Anyone BTDT-Behavioral Psyhcologist?

[Twoboos]

Has anyone had their DC see a Behavioral Psychologist for any type of issues?

ETA: DD1 is 3yrs 3mos

Our situation -DD1 has not pooped on the toilet in 4 mos. She had a bad round of constipation and that was it, even though she was basially fully PT'd before that. We have worked back up to her pooping in a diaper, mostly in the bathroom. (A huge improvement from her pooping in her underwear, anywhere in the house.) I have been trying to get her to go in the dipe while sitting on the potty. A big-crying-fit-no-go. We have incentives galore, but nothing is really motivating her.

I am seriously considering a BehPsych for her, at her GI dr's recommendation. Just wanted to see if it's worth it? Or if I should hang on and see if she gets there herself.

thanks for any thoughts...

[Momof3Labs]

How old is she?

[cchavez]

Could you see if there is a "potty training" expert in your area before you try the psychologist? That being said, I may consider seeing one for my son....My son has Sensory Integration Dysfunction and has never pooped in the potty. He only pees in familiar pottys. We are currently working on a plan to get him to pee in unfamiliar pottys. Our occupational therapist helped us devise this plan. I think with patience and persistance, it will work. We then will tackle the pooping in the potty issue after he gets comfortable w/ peeing in unfamiliar bathrooms.

We just started working with a psychologist for my son's feeding issues...he is very picky. The psychologist just came on staff to the pediatric clinic where my son receives OT. We did not seek her out but our OT recommended she work with us. The psych. said she could also help us with his bathroom issues.......

I have been to a potty training workshop given by a "potty training" expert that specializes in working w/ children w/ developmental issues. She was a big help in getting him partially trained to begin with.

I am considering taking DS to a play therapist in the next 6 months so she may be able to help us deal with the whole issue.

Finally, right after the holidays DS became constipated and did not even want to poop in his pullup or underwear....so his ped subscribed Miralax. It was a really rough 3-4 weeks but he finally got used to pooping again w/o out feeling fearful or anxious.

Don't know if any of this information helps esp. since your DD doesn't have any sensory issues.

Good luck!!!

[Twoboos]

Oops, I edited above. She is 3yrs 3 mos.

[SnuggleBuggles]

We took ds once for biting at preschool. (We had a 2nd appt scheduled but in the time btw appts- 1 month- things dramatically improved :).)

Since our health insurance covered it there was no reason not to try. It was good to hear a pros thought on things and I found it worthwhile.

Beth

[Twoboos]

Hey Christine,
Thanks for the ideas. In the beginning of the whole PT experience I had gone to a potty training "class" for parents (and it came down to - they'll do it when they're ready). So going that route again might work in this new framework of once having gone and now not.

DD has been on Miralax for a loooooooong time. Every time I try to reduce it, it seems she binds up and we have an issue. It kinda freaks me out and I have read all the warnings. But I have also heard many stories of kids being on it for many years and not having any longterm effects. I also am on her all day to drink drink drink.

I should have added before - we had been to the GI to see if she had Celiac Disease, but the scope results were negative for that. Now I can't seem to get an answer as to why this constipation happens. Seems to just be one of those things. DD2 poops about 4x or more/day. I am constantly wondering why they just can't even each other out!!

[cchavez]

DS only had to be on the Miralax for 2 weeks but I know other kids that have been on it much longer w/o any ill effects.

[gatorsmom]

Have you tried posting in the Toddler potty training forum? I hear all the time from my mom friends that their children regressed at some point when potty training. It sounds like she is going through some issues and just needs some time. When you said she puts on the crying fit it sounded like this is becoming a power struggle. 3 years old isn't too old to still be in diapers if you are working on the potty training thing. Frankly, I wouldn't push her. If she's having pooping problems to begin with, let her go in her diaper in the bathroom or in her diaper anywhere for awhile. Just don't push it. I'm sure she can sense your stress and that is why she is digging her heels in. If you relax, maybe she will too. As she gets older, it will get easier to reason with her.

Lisa
Mom to Gator July 2003
And Cha-Cha July 2005

[alexsmommy]

Professional disclaimer yadda, yadda, yadda - I don't know your kid blah blah....but I'm a psychologist and worked heavily with children for years as well as worked in a pediatric incontinence clinic. Every psychologist is different, but I wouldn't see a child for this until they were at least 4.5 or older. I know you don't want to hear this, but we (the psychologists) wouldn't even take kids in the ped incontinence clinic until they were 6+. There is a wide, wide range of "normal" for pt and A LOT of kids regress in this area after a bout of constipation. I suggest a really, really good laxative cocktail (my friends kid was drinking prune juice with mineral oil AND prescription laxatives on dr.s rec) right before sitting on the toilet. If it were me I'd reward her for even trying to sit for any length of time. I'd consider a consult with a behpsych possibly helpful to make sure you're in "normal" range, but I wouldn't be banking on it helping if there are no other developmental issues going on. Best of luck.
Oh and a friend who is also a therapist just got her kid past this after a six month pooping strike by letting her play a brand new Leapster on the toilet. Mom set the alarm for five minutes and if there was no poop, the Leapster got put away. If she pooped, she got the Leapster when she was finished for 20 minutes.
Hey, whatever works.
Alaina
Alex Feb '03
and #2 in early summer '07

[lmintzer]

warning--very long message

I have an almost 6 year-old who, at your dd's age, had one of the worst cases of "functional constipation" that I have ever heard of. Yep, that's what it's called--constipation with no physical or medical cause--no celiac disease, no problems with the lower spinal cord, etc. We ruled out everything.

Typically, functional consipation occurs when a toddler has a painful or difficult bowel movement. The fear of experiencing the pain again leads to stool witholding and associated behavior symptoms like crossing legs, standing up on tiptoes--anything to avoid pooping.

In some kids, the constipation gets so bad and goes on so long that the colon actually changes--we were taught that the colon is like a uterus--it can get stretched out and can accomodate lots and lots of stool. In extreme cases like my son's, laxatives/enemas wouldn't even help--it would clear out a little around the blockage, and that was that. He actually had to go to the OR to get things cleaned out. Very rare indeed.

(So there's the long story part--here's the hopefully helpful part) . . .

But, after that, his story is more like your dd's. He was on Miralax and mineral oil and we had to do graduated exposure to the potty. A few suggestions and a little more information--Miralax is a non-stimulant laxative. Thus, it is not addictive in the way that stimulant laxatives are. Your body doesn't get hooked on it in the same way. Kids can be on Miralax for years (my son still takes some, though the dose is less) without concern in most cases. So do not worry about weaning the Miralax. You won't want to do that until she is comfortable going on the potty. Have you tried adding mineral oil? My son would just drink this out of a children's medicine spoon. It's kind of gross, but we just called it his "clear medicine," and he took it without complaint. Mineral oil is TOTALLY harmless. It is not absorbed--just lubricates things as they come out. Since you are dealing with fear/anxiety, you want to ensure that she does not experience any more painful poops.

Let's see--here's something we learned--the time to "undo" the problem caused by the constipation/fear cycle is about equal to the amount of time it took forming. What I mean by that is that if your dd struggled with consipation and pooping problems for 6 months, it may take another 6 months to get back to baseline. In addition to working with a good GI (for the medical end of things), we took Jack to see a Behavioral Pediatrician. My own background is in Clinical Psychology (like Alaina's) but we felt like we should see someone who walked the line between medicine and mental health. A behavioral pediatrician is perfet for problems like these. You may want to consider a consult with one as an interum step.

But, as other posters have said, if your dd IS actually pooping (somewhere) with Miralax, you don't have a medical problem. She will eventually learn to go on the potty. She is still quite young. You are doing all the righ things but gently leading her that way. See if you can come up with anything that helps her sit on a daily basis. Have her sit after dinner/before bed with her feet up on a stool. This is very important. A lot of kids whose colons have been stretched have trouble with the sensation of knowing when to go. Sitting with proper posture with something under one's feet helps with this. Have her sit for a given amount of time each night. She can be fully clothed. Reward this or give her something fun to do while sitting. If she won't sit on the potty at first, have her sit on the stool next to the potty.

If you have any other questions, please feel free to PM me since this is getting ridiculously long. Good luck to you guys.

[DrSally]

..."A LOT of kids regress in this area after a bout of constipation."

That's interesting. Speaking from my expeience post-partum. That first BM was horrific!! I had to call the doctor. She said that since the bowels get sluggish right after birth you can get constipated and then hold onto it even more b/c it hurts to go. Thus, the viscious cycle. I could see the same thing happening to a child--it may hurt a little b/c she's constipated and then she holds onto it, furthering the problem. Sounds like the cycle just needs to be broken somehow (the laxative idea sounds good).

[erosenst]

Not exactly the same thing - but in case misery loves company (?).

DD is 3 years 2 months. After 15 months of sitting on the potty without ever peeing ONCE, she peed one day in early October. Since then, she's had MAYBE 5 peeing accidents - maybe not that many. Three nights later, she was dry at night - less than 5 times peeing in her pullup at night.

However, she pooped in the potty two hours after her first pee in the potty. For a while, she was pooping about 75% (?) of the time in the potty, then regressed. She knew that she was moving to the three year old room at daycare Jan 1, and that she had to be potty trained. On cue, she stopped pooping in her pullups during the day. Instead of pooping around 10a and 2p every day, she now poops twice within 30 minutes at night - after her pullup is on. On the weekends, she wears a pullup at nap - and poops then.

(FWIW - we would put her in undies all the time, but she really refuses. Even after she was potty trained, she wanted to wear pullups. Then wore panties OVER her pullup. One night, she sweated a lot in her pullups and had "crystals". I explained they were from her pullups - she now wears undies while awake.)

We've been told, and agree, that she'll poop when she's ready. While I have no problems with natural consequences, I don't want to make too big of a deal out of pooping for fear that she'll hold it even longer, have constipation problems, and we'll end up where you have all been for various reasons. The ped, etc have all said she'll do it when she's ready - so I'm trying to be patient.

As far as peeing in strange potties - she has a very mild sensory issue with hearing, or very sensitive hearing. Automatic flushing potties TERRIFY her. We don't make a big deal; however, if we've been out for a few hours and she hasn't gone, she knows she can't have anything else to eat/drink until she does. Interestingly, she calms down after a little bit of encouragement, and goes. (There's usually a "good" incentive - ice cream, water fountain, etc - but it's helping to desensitize her.)

[alexsmommy]

Yep, my client came so I had to shorten my response but this is it exactly. Once you can rule out the physical stuff you can see how a vicious cycle begins - it hurts, so you don't go, so you become more constipated, so it hurts more, and either you become impacted and need medical attention or your body finally forces you to go and it hurts so bad you never want to go again. Also TMI FYI for parents, if your child is constipated and then gets a smearing toothpaste consistency diarrhea, its often not diarrhea, its actually the newer softer feces oozing around the impacted dry old feces. I've seen parents who didn't know this and created a much bigger problem b/c they thought the child was not constipated when actually they still were.
From a beh perspective its about breaking the cycle, so several softer bowel movements on the toliet will start to break the association with pooping and pain. That's why laxatives and rewards for sitting on the toilet for any length of time can move kids in the right direction.
Alaina
Alex Feb '03
and #2 in early summer '07

[pinkmomagain]

Just want to add that you might also want to look at diet. I personally cannot have yogurt because it seems to turn to cement in my intestines and I don't go for days and days.

My oldest dd was constipated for a couple of years starting when she was 1 yo. Our ped had us mix senakot in her milk so we wouldn't encounter a witholding issue. Well, she always took milk from a bottle but when I switched her on to a sippy cup she refused to drink milk from it (other liquids were OK). So, I stopped giving her milk. Guess what...no more poopy problems. When we eliminated milk from her diet she was no longer constipated.

Several years later she was dx with a serious GI condition....unrelated to what was described above....but I thought I'd contribute the story in case you would want to try to eliminate a food that might be aggrevating your dd's problem.

Gina

[Twoboos]

First of all, I just wanted to say thank you for all the responses/perspectives on this.

After reading everything I'm probably going to hold off on the BPsych for a while. I am going to try being more active in getting her to relax and consider the potty. Maybe I went to sitting on the potty w/ diaper too soon. Probably should have gone to NEAR the potty in the diaper first.

She def knows when it's coming b/c she tells me she needs to poop in a diaper, and she holds it until we get the pullup on. I am concerned that her sitting on the floor isn't really leaving enough room for everything to get out.

Alaina, I am not above sheer bribery! I think a trip to the Disney store to show her all the Princess dolls waiting for her would help in that dept. We have a banner of new panties waiting to be worn over the tiolet, and she talks about which she'll wear when she goes on the pot. This doesn't seem to be enough. Also your prof advice was a relief, too. Being in the middle of it, it's easy to lose perspective. so thanks.

Emily, I hear you on the pullup only. This is what happened w/DD. Now it's the only place she'll go. At least you know when and where it will happen... (trying to look on the bright side)

Gina, we have thought about diet, but there's nothing that jumps out as a culprit. She's not a huge milk drinker. Except when we make Choc milk to hide Milk of Magnesia if things have slowed down. Also won't touch yogurt lately, or any dairy now that I'm thinking about it!!

ANd Lisa, thanks for your story, too. It can be so frustrating (like so many parenting things, no?) and to know others have btdt is a relief. She is young but those steps forward to PT and now the steps back to the diaper... well, it's hard for me to handle sometimes! Even though I know she's doing her best.

Holy ramble, I must stop now!

[Twoboos]

Lisa (lmintzer), question about this-
"the time to "undo" the problem caused by the constipation/fear cycle is about equal to the amount of time it took forming. What I mean by that is that if your dd struggled with consipation and pooping problems for 6 months, it may take another 6 months to get back to baseline."

Would that mean, since it's been 4mos it will take 4mos to get back to it? Or since she has been constipated since she was 9mos old, it will take 2.5years? (Does panic come through in a posting?? :-) )

I'm thinking it's since the last incident (4mos) but correct me if I'm wrong.

thanks!

[momofjandl]

I saw this and wanted to respond with our story.

DS just turned 4 and is not and has no interest in potty training. We took a class as well and were told, "what's the rush, just wait, don't bribe, kids have to do it b/c they want to for them not b/c they want to for you." So still no luck.

We asked our pedi..he said we could try reward aka bribe and if that doesn't work let it go. He said it's worse for a child to have constipation issues b/c he doesn't want to use the potty than to just plain not use the potty.

So we are back to square one and waiting. He is in preschool and he and one other 4 yr old girl are the only ones out of about 20. I just wanted you to know that it happens to older kids too.

I'm no expert but I would just give it some time.

I also wanted to give an update..since I saw the post about sensory disorder etc. I had posted sometime back on here and many people were nice enough to respond.

It looks like Justin does not have anything at this time. No SID or Aspergers or anything like that. He's just one of those on the border gray area kids. So we are working on accomodating him with a sensory diet etc. and are waiting to see how he develops.

Thank you to everyone who was so supportive..sorry I haven't posted an update before now.

Best of luck!
Ruth

[missym]

This is SO hard! Just as Gwen was PT'ing, she witnessed a very constipated, very vocal friend using the potty. She refused to poop on the potty for almost a year after that. In our case, Gwen was regular as clockwork, and fully PT otherwise, but she flat-out would not poop except in a pull-up. When she was a little over 3, I contacted a pediatric hypnotherapist/play therapist. She said to call her again when Gwen turned 4 if it was still an issue.

One day, when she was about 3.5, she just did it, and hasn't looked back. Hopefully the same thing will happen for you.

Hang in there!


Missy, mom to Gwen 03/03 and Rebecca 09/05

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[lmintzer]

Twoboos,
I would guess it would be about 4 months from the time of the incident. It probably depends on the extent of the constipation problem she had since infancy, though. This was more a rule of thumb kind of thing that we were told than rocket science--probably told to parents so that they understand that it is not going to be fixed overnight.

Sorry--I didn't mean to stress you out further with that piece of info. It sounds like you have realistic expectations about this being a gradual process, and that is good.

Have to run--my boys are antagonizing each other!

[lmintzer]

double post