Stool-toileting refusal in preschool age children: A follow-up study

Background: Stool-toileting refusal in preschool-aged children is a signi ficant issue that strongly impacts both the child and the family, signaling a challenging period. We investigated the relationships between temperament, traumatic life events, parental sociodemographic characteristics, and psychological burdens and these behaviors. Our goal was to identify factors that may contribute to the chronicity of this stool-toileting refusal behavior. Methods: Conducted as a single -center, prospective, controlled design, the research involved children exhibiting stool-toileting refusal for at least one month, alongside healthy individuals of similar age and sex. Evaluation covered sociodemographic characteristics, parental psychopathologies, children's temperament features, and life events. Follow-up questionnaires, administered one year later, assessed stool-toileting refusal behavior. Findings: An evaluation at the end of one year revealed that stool-toileting refusal behavior persisted in 11 of the 31 children. A family history of constipation, comorbid enuresis in the child, maternal psychiatric disorders, and rhythmic temperament features were signi ficantly higher than in the healthy group. Children with persistent stool-toileting refusal behavior exhibited notably lower activity levels. Discussion: The study's results indicated associations between the TSC rhythmicity score, comorbid constipation and enuresis, and maternal psychiatric illness in preschool-aged children with stool-toileting refusal behavior. A notable association was identi fied between the continuation of stool-toileting refusal behavior and a low TSC activity score. Advanced statistical methods did not reveal signi ficant differences, highlighting the need for larger sample studies. Implications to practice: Applying the study's findings to clinical practice involves considering factors such as a family history of constipation, comorbid enuresis in the child, maternal psychiatric disorders, and rhythmic temperament features as potential indicators of persistent stool-toileting refusal in preschool-aged children, guiding healthcare professionals in tailored assessments and interventions. (c) 2024 Elsevier Inc. All rights reserved.