Getting Professional Help for Toilet Training

Editor Note: Sadly, Meg Zweiback, who is recommended many times below, passed away in 2017.  View her obituary in the San Francisco Chronicle.

Archived Q&A and Reviews

Dealing with my anger that 4-year-old poops in his underwear

May 2008

Potty Psychologist? No. I don't need a psychologist to evaluate my 4 year-old pooping in his pants. I need help understanding my own feelings about this potty-training. I feel like a total failure. For centuries parents have been teaching their children where to properly dispose of their excrement . . . where did we go wrong? I HATE cleaning up giant amounts of poop in underwear (and other places). I'm disgusted, angry, frustrated and then guilty about my disgust, anger, and frustration. I want to physically hurt my son when he has an accident after I've patiently asked him ''do you want to use the bathroom?'' ''It's time to use the bathroom.'' When I see him having a bowel movement, I try to gently usher him to go on the toilet and he vehemently refuses. We've tried everything: stickers, potty charts, not making it a big deal about it, making a big deal out of it, rewards, no rewards . . . I give up. Is there a counselor that specializes in working with parents? I love my son and I know it's just poop so why is this causing so much stress? This anger scares me. (I have health net if that makes a difference) fed up with poop

Oh, sweetie, I totally understand! I've just come out the other side of a situation exactly - exactly - like yours. I tried desperately to stay neutral when my kid pooped in his pants and hated the panic, frustration, and ultimately uncontrollable anger that came out anyway. The way I responded to the accidents totally contributed to the problem and you're right to see that. I started counseling for other reasons, but spent much of the first several sessions talking about and venting my frustrations. It did a world of good to be able to express my feelings in a safe environment. I gave myself permission throw underwear out! Not environmental, but totally necessary for my sanity. I also made my child responsible for cleaning out his underwear, wiping himself off and dealing with the consequences (they are capable of doing it at this age, but I bought some dishwashing gloves especially for this task, because it can get messy). He hated it, but I found it easier emotionally to deal with his frustration over the task if I didn't actually have to handle the underwear or wipe him.

Neither rewards nor punishment worked. What did was about 3 mo. of growth and development - he finally got to a place where he was personally motivated to use the pot. I think venting the full depth of my anger and frustration in a safe place helped me to make it more his problem and not mine in the meantime. I definitely think seeing a psychologist is a great idea. Don't let insurance coverage be your deciding factor on whether you see someone - you want the right someone and that may not be found through insurance. Most counselors will do their best to work within your budget. I went to Michael Simon and I found him to be very helpful (check BPN for reviews). Breathe, find ways to enjoy your child, and give yourself permission to feel what you're feeling. This is frustrating and heart breaking, and far more common than you would suspect. You will make it through

I empathize. My daughter didn't have the same issue as your son, but she potty-trained very late (finally gave up diapers right before her 4th birthday). I'd tried everything and was at my wit's end. I also felt like a failure. Meg Zweiback (510-836-1450), a nurse-practitioner with lots of experience regarding potty training, was a real help to me. She's not a therapist, but helped me understand what was happening and made me feel a lot better. I'd try a consult with her before trying to find a shrink. BTDT

Dear Fed up with Poop,

I see you're very frustrated and I completely understand you. I'm not a mom but I take care of twins almost 4 1/2 years and they were still wearing diapers until 2 weeks ago. Being from a country children ar potty trained at the age of 2 I was, at the beggining, very upset about the fact that they couldn't follow my instructions although I was remind them every 5 minutes about their poop time. But then it just happened that I remember studying children psycology at College and they always say the children you'll be ready when they feel they're ready and we have to follow that with patient even though it's pretty hard. It's like a grown-up learning how to drive... It takes us a while not to make the same errors and we hate being pressured! After I stopped remind the boys about their poop time.... Poof! They just said: I'll now poop in the potty and they just do it now! It sounds like magic, doesn't it? But it just showed me now they're completely ready and secure about this important 'job' for them! Please be patient and one day everything will change! And, remember, he'll never be 4 years older again! Take care!

Hi - I can totally relate. My son is 4.5 and only recently was potty trained. I thought I would kill him! He is a totally normal little boy, but he is developmentally delayed and is mentally about 1 year behind his age. that is the only thing that helped me through.

I fought and fought with him to use the potty and he just would not have it. Finally I just gave up and said 'fine - we'll use pullups'. I was totally embarassed to have a 4 yr old in pull ups but got tired of cleaning up poo everywhere. We let his pull ups stage go for about 5 months before we tried again. Lo and behold, he was finally ready.

What I learned was that I couldn't make him go - he had to do it on his own time. I know everyone tells you that, but they have 2 yr olds! 4 yrs old is just old. But I had to let go of getting mad at him, yelling, even spanking because it didn't help. My letting go of it finally did.

Sounds like your son is just not ready. Don't beat yourself up. I thought I was doing it the wrong way too, but all my friends scratched their heads and said 'hmmm my kid never did that. they just went.' well mine didn't and i used the same techniques. I had to wait for his time clock to catch up. Good luck I wish a I had a magic trick for you - I tried stickers, treats, begging, etc etc and nothing worked. He just had to do it when he was ready. No more poop FINALLY!

Run, don't walk, to Meg Zweiback. She is child/family therapist specialized in potty issues. Sounds like she could really help you. Her number is 510-836-1450. Also, I don't know the details of your son's refusal to poop in the potty, but do you know if he has encopresis? Infrequent stools and/or willful withholding? My son did, and that's why we went to Meg. In the end, she didn't really help my son, but she helped us better understand his condition. On a side note, if your son does have encopresis, what DID help my son is the Soiling Solutions protocol (you can find out more about it online). We tried it after two years of poop issues and it literally changed my son's entire life. Pediatricians are wary of it, but Meg supported us in trying it, and we are so, so grateful for that program. Nothing else worked (bribes, stickers, toys, lectures etc.) Our son now goes poop in the potty every day like clockwork and just the other day said ''remember when I had problems with my poop?'' It was just six months ago that we were struggling with these issues, but it feels so long ago. Good luck! Been there too

I don't have any recommendations, but I did want to say that you're not alone. Our first kid was a tough potty trainer, but we ultimately succeeded when she was about 4.

Our second, though, is another matter entirely. She was nearly potty trained at 3, and then she just stopped. We went through a couple months of hell, power struggles, etc., before putting her back in pull-ups. Well, she just turned 4, we're trying again, and I'm already at my wit's end. She seems to have no desire to use the potty, either on her own or with reminders, on anything other than a sporadic, random basis. And for us, it's pooping and peeing. I find myself getting so angry when I have to sop up yet another pee stain on our carpeting....

So what to do? I don't know. We might go back to pull-ups (again!!) and just wait till she decides to do it on her own.

I wish you luck and peace... Right there with you

It's very nice to read positive comments about my work with families around poop issues--and I 'd like to clarify a few things. First, I'm a pediatric nurse practitioner, not a psychologist or therapist. When a child is having elimination difficulties, I always work collaboratively with a child's health care provider, since the underlying cause is usually physiological or developmental. Sometimes other psychological issues are involved, and I then will refer the family to a therapist. Last, I will be giving three workshops at Bananas in July for parents who are in the midst of toilet training--one each for parents of toddlers, pre-schoolers, and late-bloomers. Please go to for more information. The workshops are free but you should register in advance.

I also would like to echo what many parents have said about letting go of the issue. Once the pattern of constipation or withholding is resolved (basically, most children who skip days and then produce huge poops are withholding unless that has been the pattern since infancy) the best thing parents can do is tell themselves and the child, ''This will happen when it's the right time.'' It's not a fun problem, but it will get resolved . . trust your child. Meg Zweiback

Using a Child Pyschologist Re Potty Training?

May 2003

As desperate as this may seem, I am contemplating having our nearly 4 year-old daughter see a psychologist to find out if it will help with potty training. We've tried everything else. Has anyone used a pyschologist for this? Did it help at all? anon

I am a child psychologist and when I was working, I did work with families around basic toilet training issues, especially if they felt stuck. Keep in mind that a majority of the work will be with you, not your child. If you go to a .psyccologist trained in behavior management, you will learn howto use schedule, reward system, etc. and the psych will also help identify nutritional and other issues like stress that might be getting in the way of potty training. Much of this you could do on your own, but for some parents it really helps to have a professional encourage them along and give them ideas.

Meg Zweiback is the local expert on these matters. We've consulted her about a similar issue and found her to be really really good. Give her a call. I think you can find her in the phone book, in Oakland.

My daughter was on the cusp of turning four when she FINALLY started peeing in the potty. I went through every single potty training suggestion in the world and nothing worked. Around three she agreed to start wearing panties, but would hold everything in until she got her diaper back on. There was much crying and gnashing of teeth (on my part, I mean) until finally, after her baby brother was born, she decided to go pee in the potty. The poop thing took another six months. And today, at 6, she still pees in her bed three nights out of seven. Oh well. Let me add that she's a perfectly normal, if rather mellow and independent-minded, little girl. My advice to you: Save your money. Back off a bit. Because ultimately, only when SHE decides she's gonna go is she gonna go.

Although I can't speak to your exact situation, I would like to wholeheartedly recommend that you call Meg Zweiback . My husband and I recently worked with her to help us with our 2-year-old daughter's sleep issues... and got MIRACLULOUS results. I know that she also works with families on potty training issues, which is why I suggest you call her. I swear that getting her help was one of the smartest things I have done as a parent. Her number is (510) 836-1450.

I have been taking my 4.75 son to a child psychologist for a couple of months now. I initially went to see her for potty issues--going on two years of potty problems that were not getting better. My son has a number of issues that are factors in this problem, but it's not clear that any of them are medical (in fact, I posted not long ago asking about whether one could look into this medically without catheterizing the child). My son has sensory integration issues that affect his ability to ''feel'' that he's wet, but also behaviour and attention issues that cause him to ignore when he's wet. This is a long way of saying that the problem is multi-faceted and there's been no quick fix, but this woman effected a 100% improvement in my son before she even saw him, by suggesting a chart system that was not typical, in that it was about checking every hour to see if he was dry, rather than focusing on peeing or pooping, and incorporated a reward system that worked for my very--hard-to-reward child. This system took him from wetting all day to wetting once or twice a day, for the most part, and going dry many days, something he's almost never done. One of the best things about seeing this dr. was she was the first professional I've consulted (I won't even mention all the ''methods'' of potty compliance I've tried) who didn't scratch her head and say, ''Hmm, a 4 and a half year old who still wets, hmm, how unusual. I wonder what that's about.'' She said something like, ''Oh yeah, I see this all the time.'' And I felt, for the first time, not so alone and freakish. I decided to continue on with her to get my son fully diagnosed in preparation for public school. She costs a fortune but I have felt it's entirely worth it. I think as long as you don't expect the problem to be solved overnight (but do expect fast improvement) you might find great relief and help from a psychologist.

Meg Zweiback is the one for you. She's made a business of giving advice to parents and she's great. She's into short-term advice and is very balanced and non-judgmental. I believe her special skill is potty training.
Recommend Meg

We saw a behavioral specialist when our daughter was having a problem w/ constipation at age 3. The psych. actually worked with us on potty training -- which had not been going very smoothly up to that point -- as a response to the constipation issue (it's all about control - sigh). It did help for both problems. Now if we could just get out of those night diapers... Hope this helps