Taubman B
University of Pennsylvania School of Medicine, Department of Pediatrics, Philadelphia, USA.
Pediatrics. 1997 Jan;99(1):54-8. doi: 10.1542/peds.99.1.54.
To determine the incidence of toileting refusal for bowel movements and its outcome when toilet training children using a child-oriented approach.
Prospective study.
Private suburban pediatric setting consisting of middle and upper middle class families.
Healthy children between 18 and 30 months with no signs of developmental delay were enrolled in the study. Parents were given questions regarding their child's toilet training and behavior. Families were followed every 6 months during an office visit or by phone call until the child was successfully day time toilet trained.
A total of 482 children (255 males) completed the study. There were 106 children (54 males) (22%) who experienced at least 1 month of stool toileting refusal. There was an association between the presence of younger siblings (P = .023) and parental inability to set limits for the child (P = .017) and stool toileting refusal. Stool toileting refusers trained at a later age than the rest of the group (P < .0001). Fifty percent (22/44) of the children who trained between 42 and 48 months and 73% (8/11) of the children who trained after 48 months experienced stool toileting refusal. Sixty-one of the study children developed stool withholding during toilet training. Forty-nine (80%) of these children were stool toileting refusers (P < .00001). In 77 (73%) of the children no intervention was undertaken. Of these, the behavior lasted more than 6 months in 20. Intervention was undertaken with 29 children, either because of severe stool withholding (23) or the age of the child (6). Interupting toilet training and having the child return to diapers resulted in the child spontaneously using the toilet for bowel movements within 3 months in 24 of 27 children.
Stool toileting refusal occurred in one in five children in this study population. Two behaviors associated with stool toileting refusal may require the intervention of the pediatrician. The first is stool withholding causing constipation which can result in rectal impaction and primary encopresis. The second is lack of successful toilet training by 42 months of age. A child who is still untrained at this late age can be a source of family conflict and stress requiring the advice and support of the pediatrician.
确定使用以儿童为导向的方法对儿童进行排便训练时排便拒绝的发生率及其结果。
前瞻性研究。
由中上层阶级家庭组成的郊区私立儿科机构。
纳入18至30个月且无发育迟缓迹象的健康儿童。向家长询问有关其孩子排便训练及行为的问题。在门诊就诊或通过电话每6个月对家庭进行随访，直至孩子成功实现白天排便训练。
共有482名儿童（255名男性）完成研究。有106名儿童（54名男性）（22%）经历过至少1个月的排便拒绝。弟弟妹妹的存在（P = 0.023）以及父母无法为孩子设定界限（P = 0.017）与排便拒绝之间存在关联。排便拒绝者比该组其他儿童训练得更晚（P < 0.0001）。在42至48个月之间接受训练的儿童中有50%（22/44）以及在48个月之后接受训练的儿童中有73%（8/11）经历过排便拒绝。61名研究儿童在排便训练期间出现憋便情况。其中49名（80%）儿童是排便拒绝者（P < 0.00001）。77名（73%）儿童未进行干预。其中，20名儿童的这种行为持续超过6个月。对29名儿童进行了干预，原因要么是严重憋便（23名），要么是孩子的年龄（6名）。中断排便训练并让孩子重新使用尿布后，27名儿童中有24名在3个月内自发地开始使用马桶排便。
在该研究人群中，五分之一的儿童出现排便拒绝情况。与排便拒绝相关的两种行为可能需要儿科医生进行干预。第一种是憋便导致便秘，这可能会导致直肠嵌塞和原发性大便失禁。第二种是到42个月大时仍未成功完成排便训练。在这个较晚年龄仍未接受训练的儿童可能会成为家庭冲突和压力的根源，需要儿科医生的建议和支持。
