Potty Learning -- Part Deux

Hooray, your child is finally potty trained! You've jumped a big hurdle in parenting. It is no surprise that many parents do a happy dance when their child has learned to use the potty and they can say good-bye to diapers. That all being said, most children will still have accidents from time to time and this is all considered normal. Sometimes there are problems that arise after potty training that may require a visit to your child's primary care provider for further evaluation and management. Keep reading below to find out what some of those problems may be.

One issue parents may encounter during toilet training is bedtime wetting. Now, let me stress that it is not uncommon for children to wet the bed at night during or after potty training. While your child can have bowel and bladder control during the day, it may take longer to achieve bedtime dryness. This usually resolves as the child gets older, which is unique to each child, as he or she will mature at their own pace. As an example, “20% of 5-year-olds, 10% of 7-year-olds, and 5% of 10-year-olds may continue to have bedtime wetting” episodes. The overall idea is that it should happen less frequently as your child gets older. What would be abnormal is if your child has achieved nighttime dryness for > 2 months and then, all of the sudden, he/she starts wetting the bed; or, if your child continues to wet the bed after age 7. There are plethora of possible reasons why this may happen including your child is a deep sleeper and does not awaken when her bladder is full, your child is still learning to hold and excrete urine well, she is constipated thereby putting pressure on her bladder leading to problems with her being able to hold and empty urine effectively, your child may be overly tired, responding to stresses or changes happening at home or she may have a minor illness, family history of wetting the bed (most children who continue to wet the bed have a parent who had the same problem when they were little), her bladder is too small or not fully developed to hold urine for an entire night, and, finally, she may have an underlying medical condition or problem.

So what can you do to help your child that wets the bed? Well, first and foremost, don’t blame or punish your child if she wets the bed as it’s not her fault it happened in the first place. Try not to make too big of deal that she wet the bed and reassure her that other kids struggle with it too. Be honest and open with your child letting her know that most kids will outgrow it. It is sometimes helpful to offer rewards for dry nights and offer encouragement and support for wet nights, again no punishment here. Finally, managing bed wetting for your child may even be as simple as making a few changes before bedtime to increase the chance she’ll get through the night without an accident--for example limiting large amounts of fluid about one to two hours before bedtime and making sure your she goes to the bathroom right before bed. If your child is seven years of age or older and is still having bedtime wetting after trying the managing techniques mentioned above for one to three months, it may be helpful trying a bed wetting alarm. We at ABC Pediatrics have found them to be very effective when used correctly. The best alarms are the ones with the sensor that goes directly in the underwear as they detect the instant urine hits the alarm thus waking your child so she can know that she needs to get up and use the bathroom (see here). Now, this will require some work on your part, as you will need to get up at night when the alarm goes off and walk your child to bathroom and reset alarm after. Despite this, we have had good success with our patients who have tried this alarm and many times they will achieve nighttime dryness within a few months. And, if that doesn’t work, and your child is older than 6 years old, there are some medications that can be tried, but often those are not the first-line option and they do have some side-effects. Depending upon the comfort level of your primary care provider, they may refer your child to a pediatric urologist (a doctor who specializes in genitourinary problems) before starting her on medication.

Another problem that may arise after toilet training are the occasional daytime wetting accidents. Picture this, your son is watching his favorite show when he comes running to you saying he’s had a “pee” accident. Or, your daughter is running around outside playing with her cousins and you notice that the front side of her pants are all wet. While frustrating for us as parents, these daytime wetting accidents are pretty common. The reason is that toddlers and preschoolers have difficulty sorting and prioritizing the enormous amounts of information and stimuli around them. What seems obvious to us as adults, “I have to go pee, I’ll stop watching my favorite show and do that quickly”, is not so obvious to toddlers and preschoolers. Just be sure that when they do have accidents, you don’t punish them for it, but they should take responsibility for it. What I mean by that is don’t make it too easy on them either. When they have a wetting accident they must stop what they are doing and help you change their clothes, put dirty clothes in laundry, and clean up any other mess, etc. This gives them ownership over the situation and may help them remember that the next time they feel like they have to go potty they will stop what they are doing to go do that because it’s much quicker to go pee in the potty than deal with an accident. While these occasional distracted daytime accidents are normal, what would be abnormal is if your child is complaining of urgency, is frequently having to go pee or is having pain with urination. Sometimes these symptoms can be indications of a urinary tract infection, constipation, or other disease processes. If your child is experiencing the aforementioned symptoms, please call us to schedule an appointment.

If your child begins having soiling accidents after she’s been potty trained, that can be a sign of encopresis (fecal incontinence or soling). If your child never fully toilet trains, this is termed primary encopresis, and is a completely different issue. Secondary encopresis, on the other hand, is a result of stool withholding which leads to severe constipation and lessens the child’s ability to hold in her stool ultimately leading to soiling accidents that she may not even be aware of. If this sounds like something your child is experiencing (see here) for more information. It is important you make an appointment for your child with us for further evaluation and management.

Well, there you have it. Everything you wanted (or didn’t want to know) about toilet training. I hope this information has been helpful to you and please don’t hesitate to contact us here at ABC Pediatrics with further questions.

Information present adapted from:

https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/Bedwetting.aspx

https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/Why-Accidents-Happen.aspx

https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Soiling-Encopresis.aspx