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Old 09-04-2012
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Arrow Gyrus Daily Questions; Pediatrics #4

A previously healthy 3 year-old boy brought in by his parents for help with potty training. The boy refuses to use the toilet.If his parents try to place him on the toilet, he becomes upset and cries. He has regular urination in his diaper He has 1-2 soft bowel movements a day. In the office, you note that the child speaks in short sentences that are mostly understandable He runs well and can climb up on the examination table without hel.His physrcal examination is unremarkable. Which of the following is the next best step in the rnanagment of this patient ?

A) Increase fiber in the diet.
B) Put him on the toilet at regular scheduled times.
C) Use positive reward system.
D) Stop potty training attempts for several months.
E) Perform a urinalysis
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Old 09-04-2012
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Tough one I will go with Choice C

To make the kid happy
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Old 09-04-2012
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Hmmmm this is tough....... I say C because this might make him want to try but if that doesn't work then def. D, you don't want to traumatize the kid.
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Old 09-04-2012
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C again....
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Matched!!!
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D) Stop potty training attempts for several months.
The kid is obviously traumatized by his potty training. You need to de-escalate and re-start with C
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Answer is D .
Stop potty training for several months..

As child may not be ready - physiologically and developmently =- so wait for some time and restart training.

Ref Nelson 19 th edition P 33.

Preschool period.
Bowel and bladder control emerge during this period, with “readiness” for toileting having large individual and cultural variation. Girls tend to train faster and earlier than boys. Bed-wetting is normal up to age 4 yr in girls and age 5 yr in boys. Many children master toileting with ease, par -ticularly once they are able to verbalize their bodily needs. For others, toilet training can involve a protracted power struggle. Refusal to defecate in the toilet or potty is relatively common and can lead to constipation and parental frustration. Defusing the issue with a temporary cessation of training (and a return to diapers) often allows toilet mastery to proceed.
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Old 09-05-2012
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Quote:
Originally Posted by cingulate.gyrus View Post
A previously healthy 3 year-old boy brought in by his parents for help with potty training. The boy refuses to use the toilet.If his parents try to place him on the toilet, he becomes upset and cries. He has regular urination in his diaper He has 1-2 soft bowel movements a day. In the office, you note that the child speaks in short sentences that are mostly understandable He runs well and can climb up on the examination table without hel.His physrcal examination is unremarkable. Which of the following is the next best step in the rnanagment of this patient ?

A) Increase fiber in the diet.
B) Put him on the toilet at regular scheduled times.
C) Use positive reward system.
D) Stop potty training attempts for several months.
E) Perform a urinalysis
D.) no need to rush for potty training
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cingulate.gyrus (09-05-2012)



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