Doesn't Break for Potties

Dear Parentworks,

Help - my 5 year old son has been potty trained for 2 years, but he still has accidents at least 4 or 5 times a week.  He says its because he doesn't want to take the time to stop playing (usually outside) and come in to use the potty, or he's afraid to ask where a potty is when in an unfamiliar place.  He's due to start kindergarten in 2 months - what do I do?

- Potty accidents with a 5 year old

Dear Accidents,

If someone were to put out a bumper sticker that showed a child playing and the words, "CAUTION: I Don't Brake for Potties", I'm sure stores would have a hard time keeping them in stock. So first, let me assure you, it does happen that 5 year olds, often boys, can have accidents and a frequent reason they give involves unwillingness to stop playing. Before proceeding any further, though, it is imperative that you consult with your pediatrician to make sure there are no underlying or undiagnosed medical conditions which may be involved in this situation. While I don’t have much detail from your letter to go on, let me provide some ways of looking at or approaching this issue:

Enuresis is the term used for involuntary urination, there can be a hereditary component – of the children who experience this,  40% had one parent and 70% had both parents who also experienced older age urination difficulties as children themselves. So you may want to touch base with the grandparents to see what your own experiences at this age were like. A few of the medical causes might involve small bladder – so the child can’t hold fluids as long as others, undeveloped muscle control or failure to fully empty the bladder when they do go. Determining if this is a medical or psychological concern is key to how you proceed with solutions.

It can also be useful to reflect on how the original potty training efforts went. The definition of potty training involves a child tuning in to their own body signals – awareness of fullness/pressure and responding to that signal from their body. If the situation is one where the parents were actually the ones who were trained to look for those signals or put the child on a set schedule that didn’t include their body signals – i.e. frequent reminding, waking the child up to take them to the potty in the night, etc., the child’s learning could have been more oriented to other’s external signals than their own internal ones.

If you determine there is no medical cause and that the child is aware of their body signals, has clothing that is easy to take on/off – developmentally capable, then a next area to look at can involve their personality style. In the January 2004 Editorial on Stress, the effect of Temperamental Traits on behavior are addressed. Part of your son’s way of dealing with his world could involve his being a very focused guy and not easily distracted. He may be so interested in what he’s doing that the signals from his body/bladder don’t make it to his brain because he’s using up most of his awareness in the activity he’s enjoying.  He might also be the kind of person who is slow to adapt to transitions or have difficulty switching from one thing to another. If these are part of his personality make up, it is important to understand that he may go through life having these traits affect many new tasks and challenges he encounters. If this is true, it is also important for you to accept this is part of who he is and rather than wishing he were different and being upset with him, instead helping teach him skills which are positive and take these styles into account.

The old saying “You can catch more flies with honey than with vinegar” applies to kids and potty training. He probably feels somewhat guilty for these accidents so remaining positive or at least neutral is vital – getting mad, frustrated or punishing won’t help. Also, knowing that no matter what, there are two major areas where we as parents don’t ultimately have control – that is over what a child eats (you can offer nutritious foods but if you force them to eat they can always throw up) and bowel/bladder control – it is absolutely up to the individual to regulate their bathroom habits and we cannot Make them go no matter how much we want it to happen. Because of this, these two areas are ripe for power struggles, kids learn very early on that they are the ultimate say in what goes in and comes out of their bodies. It’s a game we’ll never win so it’s best not to play and being neutral is one of the best ways to prevent yourself from being dragged into a power struggle.

So with all this in mind, here are some skills for you and for your child. As I mentioned above, you want to make sure he can get his clothes on/off very quickly. Next, whenever you initiate any change in the way you’ve parented your child, it’s a good idea to talk to them about it first. You can tell them something like, “You know how (describe how the situation has happened and what was done about it) well, here’s what’s going to happen now (describe in detail what will now happen and under what circumstances). This way, especially with kids who are slow to adapt to change, they have a heads up warning and know what to expect, consistent follow through by the parent is necessary for the child to trust that this new plan is the way things will be handled now.  To begin, some people allow their child to use a combination of underwear and Pull-ups – the underwear goes close to the skin so the child is aware of the wetness but the Pull-ups reduce messes. Let your child know that you will be helping him with ways for him to avoid having accidents but when they happen he needs to help clean them up (this is not a punishment but allowing the child to be part of the solution and consequences of his actions). Teach him ahead of time how to wash out his underwear or pants. Be specific in the necessary steps but know that as a child he will not be able to perform this task ideally and that an adult will need to rewash them later. Become aware of your child’s intake of liquids as well as determining if there is any regularity to how long it takes for liquids to make their way from entry to exit. At home, set a timer for him for this time frame i.e. if it routinely takes him 4 hours to relieve himself after breakfast’s milk/juice then use that, otherwise try a regular pattern of 2 hours (experiment with the time until one seems useful). When the timer goes off, your son needs to stop what he’s doing and go to the bathroom. This helps take you out of the loop and it’s the Timer reminding him, not you. At other people’s houses, he should not be on his own with figuring out where the facilities are located. Either go in with him and find them together or alert the adult that your son needs to know this information before he begins playing. Always provide a backpack with spare clothes and plastic bags so he can clean up and change on his own. Assure him that any adult, especially friend’s parents, are open to answering his questions for directions. Don’t talk with him about school and his need to be completely trained by the time it starts, some children have accidents because they are under stress. You can ask the school what their policy is and know that the backpack/change of clothes solution can give him some control over the situation if he needs to remedy an accident. For many children, once they begin school, seeing everyone else using the restrooms regularly – teachers at this grade are usually very good at reminding – children want to be like everyone else and will get the hang of things. Many people think the process of potty training begins around two years old and ends around three but in actuality, it’s a pretty ongoing process that can last well into the  four’s (proper cleaning achieved) and in some cases can continue sporadically until seven. As long as you’ve address any medical concerns, with your loving, gentle support, your son will eventually master this.