potty training help
November 4, 2020 4:46 AM   Subscribe

My daughter is almost four and is still having problems with the potty. Suggestions?

My daughter turns four a month from today. We've been actively potty training her for over a year and a half, and it's still not going well. She can use the toilet, but a lot of the time she just... chooses not to. She generally has at least one accident every day at daycare, plus another one at home. There have been days where she's had six or seven accidents in a day.

Daycare has been pretty helpful with us. They've been putting her on a timer so that she doesn't wait until she feels like she has to go, and that's helped a bit. Recently, though, what has been happening is that she'll walk toward the bathroom but have an accident on the way there. They've also been using stickers (she's obsessed with stickers) as positive reinforcement, but she doesn't always grasp the connection.

There have been a couple of recent developments that have complicated things. First, she's realized that having accidents upsets people, so she's started covering up when she does. Both my wife and I and the daycare teachers have stressed to her that she won't get in trouble and that it's better to tell someone than to hide it, but she does anyway. Second, there was an incident at daycare a few weeks ago where a classmate pulled a fire alarm while she was on the potty, and so for a while she was terrified of the bathroom. We thought we'd gotten over that, but she's regressing over the past few days.

We're at the point now where daycare is requiring her to wear pull-up diapers all the time so that she doesn't soil the classroom.

She has seen a chiropractor a few times in case there was something physical. That helped for a while, but every time we think she's getting it, she regresses. Her pediatrician has never flagged it as a problem, but it has been a few months since she's had a checkup. My wife got her in this afternoon for a visit, with an eye toward asking for a urology referral.

I should probably add that I'm a little sensitive on this subject, because I was myself a bedwetter into my teens. I'd really really really like to not have her go through that.

Has anyone else been through this? How did you get through it? This feels like a lot and I'm not sure what to do.
posted by anonymous to Education (16 answers total)
Friends of mine had this issue with their child much later than four; up to six or seven years I think.

By then, the issue was very verbal—something discussed amongst the whole family, with the child having clear reasons and justifications for 'accidents'.

Eventually they were able to speak to a specialist child psychologist in this area. One consultation was enough to reorient the situation. I don't think they are quite out of it yet, but there's been huge improvement.
posted by einekleine at 4:56 AM on November 4, 2020

Is she neurotypical? My kid has a sensory processing disorder and that was one of the ways it manifested - she didn't feel her body well enough to become aware of the peeing urge in time. (She is now 9 years old and has mastered the art of peeing.)
posted by Omnomnom at 5:47 AM on November 4, 2020 [2 favorites]

How are you using the stickers? We used a sticker chart somewhere visible near to the toilet, so our kid could see how many stickers they'd earned when they walked past. Can you offer a prized treat as a reward for X stickers on the sticker chart?
posted by EndsOfInvention at 7:07 AM on November 4, 2020

Also, we found that trying to convince the kid to proactively go to the toilet when they needed to wasn't as effective as having us (or the daycare people) pre-emptively remind them to go at specific points in the day when we new they'd need to go. For example recently they would be desperate to go right after we collected them from school, so we got the teacher to get them to use the toilet 15 mins before home time.
posted by EndsOfInvention at 7:09 AM on November 4, 2020

My kid was like that too. She didn't fully potty train (wipe her own poops) until she started kindergarten. She just didn't want to, nothing more. It kinda sucked, and yeah we washed a lot of pee clothes, but otherwise there were no problems.
posted by The_Vegetables at 7:10 AM on November 4, 2020

We went through this with our daughter (now almost 5) and we're still in it to some extent. Overall it's gotten much better, although there have been major regressions along the way due to external stressors.

Sensory processing disorder has been a major factor, and still is. Getting that addressed has helped somewhat, and also just helped us to be more patient.

Constipation can be a contributing factor. Even kids that go every day and don't have hard BMs can be constipated. Our daughter is on a low dose of Miralax because she's also a picky eater and it's the easiest way to handle it right now. If that's not a problem, including lots of pears etc. and cutting back on cheese might help. An abdominal x-ray would be one easy-ish way to look into this as you discuss it with your pediatrician, possibly even before urology.

Stickers helped for awhile, until they didn't. As she got older and more bored with stickers, we've had to tie the chart to longer term rewards to maintain motivation. The rewards change based on what she values most at the time - right now it's time with the Nintendo Switch.

Good luck. This has been the most stressful part of parenting for us so far, but it is getting better at almost 5. Know that you might feel like you're an outlier, there are other kids and parents that struggle with this.
posted by Knicke at 7:17 AM on November 4, 2020

My son is 8-years-old and still has a difficult with bedwetting. We've asked our pediatrician and she is less worried about it right now. She said that some kids develop that body awareness later* and physically don't realize it.

My son has sensory processing issues and (as suggested above) it might be related to the toilet issues. But he is also old enough that we've come up with a plan (e.g., I get him up before I go to bed for one last try at the toilet) and that has been successful.

At the same time, reminding yourself that the experts (pediatricians, occupational therapists) have said it is normal is not really comforting when you're up early putting wet sheets into the laundry for the 3rd time that week or sending another set of extra clothes to daycare.

I think it is worth checking in with your pediatrician and (depending on your child) looking into assessing for sensory process stuff. Unfortunately, though, kids develop at their own pace and it may resolve itself naturally with time.

* My 4-year-old is already potty-trained and doesn't have any issues with bedwetting or accidents at daycare, but he is a very different child. There are some 5-year-olds in his PK class that are in pull-ups either all-day or just during naptime.
posted by TofuGolem at 7:22 AM on November 4, 2020 [1 favorite]

I was already carrying my partner's child when his mother mentioned to me that none of her four children achieved nighttime dryness until they hit puberty. Night time wetting is a matter of vasopressin production and there are genetic links. Either the kid produces enough or they don't and all the training in the world is usually of no help. However in my case it appears I had a gene that blocked the one my partner carried. His children dried late but before they started kindergarten.

You might want to figure out how you will handle her being a bed wetter until she is in her teens in a way that will be simple and stress free to take the pressure off you and her. It might happen and if it does having routines to deal with it will make it less stressful. If your child is a night time bed wetter it should manifest as a completely different issue than daytime accidents. There is a good chance that it will not be a prolonged problem for you if your partner never had a problem with it.

One of the main causes of lack of urinary control is constipation. It is hard for a kid to differentiate between bowel and bladder control, clenching front and letting go of back, or clenching back and letting go of front takes some practice. Many adults still pee whenever they defecate. If a kids has no bowel control due to constipation they may resist toileting because they fear it will hurt and they may be used to ignoring signals because if they sit down they still can't control whether they defecate or not. Signals another child would think of as urgent might mean she still has a couple of days before it's going to happen.

Unless you have already ruled out constipation as a factor I would take your kid completely off any food that does not contain roughage - no white noodles, no white rice, no white bread, no cake, no cookies unless they are high fibre oatmeal cookies. I would also increase her fluid intake and introduce lots of high fibre food. You want your kid to be having soft easy movements all the time. When someone is constipated they will often have a hard bolus higher up and be passing small amounts of soft stool that can seep past the hard mass, so it looks like they are producing soft movements more often than hard ones. If your doctor agrees I would consider giving her pediatric dose stool softeners.

Does she have a potty? Get two of them for at home and have them in the rooms where she hangs out as well as the bedroom. That way if she knows it is happening she can get to the nearest one faster. Take the pee guard off it them if they have them to ensure she doesn't prang herself on it. If she gets hurt by the pee guard on a potty she is likely to hesitate to use it. It is quite likely that when the child makes a run for a bathroom and fails it is because she starts to make the run after the pee and/or feces have already started to come out. It's not that she is failing to get there fast enough, it's that she only realises she needs to get there once she feels it arriving in her underpants.

I would try a couple of intensive training days where the kid runs around bare butt and every successful wee gets her a nice reward of something to drink. You might want to do this every time there is a two day break from daycare. On those days you load her up with fluid: bran flakes cereal with lots of milk for breakfast and some juice on the side, a glass of milk soon after breakfast, soup for lunch and so on. The object is to get her to pee as often as possible that day, and give her as many successes as possible to help her with the motor memory involved. In some families pop or sweet drinks are only introduced and given to the kids while they are training as incentive to get them to drink more, and once the kid gets the hang of it, they are no longer provided.

The important thing at this point is not to get her trained, but rather to avoid any negative issues being created. Children who soil are in the highest risk group for child abuse, and are usually suffering badly from anxiety around their bowel and bladder habits and their own development and their relationship with others - shame, resentment etc. This means that when you bring issues with late training to the attention of your pediatric team they are usually willing to take it very seriously and not dismiss your concerns. Upset adults and anxious adults are contra indicated. You need to be totally chill about this with no scolding or shaming, or hand wringing, or earnest reassurances. Explaining to her that she is Good Girl and Daddy Knows She Tries So Hard is apt to create cognitive dissonance when she also knows that she is already supposed to have the same level of bowel and bladder control of her peers at daycare. Brief, matter of fact and unflappable is the way to go.

Anxious kids are more likely to have problems this way, and the less you reinforce their anxiety the more chance they have to find a good body rhythm where they can attain control. It is worth trying to make sure her life is one of comfortable routines and that she loves her day care and that her worries are very minor ones.

Another thing to watch out for is if she has trouble dressing and undressing. If she struggles to hold the skirt up and get the pants down, or if there is a cute outfit that requires fumbling and she is anxious not to get it wet she may be hesitating. She needs to be wearing stuff she can take down herself confidently. You may want to observer her both at home and day care until you are confident that there is no problem creating some hesitation or aversion. An example might be that if she is shy to leave circle time at the day care or has to line up to use the bathroom, or if she can't use the one bathroom at home when someone else is has closed the door for ten minutes. Another example may be if she theoretically has all the conditions for success and somehow there is an aiming issue and it all goes down her leg.

You can play games with her if you catch her with a full bladder, of getting her to pee a little and hold, pee a little and hold. This works better if she is on a potty than on a toilet.
Her pediatrician may want to check for urinary tract infections now or later, so playing a game of pee in the little jar but don't over flow it is good training.

Another game you can play is toilet training a doll or stuffed toy. Her plush flamingo can get a sticker chart too, with little coloured dots for elimination that happens outside of her clothes even if it ends up on the hall floor, for elimination that happens in the bathroom whether or not she gets her pants down on time and the cute sticker for in the bathroom-not in her clothes-AND- in the toilet or potty. A full score will net her two dots and the cute sticker. Use the same coloured dots for the same successes for consistencies sake.

Also remember to never punish for failures. If there are additional rewards they should not be granted for unbroken streaks but for total number of successes. Having to start over and aim for a streak is more discouraging than not getting any reward at all. So if she gets ten cute stickers for ten full successes she gets the reward even if there is an accident or two or seven before she makes the ten. It is demotivating if she gets nine full successes and one failure erases all that progress.
posted by Jane the Brown at 7:32 AM on November 4, 2020 [9 favorites]

Echoing EndsOfInvention, we used a reward chart with stickers and a prize. Basically a winding six-step path leading up to a picture of Ariel, which she got as a reward after six days of success. And we got new kitty stickers that she was only able to use on the chart.

And once we were confident that she was able to anticipate going potty, we had success with a pantsless weekend.
posted by Hermes32 at 8:14 AM on November 4, 2020

Have you discussed this with her pediatrician? I see you consulted a chiropractor, but a chiropractor is not a replacement for a qualified pediatrician. If there are physical reasons for her potty training delay, a pediatrician would be much more prepared to diagnose and assist you and your daughter.

You're lucky to have such a cooperative daycare, too. Many, if not most, will not accept 4 year olds who are not completely toilet trained. A 4 year old in my life had a urinary accident in preschool when he uncharacteristically fell asleep during naptime (he still needs pull-ups at night but never has accidents when awake) and the preschool said if it occurred regularly they would have to suspend his registration. They refused to use pullups, which I understand, but they do take him to the bathroom just before naptime. This has worked well.
posted by citygirl at 9:20 AM on November 4, 2020 [2 favorites]

I would just take this way, way, waaaay back. She's telling you she's not ready.

I was a little freaked out when my kid started his final year of preschool still in diapers, a little past 4 years old. I asked the director what to do and she counseled me to wait. "Some of them start this year in diapers," she said. "But none of them finish it in diapers." And she was right. Around 4.5 years old we tried potty training and it took a whopping week or two. I think my kid had two or three accidents total and then it was done. Easy peasy.

Wait six months and try again.
posted by BlahLaLa at 9:23 AM on November 4, 2020 [1 favorite]

This is pure speculation, but I have ADHD (only diagnosed as an adult) and I definitely had a tendency towards this around that age. I think it was that I'd get so absorbed in things that I'd notice "ok I need to go to the bathroom" and then get distracted again before I actually did. Maybe something to check out if other routes don't seem like they're making sense.
posted by augustimagination at 12:53 PM on November 4, 2020

Not being fully potty trained at 4 is within the normal range. I worked until recently in a school with four year olds, and accidents, and even pull-ups were something that were happening in all three of the four year old classrooms. If I were you, I would stick with the pull-ups for the time being, and also keep encouraging bathroom use. See what the doctor says, and follow some of the advice here. Know that just because you had an experience doesn't mean your kid will- it is easy to have that fear,and is 100% normal to have it, but try not to let it color what is going on currently with your child. Bedwetting is seperate from day time accidents, and you should try and keep them seperate in your mind.

One thing I did with my own kids was insist the sit on the toilet, even if the felt they didn't have to go. I would run the water on the sink once they were in position on the toilet, and that helped them to pee, and it got them familiar with the idea that they didn't have to wait until they felt the urge to use the bathroom. The other thing I found helpful was disposable pads for their bed- they went on top of the mattress, and caught any "accidents" and could be reused in case they didn't. It made for an easier middle of the night clean up.
posted by momochan at 2:03 PM on November 4, 2020

Just want to say I feel.your.pain as I have a similar child.

In our case it was constipation. Miralax did not help unless no bowel movements were happening. What worked for us was daily fiber pills.

I'm sorry, it is really a struggle.
posted by aetg at 2:25 PM on November 4, 2020

A lot of late potty-training issues can arise or get worse with constipation. Dr. Hodges at bedwettingandaccidents.com has lots of info (take a look at the blog posts first, lots of good explanations and strategies there). (I’ve read most of them plus the book so memail me if you want)
posted by CrazyLemonade at 11:57 AM on November 5, 2020

We went through this too and I'm not sure anything we did really helped. In the end, I think it's better to just relax about it a little. Remind her to go every X minutes/hours until she doesn't need reminders anymore. She'll get it eventually. Make sure not to shame her or let daycare shame her for something she can't totally control.
posted by callmejay at 4:31 PM on November 7, 2020

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