Heterogeneity of Diaper Dependency in Three to Six Year-old Children: Implications for Case Management
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A retrospective review of 395 charts of children referred for pediatric gastroenterologic evaluation of fecal soiling and other toileting difficulties revealed that thirty ( 8% ) of this series were children between 3 and 6 years of age who persisted in the use of diapers for urination and/or defecation. They could be categorized as those with permitted diaper dependency, whose parents were vague regarding use of the toilet and in their expectations for progress towards that goal, and those with contentious diaper dependency, whose parents' expectations and demands were abundantly clear, but met with stubborn resistance. Children with permitted diaper dependency are helped by clarification of the goals of age-appropriate toileting and strengthened demands for using the toilet instead of diapers. By contrast, increased pressure to give up diapers in children with contentious diaper dependency exacerbates parent-child conflict and may impede progress towards more mature toileting.