Abstract General Information

Title

FEAR AND REFUSAL TO DEFECT AND ITS LONG-TERM REPERCUSSIONS IN CHILDREN: A NARRATIVE LITERATURE REVIEW.

Introduction and objective

The process of acquiring sphincter control is an important milestone in the child's life, and also a challenging moment in which feelings of fear, shame and refusal to have a bowel movement can occur, possible fecal impaction, painful evacuation that reinforces the refusal and that can lead to constipation in the long term, bringing difficulties in toileting. Given the impact and the negative cycle generated by this behavior, it’s necessary to understand all aspects involved in its appearance, therefore the objective of this study was to identify and gather evidence on the factors that contribute to the development of fear and refusal behaviors to evacuation, as well as the long-term repercussions on children.

Method

A narrative review of the literature was carried out in the PubMED database, surveying the studies published in the last 10 years, based on the descriptors "Toilet Training", "Child", "Constipation", "Stool refusal" and "Toilet Refusal” with the boolean operator "AND".

Results

66 articles were found, 39 of which addressed specific treatments and associated disorders were excluded. 5 articles were obtained from the selected studies. 32 were included in this review were systematic reviews of the literature, clinical trials, case-control studies and cross-sectional studies. It was observed from the data that the main factors for the fear and refusal of the child to evacuate were the previous negative experiences with 40% and the Toilet training process with 28%, the other studies cited more factors associated and bring the direct link between fear and refusal to defecate with the development of long-term repercussions.

Conclusion

Data from the literature showed that the factors that contribute to the development of fearful behaviors and refusal to evacuate are negative experiences; pain; hard stools; evacuation learning process and toilet training; poor behavior by parents and caregivers in the children's learning process; intrinsic and extrinsic factors; bad eating habits; ineffective fluid intake and that these contribute significantly to the occurrence of functional constipation.