Early Childhood Today - Ask The Experts: A Four-Year-Old Who Won’t Potty Train

Question: There is a four year old girl who had been in my class and who refuses to use the potty. She has multiple accidents daily, but doesn’t seem to care about that, so she was just recently put back down to a lower class. The mom is frustrated and doesn’t know what to do. An ultrasound revealed no medical explanation. I feel bad that the child is not getting the learning opportunity she needs; but how can I teach a classroom of 10-12 while dealing with her potty issues?

Adele Brodkin: I agree that this is a situation that requires help outside of school. The pediatrician’s role doesn’t end with a negative ultrasound. The chances are this is a behavioral issue, not an anatomical one. It is my (anecdotal only) impression that there may be a comfortable window for toilet training that often ends at four. Many children who are not trained by then get locked in an unfortunate power struggle. Eventually, they come around, but put up a big fight, some even endure an impacted bowel. Make it clear to the Mom that this is no one’s fault, but the pediatrician should be guiding her. If the doctor feels it is over his or her head, a referral to a mental health professional who specializes in working with young children is in order, perhaps even an early childhood mental health team. A more complete inquiry of both possible medical and psychosocial origins of the problem is in order. Did the mother just recently give birth to baby twins? That could do it!

The school has a right to limit registration to kids of 4 who are 90% trained (Any youngster can have an occasional accident). Since it is now the end of the school year, you might give the parents an ultimatum: the child’s return to school in the fall is contingent on her being potty trained.