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4-year-old still having accidents

4 year old still having accidents

My daughter is 4 years and 3 months and potty trained at age 2. She was amazing and within 3 weeks she had mastered potty training and by the time she was 2.5 y.o she was dry at night too so we said goodbye to pull ups. 9 months after being completely potty trained she started nursery (school) and within 2 weeks of having started she started to wet herself and have a few soiling accidents too. She was very happy in nursery, I checked for urine infection but that was fine too. This potty regression lasted about 5 weeks and then it stopped at once when I started a sticker chart. I assumed it was transition stress related to having started nursery and having dropped her afternoon nap. She seems to go through this regression phase every 2-3 months now and I am at my wits end. I have tried everything from telling her off to ignoring, nothing seems to work. Within a week of starting pre-school she has started to have accidents again. She has even started to soil herself now and then and when in the bath! She does not seem bothered and she says she does know when she needs to go. I have promised her a treat on 2 separate occasions to see if she really knew when she needed to go and was just leaving it too late or if perhaps there was some other cause that she has no control of and in both occasion she did not have an accident all day. She is very happy in school and gets upset at the weekends when there is no school. I have even bought a vibrating watch especially designed for children with incontinence issues and set up hourly alarms to remind her to go but she just ignores it. We even left birthday parties when she had an accident so she could realize that there was a consequence to getting herself but she was upset for all but 5 seconds. I really don't know what else to try and would appreciate suggestions. Please help! 

We Gordon’s aren’t the best potty trainers. Some families and some children seem to quickly, effortlessly potty train - not us. We are certainly experienced now with 7 (maybe 8) potty trained children. So far our 6th child was the most difficult to potty train. He is super smart, but he just didn’t care. We declared him potty trained at 3 years and 7 months old (our latest). He continued to have accidents (frequently) until 6 years old. The accidents happened at church, in our van and at school. Yes, a very humbling experience for any parent.

We are taught in our training that a child is officially potty trained after being dry for 6 months. Wetting that occurs beyond that 6 month period is called “secondary” incontinence and should have a root cause - i.e. UTI, constipation or stress. I doubt your daughter has a “cause” since she seems to response (at least initially) to behavior modification. I still would recommend she see her pediatrician to be evaluated. Even if there is not a root “cause”, it is important for her to hear your concerns and for her to hear your pediatrician agree that this is not typical for her age.

With our son (and expect with your daughter), he got better with time and patience. You need to establish set times where she is expected to sit on the potty and “try”. Often upon waking, after breakfast, when arriving at school, before getting in the bathtub, etc. You can’t force her to go, but you can require her to “try”. I fear your daughter is refusing to “try” which is a discipline issue. Meet with her teachers as well to discuss this issue.

I agree with leaving the birthday party when she had an accident. She needs to realize the consequences of her lack of effort. In our home, children who have an “accident” while swimming are not allowed back in the pool. In contrast, when our younger children leave to pool to go the bathroom, we make sure they are rewarded with more swim time.

When we have a toddler in our home (pretty much all the time) we spend a lot of time talking about “babies” and “big kids” - often saying things like “Babies have to wear stinky diapers” or “ She looks like a “big girl”. I bet she keeps her panties dry all day”. We deny the title “big girl” or “big boy” to our children who have accidents. We’ll say “Your almost a big girl you do so many big girls things, but your still having accidents so you’re not there yet.”

You need to develop and detailed plan. What are you going to do if she refuses to “try”? What are you going to do if she wets? What are you going to do if she stays dry all day? This could be as simple as time out, leaving school or a party, changing her into clothes she doesn’t like, a sticker chart or natural consequences. If you know your next move, you will greatly decrease your stress.

My wife and I have been changing diapers and potty training children for 20 years now. We are starting to get some perspective (yeah we are getting old). I know it is hard, but you need to pull back emotionally. Screaming and tears are not going to make this process easier or help in anyway. You have not “failed as a parent” and she “won’t go off to college still potty training”. How do you want to remember this challenge? You want to remember your patience and perseverance. You want to remember the difficulties and how your family overcame them.

 

Written November 2015 by
Gregory Gordon MD, Orlando Pediatrician

 

 

 

 

 

 

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