"My son just turned 7 and we started potty training him and he's doing really good ....but never poops in the toilet, always in his pants. How can I get him to poop in the toilet? I would like to find a picture of showing the pooping, but that's impossible." Patty

Answer: Dr. Pam DiLavore, Lead Psychoeducational Therapist, Raleigh TEACCH Center

Pooping in the potty has been a challenge for many children with autism and their parents. Even children who are bladder trained may have difficulties with bowel training. Sometimes they may not connect the two, so they end up thinking that the toilet is only for peeing, not for pooping. Some children may have a tendency to hold their bowel movements for some reason such as discomfort when pooping, wanting to stick to their own internal routine, or resisting the change from using the diaper/pants to using the toilet. Your idea of using a picture of pooping is a good one. There is a children's book entitled "Everyone Poops" that has good pictures of all different kinds of animals, including a child, pooping. That is a good source for the picture. There are also books for young children about toilet training that have pictures that might be helpful. In addition to the picture, you might try a few other ideas.

1. Pick one time of the day for your child to sit on the toilet to poop. It should be about the same time each day. If your child is fairly regular, you should pick a time that's close to the time that he usually poops (maybe a little bit earlier so that you catch him before he goes). If he's not regular or if he doesn't go every day, you might want to pick a time that is shortly after a meal. It should also be a time when you don't have a lot of other things going on. You should be able to be relaxed and unhurried during this time in order to help your child be relaxed.

2. Have your child drink an ice-cold drink (juice or water) before sitting on the toilet. Cold drinks help stimulate the bowel, especially if it's shortly after eating a meal.

3. While your child is sitting on the toilet, you might let him hold a toy if he needs it. Some people like to let the child read books for the whole time on they're on the toilet, but I am sometimes concerned that the child might get confused about what they're supposed to do there. The main message is "you sit on the potty to poop" NOT you sit there to read or play with toys.

4. Set a timer for about 5 minutes. I have tried to have a child sit on the toilet for longer, but I have usually found that if somebody's going to poop, they'll do it pretty quickly. If they don't go or actively try and start to go within the first few minutes, they probably aren't going to. This is a little different from bladder training because eventually a child has to urinate and it doesn't take any effort. For most kids, it actually takes effort to use the muscles to move the bowel.

5. If your child poops, get him up from the toilet pretty quickly; he shouldn't have to continue to sit there after he's pooped. Again that may confuse him about why he's there. You may want to give him a really good reinforcer (like a piece of special candy) - something that he gets ONLY for this.

6. If your child doesn't poop, get him up from the toilet when the timer rings. Don't give him the reinforcer, but be sure you don't scold him either. Matter of factly say something like, "Okay, the timer rang, we'll try again tomorrow."

7. When your child poops in his pants, take him to the bathroom, have him take his pants off, and (if possible) dump the poop into the toilet. You might say something like "Poop goes in the potty." Make sure he actually sees it in there so that he will start to know that it belongs there. Although it's sometimes hard at this point, it's important to again be calm and matter of fact. Try not to scold him in any way. As much as possible, have your child be responsible for cleaning himself up and changing his clothes.

8. If your child is irregular and has difficulty having a bowel movement or only has one every two to three days, you may want to try to give him more fiber as in bran muffins or cereal, or more fruits and juices. If this is a chronic issue, talk with your pediatrician about ways to help your child become more regular. Bowel training will be much easier with a child who regularly has a bowel movement every day.

Site Links:
"poop in toilet" picture card in 1", 2" and large coloring page sizes
Everybody Poops