1. Toilet Phobia and Toilet Refusal In Children
- Author
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Justine Niemczyk, Catharina Wagner, and Alexander von Gontard
- Subjects
Male ,medicine.medical_specialty ,Constipation ,media_common.quotation_subject ,030232 urology & nephrology ,03 medical and health sciences ,0302 clinical medicine ,Behavior Therapy ,Risk Factors ,Intellectual Disability ,Intellectual disability ,Avoidance Learning ,medicine ,Humans ,Outpatient clinic ,Girl ,Child ,Psychiatry ,media_common ,Toilet ,030219 obstetrics & reproductive medicine ,Phobias ,business.industry ,Toilet Training ,Infant ,University hospital ,medicine.disease ,Combined Modality Therapy ,Urinary Incontinence ,Phobic Disorders ,Attention Deficit and Disruptive Behavior Disorders ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Defecation ,Female ,medicine.symptom ,business ,Day Care, Medical ,Nocturnal Enuresis - Abstract
Objective: Toilet refusal syndrome (TRS) is a common disorder in toddlers, defined by use of diapers and refusal of toilet for defecation, while toilet phobia (TP) is a rare disorder in which toilets are avoided completely. Both disorders have not been described systematically in children, yet. Therefore, the aim was to present typical case vignettes illustrating different clinical presentations of TP and TRS. Methods: 5 typical cases were selected from all patients presented at a specialized outpatient clinic for incontinence at a tertiary university hospital during the last 3 years. Results: The first case is a girl with incontinence and no behavioral comorbidities, for whom treatment was more complicated than expected because of her TP. Second, a boy with an IQ on the border to mild intellectual disability will be presented, who revealed phobias regarding the toilet. Case 3 is exemplary for a group of patients with TRS, who also have ODD and show oppositional behavior in different situations. Cases 4 and 5 show “classical” TRS with constipation following painful defecation. Similarities and differences of TRS and TP, the current state of research, diagnostic and management recommendations are presented in detail. Conclusion: TRS in preschool children is a common condition, associated with high rates of constipation and behavioral problems. In contrast, TP is rarer and harder to recognize for pediatricians, but is often accompanied with somatic and behavioral problems, as well. Although there is a paucity of studies on these pediatric disorders, pediatricians should keep them in mind.
- Published
- 2016