Encopresis Pediatric Research and Clinical Trials

Toilet School

Directed by Kimberly Dunn, PNP, the Toilet School at Boston Children’s Hospital helps kids get comfortable using the toilet for bowel movements.

“Toilet School is a six-week program for 4-, 5- and 6-year-olds who have toilet refusal,” Dunn says.“Week six is graduation and the kids who’ve pooped in the toilet get a gold medal.”

Kids come to class once a week for an hour to an hour and a half. Each week there’s a different theme, which can be anything from fear to anatomy. And each week the kids are given a job — such as sitting on the toilet or learning to wipe — to do at home.

“We focus on what the child can already do,” says Alison Schonwald, MD, a staff member in our program and author of The Pocket Idiot’s Guide to Potty Training Problems.

And while the kids are in school, the parents are too. “They are incredibly stressed, very embarrassed and often, disgusted. They can't understand why their otherwise terrific kid is doing this, and they can't stand to wash another pair of underwear,” says Schonwald.

In group sessions with a psychologist, parents can commiserate and learn helpful tips, such as how to reduce your child’s risk of constipation and how to defuse tense toilet situations.

The atmosphere — both in school and in the counseling sessions — is supportive and fun. And Toilet School seems to be working. By graduation time in the sixth week, about sixty percent of the kids have successfully had a bowel movement on the toilet. The ones who haven’t get follow-up visits until they’re successful.

Schonwald and Leonard Rappaport, MD, MS, chief of Developmental Medicine, took a survey of 62 parents whose children entered the program at an average age of 5. The results showed that 54 percent were fully toilet trained for stool within three months after the program. Children were equally likely to succeed regardless of age, sex, degree of constipation, medical, psychiatric or social concerns, and how long toilet training had been tried unsuccessfully in the past.