A 4-year-old who still has accidents

Posted by Barbara F. Meltz  January 25, 2011 06:00 AM

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Hi, Barbara:

I wonder if you could tell me if my daughter's behavior is not atypical for her age, and also what is the best way to handle it. My daughter is four and a half, and while she has never wet the bed, she still on occasion has accidents. I don't mean those little I-didn't-quite-make-it-to-the-bathroom accidents; I mean a-gallon-of-pee-all-over-the-new-couch accidents. I had thought we had finally gotten beyond this, as she hadn't had one of these episodes in a couple of months, but then today the floodgates opened once more.

When a child is two or three and just being potty-trained, accidents are to be expected. I know that the appropriate response is to be matter-of-fact about the slip and to find the positive. I've certainly tried that even up through age four: "Gee, you didn't make it to the toilet on time, but at least you made it to the bathroom, which is a good thing." But finding the positive is not always easy, or - looking at my sad couch right now -- even possible.

I don't know if it is significant, but we adopted our little girl from another country when she was about 12 months old. She's reasonably bright, though socially she is a bit young for her age compared to her classmates.

I'm just wondering if, at her age, I should be using different tactics to help her (and me!) with this. The responses that work well with a three-year-old are perhaps not as effective with a preschooler. Thank you for any advice on this "sticky" problem!

From: Adoptive mom, Georgetown

Dear Adoptive Mom,

There are a number of possibilities for you to explore:

1. Urinary tract infection. If she's complained about pain or itching, and even if she hasn't, UTIs are not uncommon in girls this age, and it's worth checking out, even if just to rule it out.

2. Is there a stress in the family or extended family, someone sick or dying, out of work? Are you having a problem? Children pick up on our stress and it can cause regression.

3. Is there a stress in her life, maybe something at preschool? Is her favorite teacher or a best playmate leaving? Is there a pressure at school that may be stressing her out -- something she's being teased about because she is more "babyish" or not as accomplished as classmates? Is there conversation (already!?) about kindergarten and being "grown up"? Worry about kindergarten ("What if I can't do X....?") is often a source of regression. Ask teachers or caregivers if they are aware of any of these issues.

Underlying all of these issues, of course, is the fact of her adoption at 12 months old. Any of the events I've listed above could be a trigger for her to something that happened in the first year of her life that could, in turn, lead to these kind of accidents.

You don't want to respond in anger (even though you have to be feeling some of that!); you don't want to pretend this isn't a big deal because, at 4, she knows it is. In fact, you hit the nail on the head when you wonder if your response needs to be different because she is older. Yes. At 4 1/2, she's not only cognitively more aware of her own abilities, but she's also more aware of the effect her behaviors have on those around her. She surely feels badly, even ashamed and humiliated, for ruining the brand new couch: "I'm 4 1/2 years old! Wetting the couch is what babies do, and I'm not a baby!"

A good starting point is to identify and acknowledge her feelings: "That must have made you feel bad yesterday when you wet the couch." That's likely going to lead somewhere, and your next response needs to be collaborative and supportive at the same time, so that she can be part of the solution. If she says, "Maybe I need to go to the bathroom every time before I sit on the couch," you can be sure she will do it willingly, rather than if you impose that as a new rule. Plus, coming up with the solution herself will give her the power and confidence she needs as a 4 1/2 year old. So ask her, "What ideas do you have about why this is happening? What ideas do you have so it won't happen again?"

Meanwhile, I would also tell her, "Let's talk to the pediatrician; sometimes there's a small infection and that's why accidents happen."

I answer a question from a reader every weekday. If you want help with some aspect of child-rearing, just write to me here.

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7 comments so far...
  1. Um, why is the 4-year-old on the couch? If she's watching TV, are you making sure to pause/turn off the TV regularly to encourage her to go to the bathroom when she needs to?
    Mine had accidents at older ages when they were absorbed in something and didn't want to stop in order to go to the bathroom. Or were so rapt they didn't even notice their bodily signals until it was an emergency and they couldn't walk without "letting go". And TV can definitely be that engrossing. So can other things. I don't want to turn this into an anti-TV rant.

    Posted by Reading mom January 25, 11 07:39 AM
  1. As an adoptive mom, I get twitchy when people assume any issue a kid has is because they are adopted. It can be a factor, but less often than you'd think. Don't neglect the obvious by assuming it is an adoption issue. Exhaust all the physical and attention related stuff first, then consider that her adoptedness might be a factor, especially since she was still relatively young when adopted.

    Posted by BMS January 25, 11 09:06 AM
  1. @Reading mom

    What do you mean, "why is the 4 year old on the couch?". Maybe she was only sitting there for a minute when it happened. Even if she was there for an hour, the writer said it hadn't happened for a couple of months, so when you have a four year old who regularly goes to the bathroom, you don't think you need to keep checking on them anymore.

    Also, I'm pretty anti-TV myself, but I doubt watching too much is the root of this little girl's problem, unless that is the only time it happens. I completely agree with the rest of your comments about kids waiting too long when they are absorbed in something; I have one that does the same. However, by stating "I don't want to turn this into an anti-TV rant", you did just that.

    Posted by mom2boys January 25, 11 11:52 AM
  1. My daughter had this problem all the way through the first month or two of kindergarten. Eventually, we started being more proactive in helping her avoid accidents. Whenever we noticed the tell-tale signs that she needed to go to the bathroom--we've all seen the little dance they do--we would just tell her that she *had* to at least try to do something in the toilet. She would insist she didn't need to go as she stomped all the way to the bathroom, and then she'd proceed to unleash what seemed like a gallon of liquid into the bowl.

    For whatever reason, she couldn't seem to sense that her bladder was full and needed us to tell her. Even now that she's closer to six, I still have to remind her to go, and accidents still happen on rare occasions. For her, I really think it's an attention issue. Whenever she's engrossed in an activity, she simply doesn't pay attention to her body.

    Aside from watching for the cues and sending her to the bathroom whenever you see them, I'd also recommend having regular times that your child goes to the bathroom. For us, it's at least once in the morning before school, once in the afternoon when she gets home from school and at least once in the evening before bed. Obviously, she goes on her own sometimes, but by having a schedule of regular times for her to go, it definitely decreased the chances of having an accident. Make it clear that she doesn't have to produce anything during these scheduled bathroom breaks, she just has to sit on the toilet and give it a chance. You'd be surprised how well that works. I've definitely noticed a marked improvement in recent months, and I think the regular schedule at school also helps tremendously.

    Posted by Robin January 25, 11 01:32 PM
  1. My daughter started wetting the bed at 6. Not every night but often enough. I had just gotten married, we moved to a new house and she started a new school so we thought it was psychological. Turns out she had constant urinary track infections and our pediatrician finally referred us to a pediatric urologist and we were in surgery a month later - she had severe congenital bladder malformation - both left and right ventricle vesicoureteral reflux - and everyone was surprised I was able to potty train her AND it didn't show up for so long. She has permanent kidney damage and a life time of not really knowing whether she has to urinate or not.
    Please do not discount getting checked medically.

    Posted by firstmomable January 25, 11 04:16 PM
  1. @Readingmom
    Because the *only* time a child will sit on the couch is when they're watching TV, right? That's the only reason I can understand for your first two sentences.

    My family had no couch within eyeshot (or, come to think of it, earshot) of the TV, yet somehow I spent quite a few hours of my (early) childhood curled up on the couch. And what was I doing, at such a tender age? Reading! Which is every bit as engrossing as TV-- but not nearly as reviled.

    TV gets a really, really bad rap on parenting blogs and boards and I'm at a loss to explain why any and all TV is bad. I remember watching the news when I was little, and my parents attempting to explain current events to a three year old. What damage was this supposed to have done to my brain?

    Posted by MNGrad June 6, 11 12:20 AM
  1. I am having this problem with my four year old son. He will be five in December. He sits and watches tv and will wet himself. Every time I can think of it I tell him to go to the bathroom and he has no problem going when I ask him to. But he forgets sometimes on his own, only when we are in the house. I use the tv as punishment since its the reason why he can't get up and go. I make him lay in bed without tv or a toy. He doesn't like it and cries but he still does it. I ask him why and he sits there and tries to make up excuses. Such as ...it was an accident or somebody was in the bathroom (mind you we have 2 bathrooms). I think I will take that advice and take him to the doctor. Im very irritated and tired of washing the nasty wet clothes. The bad thing about it he will walk around with the wet undies because he doesn't want to get in trouble. Smh...

    Posted by Irritated Mom July 6, 12 01:10 AM
 
7 comments so far...
  1. Um, why is the 4-year-old on the couch? If she's watching TV, are you making sure to pause/turn off the TV regularly to encourage her to go to the bathroom when she needs to?
    Mine had accidents at older ages when they were absorbed in something and didn't want to stop in order to go to the bathroom. Or were so rapt they didn't even notice their bodily signals until it was an emergency and they couldn't walk without "letting go". And TV can definitely be that engrossing. So can other things. I don't want to turn this into an anti-TV rant.

    Posted by Reading mom January 25, 11 07:39 AM
  1. As an adoptive mom, I get twitchy when people assume any issue a kid has is because they are adopted. It can be a factor, but less often than you'd think. Don't neglect the obvious by assuming it is an adoption issue. Exhaust all the physical and attention related stuff first, then consider that her adoptedness might be a factor, especially since she was still relatively young when adopted.

    Posted by BMS January 25, 11 09:06 AM
  1. @Reading mom

    What do you mean, "why is the 4 year old on the couch?". Maybe she was only sitting there for a minute when it happened. Even if she was there for an hour, the writer said it hadn't happened for a couple of months, so when you have a four year old who regularly goes to the bathroom, you don't think you need to keep checking on them anymore.

    Also, I'm pretty anti-TV myself, but I doubt watching too much is the root of this little girl's problem, unless that is the only time it happens. I completely agree with the rest of your comments about kids waiting too long when they are absorbed in something; I have one that does the same. However, by stating "I don't want to turn this into an anti-TV rant", you did just that.

    Posted by mom2boys January 25, 11 11:52 AM
  1. My daughter had this problem all the way through the first month or two of kindergarten. Eventually, we started being more proactive in helping her avoid accidents. Whenever we noticed the tell-tale signs that she needed to go to the bathroom--we've all seen the little dance they do--we would just tell her that she *had* to at least try to do something in the toilet. She would insist she didn't need to go as she stomped all the way to the bathroom, and then she'd proceed to unleash what seemed like a gallon of liquid into the bowl.

    For whatever reason, she couldn't seem to sense that her bladder was full and needed us to tell her. Even now that she's closer to six, I still have to remind her to go, and accidents still happen on rare occasions. For her, I really think it's an attention issue. Whenever she's engrossed in an activity, she simply doesn't pay attention to her body.

    Aside from watching for the cues and sending her to the bathroom whenever you see them, I'd also recommend having regular times that your child goes to the bathroom. For us, it's at least once in the morning before school, once in the afternoon when she gets home from school and at least once in the evening before bed. Obviously, she goes on her own sometimes, but by having a schedule of regular times for her to go, it definitely decreased the chances of having an accident. Make it clear that she doesn't have to produce anything during these scheduled bathroom breaks, she just has to sit on the toilet and give it a chance. You'd be surprised how well that works. I've definitely noticed a marked improvement in recent months, and I think the regular schedule at school also helps tremendously.

    Posted by Robin January 25, 11 01:32 PM
  1. My daughter started wetting the bed at 6. Not every night but often enough. I had just gotten married, we moved to a new house and she started a new school so we thought it was psychological. Turns out she had constant urinary track infections and our pediatrician finally referred us to a pediatric urologist and we were in surgery a month later - she had severe congenital bladder malformation - both left and right ventricle vesicoureteral reflux - and everyone was surprised I was able to potty train her AND it didn't show up for so long. She has permanent kidney damage and a life time of not really knowing whether she has to urinate or not.
    Please do not discount getting checked medically.

    Posted by firstmomable January 25, 11 04:16 PM
  1. @Readingmom
    Because the *only* time a child will sit on the couch is when they're watching TV, right? That's the only reason I can understand for your first two sentences.

    My family had no couch within eyeshot (or, come to think of it, earshot) of the TV, yet somehow I spent quite a few hours of my (early) childhood curled up on the couch. And what was I doing, at such a tender age? Reading! Which is every bit as engrossing as TV-- but not nearly as reviled.

    TV gets a really, really bad rap on parenting blogs and boards and I'm at a loss to explain why any and all TV is bad. I remember watching the news when I was little, and my parents attempting to explain current events to a three year old. What damage was this supposed to have done to my brain?

    Posted by MNGrad June 6, 11 12:20 AM
  1. I am having this problem with my four year old son. He will be five in December. He sits and watches tv and will wet himself. Every time I can think of it I tell him to go to the bathroom and he has no problem going when I ask him to. But he forgets sometimes on his own, only when we are in the house. I use the tv as punishment since its the reason why he can't get up and go. I make him lay in bed without tv or a toy. He doesn't like it and cries but he still does it. I ask him why and he sits there and tries to make up excuses. Such as ...it was an accident or somebody was in the bathroom (mind you we have 2 bathrooms). I think I will take that advice and take him to the doctor. Im very irritated and tired of washing the nasty wet clothes. The bad thing about it he will walk around with the wet undies because he doesn't want to get in trouble. Smh...

    Posted by Irritated Mom July 6, 12 01:10 AM
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Barbara F. Meltz is a freelance writer, parenting consultant, and author of "Put Yourself in Their Shoes: Understanding How Your Children See the World." She won several awards for her weekly "Child Caring" column in the Globe, including the 2008 American Psychological Association Print Excellence award. Barbara is available as a speaker for parent groups.

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