Wednesday 26 September 2018

Dear David Coleman: Our three-year-old is refusing to use the toilet since she changed crèche recently. What should we do?

Photo: Thinkstock
Photo: Thinkstock
David Coleman

David Coleman

Clinical psychologist David Coleman offers parenting advice in his weekly column.

Q. Our daughter who is three, and toilet trained for the past six months, refuses to use the toilet in her new crèche since she started three weeks ago. She says she's scared to go but has no problem using any of the toilets there with my husband or with me. The toilets have three cubicles without doors and she was worried about bigger children coming in when she was going. The staff have been very good, trying lots of different approaches, but nothing seems to work. She seems very happy otherwise but we don't know what else to do?

David replies: I could imagine that it is very distressing for your daughter to feel like she is bursting to go to the loo, but yet feels unable to use the toilets at the crèche. Has she been wetting herself or complaining of pains associated with holding on?

Her reluctance to use the toilet does seem to be linked to the somewhat "public" nature of the cubicles. I wonder if the decision not to have doors is based on some kind of safety concern? It seems unusual that children can't have privacy, but I presume there is some reason for it.

The fact that your daughter has also just moved to this particular crèche might also be creating an underlying anxiety that is manifesting as a "fear" of going to the toilet. If that is the case then some empathy about how big a transition it might be to have moved crèche will help.

It is not unusual for children to experience disruption to some aspect of their developmental progress when their daily routine and rhythm has been disturbed by some significant change. Often that disturbance can be seen in their sleeping habits, their eating habits or their toileting habits.

So, perhaps the change of crèche is more significant and disruptive for your daughter than you may have anticipated, or been aware of? Even though, your daughter expresses a fear of using the toilet for privacy reasons, separation anxiety associated with the new environment may be a more relevant explanation.

Most children are more willing to accept our help and our rationale, about something that is anxiety provoking, when we have first shown ourselves to fully understand the nature and extent of their anxiety. So, rather than focusing your empathy on the issue surrounding privacy, perhaps you could focus it more on her experience of the change associated with moving crèche and how that might have affected her.

Time will also help your daughter. I know it may not be very palatable to just wait, given how painful or upsetting it might be for her to hold on every day, but as she settles into the crèche and becomes accustomed to the daily routines and rhythms, any anxiety should reduce. As she gets more comfortable in the crèche she may also feel easier about using the toilet.

I do hear you say that the crèche staff have tried lots of different approaches. Hopefully those approaches have included positive reinforcement of any use of the bathroom, even if she doesn't actually use the toilet.

So, for example, if your daughter could get rewarded for going into the bathroom and washing her hands, or for just visiting the bathroom, perhaps walking into and out of the cubicle, it might be the first steps in familiarising herself with the bathroom and reducing her anxiety about being in there.

The fact that she has successfully used the toilet, in your company, since refusing to use it on her own is also a very positive fact. It suggests that if she has enough security (in terms of feeling that she has a strong attachment figure, or someone she trusts) that she is then able to overcome her fear.

Perhaps if one particular member of the crèche staff can build up a relationship with your daughter it will allow your daughter to experience the same level of security and safety so that she manages to use the loo herself.

I do think that once she gets over this internal hurdle, where she has associated the toilet with an underlying distress or anxiety, she will revert to her former rhythms and practices.

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