need: a willing Daddy (this is manly stuff, and seems to work better mano-a-mano), two hardhats, two bright orange construction worker vests, and two big chunky flashlights. Feel free to add any other mechanical-plumber sort of equipment.

Dad puts on his outfit with hat and vest, and goes to get the child so he can put his set on. They’ve both got their own big flashlights. Dad says something like, “Something’s up with the toilet, we’ve got to get it fixed so the poop can go to The Poopy Party!”

Don’t talk more about The Poopy Party…yet. Let the excitement build!

Then go to the toilet and take it apart, or as much of it as Dad feels comfortable putting back together. Talk about the parts, the flusher, the bobber thing, the insides, and where the poop goes down. Then, if you can, go to the basement and pull down some tiles, and shine your light along the big drain pipe all the way outside the house. Go out to the street and pull off a manhole cover (or the utility cover over the water main, or just peer down a storm drain) and shine your lights down there. Then talk about The Poopy Party. Yep, that’s where the poop goes, down there. There’s dancing and singing, and it’s a great place for poop to go!

If you want to go a step further, take the child to the county wastewater treatment plant. You’ve got to keep the hardhat on. Explain there that you want to show your son where the poop goes. They’ve got big tanks and turbines and other manly things. Then go out for ice cream.

Afterwards, hang up the vest in the bathroom where he’ll see it, but – and this is very important – do NOT talk about this any more. You set the stage, make it exciting, but do not remind or suggest. Anything like that will further delay potty success.

And be prepared, once he’s using the potty, to bring the vest everywhere you go.

Holiday twofer: Bananas, constipation, and corn syrup

December 2, 2008

I’ve got two short questions in the hopper, and I’ve come up with a fairly lame segue to tie them together. So let’s see how it works out: for the first time ever, two questions answered in one blog post! It’s like getting something free for half-price!

First, Claire asked: “Dr. Roy, can a child consume too many bananas to the point it is harmful? My son is a darling toddler who refuses to eat (literally) but he loves bananas. Less than 36 hours ago I bought 13 bananas and he ate them all. He seriously consumes at least 4 or 5 bananas a day (this is with me limiting the bananas-he would eat more if I let him). Every time he sees our bananas in the pantry he freaks out and wants them. Should I be worried? He only weighs 20 pounds so it seems like so much for him to be consuming but when offer other foods he just doesn’t eat. He has always been on the tiny side so sometimes I just want to eat anything.”

I’m not worried about a mostly-banana diet. The monkeys at the zoo look pretty healthy to me.

More seriously: You could try to broaden his diet a little by offering dips or spreads. A banana might be even more yummy smeared with peanut butter or Nutella. You could cut it into little rounds and top them with cottage cheese, or make little banana and cream cheese sandwiches.

As for his overall growth, review this with your pediatrician to make sure he’s tracking along an appropriate percentage. As long as he’s growing normally, I wouldn’t worry about his calorie intake. You should though ensure he’s getting enough calcium, vitamin D, and iron—these are not found in a limited diet. A daily multivitamin is probably a good idea.

The only problem I can foresee is that a diet rich in bananas might be constipating….which brings us to the second question of the post!

A question from Brad: “What is your opinion on using Karo syrup for baby’s constipation?”

Karo is a brand of corn syrup, useful for baking pecan pies. It’s safe and tastes sweet, and is often used to treat constipation in babies. I could find only one study looking at the effectiveness of this approach, lumping in corn syrup with other dietary modifications. It found that this approach relieved constipation about 25% of the time.

Keep in mind that the stooling patterns of babies can be quite variable. At about six weeks of life, breast fed babies may start to have especially infrequent stools, maybe just once a week or even fewer. The stools continue to be soft, and the babies are thriving and happy. Because the frequency of poops is so variable, it’s best to consider constipation only present if the stools are hard and uncomfortable. Infrequent stools, as long as they’re soft, are not constipation.

If your baby is having hard stools, one reasonable step to try is corn syrup. Check with your pediatrician on the exact dosing and how to use it. Keep in mind that corn syrup and honey are not the same thing– never give raw honey to a baby less than one year of age.

Clueless little accidents

October 29, 2008

Here’s a question from AB: “Our daughter who is almost 5 years old has started a habit of wetting her pants at least once a day. She only wets a little each time and it doesn’t seem to bother her at all – she never tells us that it happened or complain about wet panties. We’ve talked to her continuously about not wetting her pants and tried all types of incentives and punishments, but nothing seems to make her stop. Could this be a medical problem? Or could it be some other behavioral issue such as an attention getter (She has a little brother who is 20 months old)? If this is only behavioral, what are your suggestions that we can use to help her stop?”

I doubt this represents a “medical” problem—she isn’t dribbling continuously or even that frequently, just once or a few times a day. And it doesn’t sound like it’s very likely to be a neurologic problem if she’s running around and otherwise acting normally. However, it would be very reasonable to see her pediatrician for a simple urine dipstick test for infections or (far, far less likely) diabetes.

What you’re describing is part of a very common problem among children called “dysfunctional voiding.” I’ve written about this before, but it comes up so often that it’s worth covering again in more detail. First, though, you should probably stop with any kind of incentive or punishment—that’s not going to get you anywhere, and may prolong the problem by making the accidents an attention-getter.

What is dysfunctional voiding?

Dysfunctional voiding is a term for an abnormal pattern of urination. The symptoms can include wetting during the daytime, urinating very frequently, rushing to the bathroom, or sometimes pain with urination. Some children who have these symptoms squat down on their heels, cross their legs or hold themselves between their legs to keep from wetting. Sometimes, children with dysfunctional voiding also start to ignore the urge to have a bowel movement.

How does dysfunctional voiding develop?

For many different reasons, children start holding their urine for a long time. They may be reluctant to stop doing fun activities for a bathroom break, or they might be embarrassed at school to ask for a hall pass. Kids who feel that the bathroom at school is dirty will sometimes hold their urine all day long! Once a child starts holding urine, the bladder wall becomes thicker and less able to empty completely. Also, children begin to lose the sensation that their bladder is filling until it almost overflows. Though dysfunctional voiding may begin in part because of habits, it does become a physical problem once the body begins these bad adaptations. Fortunately, these physical changes can be reversed by following good voiding habits.

Dysfunctional voiding with constipation

Children with dysfunctional voiding may also have constipation. When a child is constipated, the rectum may be full of hard stool and can irritate the bladder and keep it from holding as much as it should. The constipation can make the wetting problem worse. You cannot treat the problems of dysfunctional voiding unless you fix the constipation, too.

How is dysfunctional voiding treated?

The most important part of treated is regular bowel and voiding habits. These must be used together in order for this condition to be treated successfully Changing your child’s habits can take a long time. At school, children may need to be reminded to go to the bathroom.

 

Medicine

Medicine is not usually needed to help with dysfunctional voiding. Sometimes, a stool softener can help with the constipation that often accompanies dysfunctional voiding.

 

Timed voiding schedule

Your child should urinate during the daytime every 2 hours (some children may need to go more often). This schedule will help train your child to empty the bladder before it gets full and begins to leak. It’s a good idea to use a kitchen timer to go off at set intervals, so a parent doesn’t have to be the “bad guy” enforcing trips to the bathroom. Make sure that the bathroom breaks aren’t perceived as a punishment, and that any fun activity that was interrupted for a bathroom break will continue when the child comes back—and doesn’t rush!

How to urinate correctly

  • It is very important for your child to relax when urinating. Relaxing helps the bladder to empty completely.
  • Girls should remove pants or tights completely off of one leg so that they can spread their legs far apart.
  • Girls should sit way to the back of the toilet and lean forward. Alternatively, girls can sit backwards on a toilet, facing the tank.
  • While establishing good habits, boys should be encouraged to sit to urinate. This prevents rushing.
  • Breathe deeply.
  • Relax the muscles of the head, arms, body and legs.
  • Feet should be on the floor or a footstool, not dangling.
  • Imagine urine flowing (turn water on in the sink).
  • Allow plenty of time for urination. The process of relaxing to empty the bladder takes time. Plan to spend 3-5 minutes in the bathroom.
  • For younger kids, it can be especially helpful to bring a toy. An electronic game that is only used while sitting on the toilet will keep kids sitting for a long time!

Dysfunctional voiding is a common problem encountered in a pediatrician’s office. There are no expensive tests or medicines that need to be used. It’s a matter or re-training good habits. The best way to handle this is with relaxation and good humor—you can’t force it. Fortunately, children who have developed dysfunctional voiding habits can quickly reverse this problem with some gentle support and simple steps.