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Blum et al examined children between the ages of 30 and 48 months who had achieved bladder control but refused to defecate on the toilet. They found that children with refusal to sit on the toilet did not have more behavior problems than matched children who were toilet trained. However, children who refused to sit on the toilet did have a much higher frequency of painful bowel movements.
This study reinforces my opinion that the typical child with constipation/stool withholding does not need extensive psychological counseling. A physician who works with the child and family to make sure any fecal im pac tion is removed, that the stool is appropriately softened, and that behavior is modified to ensure proper postprandial efforts at defecation will have a patient population that has an astounding rate of success with this problem. The confidence and time that the health care pro vider can afford to these patients and their families is the most significant variable in determining successful therapy. Only a small minority of children with significant problems of constipation/encopresis require professional psychological counseling.