Signs & Symptoms

Toileting Accidents

Is your child having accidents?

Does your child have frequent toileting accidents? Was he or she easy enough to toilet train initially but continues even on into kindergarten or first grade to have accidents during the day at school or at home during the night? You may find that your child wakes up with a wet bed or can’t have sleepovers for fear of accidents.

You may notice that your child stands and pees on the floor without realizing it. She may get up from playing and notice that she wet herself.

Alternately, your child may wet himself during times of emotional distress. It also could be that your child simply refuses to use the potty because he or she is enjoying playing and does not want to be bothered to go to the restroom.

What do challenges with Toileting Accidents look like?

  • Doing the Pee-Pee dance?
  • Withholding urine or feces?
  • Always running to the restroom at the last second?
  • Having toileting accidents?
  • Refusing to go potty unless you remind him?
  • Wetting his pants on purpose?
  • Having an accident whenever she is doing something fun?
  • Seeming defiant; deliberately peeing on the carpet?
  • Holding it so long you must see the doctor about constipation?

Why is Toileting Accidents happening?

Here, the underlying problem could be sensory, perseveration, or need for control. There are three questions to ask yourself if you are concerned about your child’s persistent toileting accidents.

 

  1. Is he or she “wired differently” from a sensory perspective? That is, is your child less sensitive to bodily sensations, the feeling of being dirty and needing to bathe? Does he or she seem to have less awareness of his or her body and need to go to the restroom? Some children’s sensory systems are developed differently, and they don’t feel the cues that one would typically feel to indicate a need to go to the restroom. These children might not know what it feels like to “have to go pee.” If you suspect it is more of a sensory need, an Occupational Therapist may be able to provide therapy for toileting and other Activities of Daily Living (ADL’s).           
  2. Does your child have trouble with perseveration or hyper-focus? This term means trouble shifting off of a fun activity like the computer to do something else like take a bathroom break. In this case, you may find that your child has adequate control over his body but simply refuses to go because he is having so much fun. Some children may become distracted by something motivating and misjudge the time it will take to make it to the restroom, thus resulting in an accident.
  3. Does he or she seem to want to be in control? Is not going to the bathroom related to anger, defiance, or rigidity? Perhaps your child never does anything you suggest. In this case, children may restrict and withhold themselves from going to the bathroom in an effort to have control. Children cannot control very much in life, but they do ultimately control using the bathroom. 

Any of these reasons is amenable to intervention. Typically occupational therapists or Applied Behavior Analysis (ABA) therapists help families with toileting issues.

How can I manage Toileting Accidents at home?

The strategy to use depends on the reason for your child’s accidents. See guide below based on the type of toileting issue.

  1. What to do about sensory toileting accidents: Work with your child to understand what going potty is all about. For example, you could review a book about understanding our bodies. Describe how digestion works, and even draw a picture together of what happens when you drink water all the way to having to go pee. Then talk about the feeling of needing to go potty.

Many sensory impaired children have neurological issues that are interfering with their ability to know when they have to go. Children with ASD and some with ADHD also have toileting accidents. Disorders like Cerebral Palsy and Down syndrome may induce toileting issues. In that case, a variety of on-line resources [2] is provided below. Occupational therapy intervention may also be helpful.

  1. What to do about perseverating or hyper-focus toileting accidents: If your child is having so much fun that he forgets to stop to use the bathroom, try these strategies. Devise a reminder system, such as a watch that vibrates on the hour to signal the need for a bathroom break. Then reward your child for trying to go to the bathroom each hour. Make this activity pleasant and positive, not punishing.

When there are accidents, have wipes and tools needed to get cleaned up in the bathroom, and allow your child to do most of the clean-up (depending on appropriateness for child’s age and ability). Cleaning up, washing hands, taking a shower, or depositing clothes in the washer can be good jobs for your child to get into the routine of doing. Again, these activities should be a part of an overall hygiene regimen, not punishment.

  1. What to do about control related toileting accidents: If your child is also having eating challenges, control is the likely culprit. Offering control to children in other areas can help to decrease accidents. Although this is a frustrating situation for a parent, it is very important that you do not lose your cool. Show your child that you are calm and flexible. Deliberately offer choices and be willing to negotiate on minor issues. Decide to let other rules and instructions go while you are working on this problem.

Some children with emotional issues will want control within their environment. Elimination is within the child’s control.

In situations where a child has experienced trauma or a recent loss, a child may struggle with toileting. They may even smear feces or urinate on things. Children with emotional control issues require consistent support and nurturing. When you have concerns, seek help early and often.

Should these strategies not go smoothly, first meet with the pediatrician, to be sure no medical cause for accidents is present. Then seek out a professional, such as a behavioral therapist or psychotherapist, depending on the underlying causes for your child’s struggles. Get into a proactive routine to avoid frustration, shame, constipation, and bad habits.

How can Clear Child Psychology help with Toileting Accidents?

If your child is struggling with this symptom to the point that it is getting in the way of his or her learning, relationships, or happiness, it’s time to seek professional help.

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