Behavioral Characteristics of Children With Stool Toileting Refusal

Blum, Nathan J.; Taubman, Bruce; Osborne, Mary L.

doi:10.1542/peds.99.1.50

Cited by 46 publications

(38 citation statements)

References 15 publications

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“…Se han sugerido diversos factores que pueden estar relacionados con este rechazo: un entrenamiento demasiado precoz, exigente o coercitivo, conflictos entre los padres y el niño, miedo irracional o fobia al retrete o temperamento temprano difícil. Aunque, hoy por hoy, la evidencia empírica disponible no es concluyente, existe una percepción generalizada entre los clínicos de que los niños con este rechazo suelen presentar más altera-ciones de conducta e interacciones disfuncionales en la relación padres-hijo 1,6,7 .…”

Section: Discussionunclassified

“…Generalmente, la secuencia de adquisición de la continencia sigue el patrón siguiente: fecal nocturna → fecal diurna → urinaria diurna → urinaria nocturna; aunque muchos niños adquieren el control fecal y vesical de forma simultánea 1,2 . Es a partir de los 12 meses cuando el niño comienza a desarrollar las habilidades motoras necesarias y existe un acuerdo generalizado de que hasta el año y medio no se logra la madurez biológica que permite ejercer un control voluntario sobre los músculos que controlan la micción y la defecación 3,4 .…”

Section: Introductionunclassified

“…A pesar de que la mayoría de los niños están entrenados en el uso del inodoro a los 30 meses, los estudios muestran que entre el 2 y el 10% de los niños no lo está a los cuatro años 1 . Durante el proceso de entrenamiento, un 20% de los niños desarrolla rechazo a usar el retrete.…”

Section: Introductionunclassified

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¿Qué esconden los problemas del control de esfínteres?: A propósito de un caso

Saldaña¹,

Ceruelo

2012

Rev Pediatr Aten Primaria

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What do sphincter control problems hide?: a case reportToilet training disorders are common in the Primary Health Care Pediatrician's practice. A case report of a four year-old boy with functional encopresis and stool toileting refusal is presented; the interdisciplinary intervention conducted by the Pediatricis and Clinical Psychology is also discussed. This clinical case presentation shows that the same symptoms may underlie different problems which would require different therapeutic interventions. The need of paying attention to the context surrounding the child (family, school, professionals) is also highlighted; as well as assessing the interaction and reciprocal influence between the child's symptoms, the parents' attitudes and other external factors, in order to understand and approach the problem in a more comprehensive way.Los trastornos del control de esfínteres son uno de los problemas más comunes en la consulta del pediatra de Atención Primaria. Se expone un caso clínico de un niño de cuatro años que presenta encopresis funcional por rechazo a utilizar el inodoro, así como la intervención llevada a cabo en conjunto por Pediatría y Psicología Clínica. La exposición de este caso muestra cómo la misma manifestación puede esconder distintos problemas que requerirán diferentes abordajes terapéuticos. Asimismo, se pone de manifiesto la necesidad de prestar atención a los diversos contextos que rodean al niño (familia, escuela, profesionales), así como valorar la interacción y la influencia mutua de los síntomas de este con la actitud de los padres y con otros factores externos para entender y abordar el problema de forma más precisa y global. Key words:  Elimination disorders Encopresis  Toilet training INTRODUCCIÓNLos hitos evolutivos relacionados con la adquisición del control de esfínteres son procesos complejos que tienen lugar durante el periodo entre los 18 y los 36 meses de edad en un niño normal. Generalmente, la secuencia de adquisición de la continencia sigue el patrón siguiente: fecal nocturna → fecal diurna → urinaria diurna → urinaria nocturna; aunque muchos niños adquieren el control fecal y vesical de forma simultánea 1,2 . Es a partir de los 12 meses cuando el niño comienza a desarrollar las habilidades motoras necesarias y existe un acuerdo generalizado de que hasta el año y medio no se logra la madurez biológica que permite ejercer un control voluntario sobre los músculos que controlan la micción y la defecación 3,4 . Además de la maduración biológica como requisito para el control de esfínteres, existen múltiples factores que influyen en esta adquisición: la madurez socioemocional del niño, su capacidad intelectual, los determinantes culturales y las interacciones psicológicas entre el niño y sus padres. En cuanto a esta última variable, uno de los aspectos más estudiados en la literatura médica está relacionado con el entrenamiento en el uso del inodo-

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Section: Discussionunclassified

Section: Introductionunclassified

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¿Qué esconden los problemas del control de esfínteres?: A propósito de un caso

Saldaña¹,

Ceruelo

2012

Rev Pediatr Aten Primaria

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“…The data collection instrument was specially designed for this investigation on the basis of an extensive review of the literature (1)(2)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) . A pilot test was performed on a sample with varying socioeconomic levels and the definitive data collection instrument was produced after evaluation of interviewees' responses and any difficulties they had with understanding.…”

Section: O N C E N T R a T E S O N A C T I V I T I E S R E S P O N mentioning

confidence: 99%

Treinamento esfincteriano anal: estudo transversal em crianças de 3 a 6 anos de idade

Miranda

Machado

2011

Rev. paul. pediatr.

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Objective: To assess the practice of children's toilet training through interviews with parents and caretakers.Methods: A cross-sectional study of healthy children using a questionnaire applied to parents or caretakers of 100 consecutive children aged 3 to 6 years old.Results: 97% of the children were home-trained by their mothers and 92% of them used their intuition, previous experience with an older child and grandmothers' experience. Bowel and bladder toilet training started simultaneously in 84% of the cases, whereas 41% of the children mastered stool control earlier. Mothers with lower educational level and of social classes C, D and E initiated the training earlier and one of the related reasons was the cost of disposable diapers. Age in initiation or duration of toilet training was similar for boys and girls. Children presented most of the "readiness symptoms" for toilet training and only a small number of them used a seat reducer or a foot support. There was no increase in constipation prevalence after toilet training and there was no encopresis.Conclusions: Mothers were responsible for bowel toilet training and initiated it with no specialized help. In C-D-E social classes, the cost of diapers was determinant to initiate bowel toilet training.Key-words: toilet training; child development; child, preschool. RESUMOObjetivo: Avaliar o treinamento do controle esfincteriano anal em crianças, por meio de entrevista aplicada aos pais ou cuidadores.Métodos: Estudo de corte transversal em crianças sadias, aplicando-se um questionário estruturado para 100 responsáveis por crianças entre três e seis anos de idade.Resultados: 97% das crianças foram treinadas em casa pelas mães e 92% delas utilizaram a intuição, a experiência com o filho anterior e o aprendizado com as avós. O treinamento do controle esfincteriano anal e vesical foi iniciado simultaneamente em 84% dos casos, sendo o controle anal adquirido primeiramente em 41% das crianças. As mães com escolaridade menor e das classes C-D-E iniciaram o treinamento mais precocemente, sendo um dos fatores relatados o custo das fraldas. Não houve diferença entre meninos e meninas para idade de início e duração do treinamento. As crianças apresentavam a maioria dos "sinais de prontidão" para o início do treinamento e, das crianças que foram treinadas no vaso sanitário, uma pequena parcela utilizou redutor e apoio para os pés. Não houve aumento significativo de constipação intestinal após o treinamento e não foram observados casos de encoprese.Conclusões: As mães foram as responsáveis pelo treinamento esfincteriano anal e o iniciaram sem auxílio especializado. Nas classes sociais C-D-E, o custo das fraldas foi determinante para o início do treinamento esfincteriano anal.Palavras-chave: treinamento no uso de toalete; desenvolvimento infantil; pré-escolar. José Eduardo G. B. de Miranda et al RESUMENObjetivo: Evaluar el entrenamiento del control del esfín-ter anal en niños, mediante entrevista aplicada a los padres o cuidadores.Métodos: Estudio de corte transversal...

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“…[62][63][64] In common with voiding dysfunction, constant contraction of the pelvic floor results in contraction of the anal sphincter, resulting in incomplete emptying of the bowel, constipation and soiling. Incomplete evacuation leads to stools becoming dry and voluminous, causing pain when they are passed.…”

Section: Constipation Refusal To Go To the Toilet And Encopresismentioning

confidence: 99%

Treinamento esfincteriano: métodos, expectativas dos pais e morbidades associadas

Mota¹,

Barros²

2008

J. Pediatr. (Rio J.)

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Objective: To review both the scientific literature and lay literature on toilet training, covering parents' expectations, the methods available for achieving bladder and bowel control and associated morbidities. Summary of the findings:Parents have unrealistic expectations about the age at which diapers can be withdrawn, not taking child development into account. Toilet training strategies have not changed over recent decades, and in the majority of countries the age at which children are trained has been postponed. Training methods are rarely used.Starting toilet training prematurely and stressful events during this period can extend the training process. Children who have not been trained correctly present with enuresis, urinary infection, voiding dysfunction, constipation, encopresis and refusal to go to the toilet more frequently. Literature intended for lay parents is both abundant and adequate, available in book form and on the Internet, but it is not widely available to the Brazilian population. Just three international pediatrics societies have published guidelines on toilet training. Conclusions:Toilet training is occurring later in the majority of countries. The training methods that exist are the same from decades ago and are rarely used by mothers and valued little by pediatricians; incorrect training can be a causative factor for bladder and bowel disorders, which in turn cause problems for children and their families.J Pediatr (Rio J). 2008;84(1):9-17: Toilet training, enuresis, child, urinary tract infection, elimination disorders.

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Behavioral Characteristics of Children With Stool Toileting Refusal

Abstract: Children with stool toileting refusal do not have more behavior problems than controls who are toilet trained. Parents do report higher rates of constipation and painful defecation, but it is not clear whether this is a cause or effect of stool toileting refusal.

Cited by 46 publications

References 15 publications

¿Qué esconden los problemas del control de esfínteres?: A propósito de un caso

¿Qué esconden los problemas del control de esfínteres?: A propósito de un caso

Treinamento esfincteriano anal: estudo transversal em crianças de 3 a 6 anos de idade

Treinamento esfincteriano: métodos, expectativas dos pais e morbidades associadas

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