Children who hide while defecating before they have completed toilet training: a prospective study.

OBJECTIVE To examine the incidence and age at onset of hiding while defecating in children before they have been toilet trained and its association with difficulties in toilet training. DESIGN Prospective study. SETTING Suburban private pediatric practice. Subjects Three hundred seventy-eight children aged 17 to 19 months. METHODS Children were followed up by telephone interviews with the parents every 2 to 3 months until the child completed daytime toilet training. Children who were described at any follow-up telephone call as always or almost always hiding when defecating prior to completing toilet training were defined as the hiding group. The remainder of the children, who were described as never hiding or only sometimes hiding, was defined as the nonhiding group. RESULTS Two hundred sixty-three children (69.6%) met the criteria for the hiding group. The median age at initiation of hiding for the group was 22 months. Thirty-eight began hiding before toilet training was initiated and 64 started hiding after intensive toilet training had begun. The nonhiders (115 [30.4%]) were significantly less likely to have stool toileting refusal, frequent constipation, or stool withholding. They also completed toilet training at an earlier age than the hiders (34.5 +/- 5.9 months vs 38.1 +/- 5.9 months; P<.001). CONCLUSIONS The behavior of hiding while defecating before completion of toilet training is associated with stool toileting refusal, constipation, and stool withholding. These behaviors may make toilet training more difficult.