Daytime Wetting and Soiling
Children who refuse to be toilet trained either wet themselves, soil themselves, or try to hold back their bowel movements (thus becoming constipated). Many of these children also refuse to sit on the toilet or will use the toilet only if the parent brings up the subject and marches them into the bathroom. Any child who is older than 3 years, healthy, and not toilet trained after several months of trying can be assumed to be resistant to the process rather than undertrained. Consider how capable your child is at delaying a bowel movement (BM) until he (or she) is off the toilet and has had a chance to hide. More practice runs (as you used in toilet training) will not help. Instead, your child now needs full responsibility and some incentives to respark his motivation.
The most common cause of resistance to toilet training is that a child has been reminded or lectured too much. Some children have been forced to sit on the toilet against their will, occasionally for long periods of time. Others have been spanked or punished in other ways for not cooperating. Many parents make these mistakes, especially if they have a strong-willed child.
Most children younger than 5 or 6 years who have daytime wetting or soiling (encopresis) without any other symptoms are simply engaged in a power struggle with their parents. They can be helped with the following suggestions. (If your child holds back BMs and becomes constipated, medicines will also be needed. Ask your doctor for the Guide for Parents on stool holding.)
Transfer all responsibility to your child. Your child will decide to use the toilet only after he has realized that he has nothing left to resist. Have one last talk with him about the subject. Tell him that his body makes pee and poop every day and that it belongs to him. Explain that his pee and poop wants to go in the toilet, and his job is to help the pee and poop come out of his body. Tell your child you’re sorry you forced him to sit on the toilet or reminded him so much. Tell him from now on he doesn’t need any help. Then stop all talk about this subject (“potty talk”). Pretend you’re not worried about it. When your child stops receiving attention for nonperformance (not using the toilet), he will eventually decide to perform for attention.
Stop all reminders about using the toilet. Let your child decide when he needs to go to the bathroom. Don’t remind him to go to the bathroom nor ask if he needs to go. He knows what it feels like when he has to pee or poop and where the bathroom is. Reminders are a form of pressure, and pressure keeps the power struggle going. Stop all practice runs and never make him sit on the toilet against his will because these tactics always increase resistance. Don’t accompany your child into the bathroom or stand with him by the potty chair unless he asks you to. He needs to gain the feeling of success that comes from doing it his way.
Give incentives for using the toilet. Your main job is to find the right incentive. Special incentives, such as favorite sweets or video time, can be invaluable. When encouraging your child to use the toilet for BMs, initially err on the side of giving too much (several food treats each time). You can increase the potency of incentives by reducing your child’s access to them except when he uses the toilet. If you want a breakthrough, make your child an offer he can’t refuse, such as going somewhere special. In addition, give positive feedback, such as praise and
hugs every time your child uses the toilet. On successful days, consider taking 20 extra minutes to play a special game with your child or take him to his favorite playground.
Give stars for using the toilet. Get a calendar for your child and post it in a visible location. Have him place a star on it every time he uses the toilet. Keep this record of progress until your child has gone one month without any accidents.
Make the potty chair convenient. Be sure to keep the potty chair in the room your child usually plays in. This gives him a convenient visual reminder about his options whenever he feels the need to pass urine or stool. For wetting, the presence of the chair and the promise of treats will usually bring about a change in behavior. Don’t remind your child to use the potty chair even when he’s squirming and dancing to hold back the urine.
Replace diapers or pull-ups with underwear. Help your child pick out underwear with favorite cartoon or video characters on it. Then remind him that the characters “don’t like poop or pee on them.” This usually precipitates the correct decision on the part of the child. Persist with this plan even if your child wets the underwear. If your child holds back BMs, allow him access to diapers or pull-ups for BMs only. Preventing stool holding is very important.
Remind your child to change his clothes if he wets or soils himself. As soon as you notice that your child has wet or soiled pants, tell him to clean himself up. Your main role in this program is to enforce the rule: “people can’t walk around with messy pants.” If your child is wet, he can probably change into dry clothes by himself. If he is soiled, he will probably need your help with cleanup. If you child refuses to let you change him, ground him in his bedroom until he is ready.
Don’t punish or criticize your child for accidents. Respond gently to accidents, and do not allow siblings to tease the child. Pressure will only delay successful training, and it could cause secondary emotional problems. Your child needs you to be his ally.
Request that the preschool or day care staff use the same strategy. Ask your child’s teacher or day care provider to allow him to go to the bathroom any time he wants to and to take the same approach to accidents as you do. Keep an extra set of clean underwear at the school or with the day-care provider.
Call our office during regular hours if:
- Your child holds back his BMs or becomes constipated.
- He experiences pain or burning when he urinates.
- He is afraid to sit on the toilet or potty chair.
- Resistance has not decreased after one month on this program.
- Resistance has not stopped completely after three months.