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Child Caring

Possible causes of toileting regression

Hi Barbara -

My 3 year old son has been fully potty trained since last fall. However, he has recently been having accidents and I can't figure out why, or, perhaps more importantly, figure out how to respond. The accidents are becoming fairly frequent - say, once or sometimes even twice a day. He will pee in his pants (sometimes just a little, sometimes quite a bit) and then tell me he needs new pants. So far my response has been to ask him why he peed in his pants (he doesn't seem to understand this question -- his response is usually along the lines of "because I need new pants"), and to remind him that he needs to pay attention to his body and use the potty when he needs to pee. Then I ask him to take off his wet clothes, put them in the laundry, and I help him get dry clothes.

Can you help me figure out what is going on, or if there is anything I can do to get him back on track? To give you some more background:
- There have been no changes at home, and no other changes in his behavior or temperament.
- He has not had any poop accidents, but he has recently started insisting on privacy when he poops.
- He does not seem to be particularly bothered by the accidents.
- I work part time, and when I am at work he is home with his sister and our wonderful nanny who has been with us since last summer.
- He does wear a diaper (and consistently uses it) at night, but otherwise he has been diaper free since October or so of last year.
- Prior to the past few weeks, he had several months with no accidents at all.
Thanks in advance!
From: Brooke

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Dear Brooke,

You're handling this just fine, but just to recap: Stay matter-of-fact when he has an accident; enlist his help; then move on. What's most important is that there is no punishment, no judgment on your part. Even though you can't pinpoint a stress, that doesn't mean that there isn't something in his young life that is bothering him; with any luck, it will pass and so, too, will the accidents.

In the meantime, I also asked Carlos Estrada, a pediatric urologist at Children’s Hospital and director of the Voiding Improvement Program, to weigh in. (This program is for children who have been trained and then regress. Watch this video.) He suggests putting your son on a schedule, where you take him to the bathroom every two or three hours, even if he insists he doesn't have to go. Tell him (again, matter-of-factly) that it's a way to help him avoid having an accident. Estrada also recommends trying to get a handle on consistency and frequency of his bowel movements, as much as he will allow, given that he wants his privacy which is, by the way, totally age appropriate.

Estrada says this what you describe is a fairly common scenario, especially among boys, especially among early-trainers. Nonetheless it's important to rule out any medical issues. He suggests asking your pediatrician for a referral to a pediatric urologist for a renal and bladder ultra sound that would screen for anatomical abnormalities.

"It's rare that there is an underlying, serious medical issue, but it would be a mistake not to make sure nothing else is going on," Estrada said in a phone interview.

So why does this happen? The cause of what you're describing is typically due to a child withholding or waiting too long to urinate which leads to irritation of the bladder. The other common cause is constipation. Even though you think he's pooping regularly, "he literally could be moving only the tip of the iceberg," said Estrada. "It's not unusual for parents of a child this age to lose track of what's happening in the bathroom."

In fact, constipation is what Estrada guesses will turn out to be the cause of your son's problem."If the rectum fills with stool, it expands to bother the bladder," he said. He would also recommend a stomach x-ray. He's particularly confident of this theory since you describe no behavioral changes, stress, or family issues.