Toilet Training and Bedwetting Clinic with ERIC
Dealing with bedwetting, potty training and soiling in older children can be a stressful time.
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We were joined in the Coffee House by Eileen, an advisor at ERIC (Education and Resources for Improving Childhood Continence), to answer parents' questions on this issue, which can be emotive for both parent and child. Eileen's expert advice covered topics such as fear or toilets, dealing with confidence issues, the right time to potty train and where to get additional support for night-time soiling. You can read a summary of the webchat below:
My son, who is almost four, was toilet trained in October last year with no problems at all. Suddenly he has started pooing in his pants (not wee, which he still does on the toilet). I've tried threatening nappies, telling him only babies poo in their pants, and all he does is cry and tell me he doesn't want to wear nappies and he's not a baby. I've tried the sticker chart, which he can manage for one day before he forgets. I've tried promising him a treat if he can go for several days without accidents (he forgets after two days). I've got cross, I've stayed calm, I've said nothing, just put him on the toilet. About the only thing I haven't tried is making him wash out his own pants. I've even denied him television and computer games because he can't be bothered to get up to go when they're on. Nothing seems to work. He doesn't have a medical condition, his poos are perfectly normal, and he goes at about the same time each day, but when I ask him if he needs to go, he says no, then a couple of minutes later, he'll poo his pants. When I ask him if he's had an accident, he denies it, and refuses to let me change him. He doesn't seem to mind the feeling of it in his pants. I've got to the stage where I'm in tears every time, because I'm so frustrated.
This is a very common problem - he did very well to be trained and this is only a little setback. It is very important for you to handle this well at this stage. What you don't want him to do is to be put off using the toilet because he sees that you are cross with him. We probably will never know why he suddenly decided that he no longer wished to sit on the toilet but it will help if you give him lots of praise and support. As you know the time of day that he is his most likely to open his bowels or want a poo, I would suggest that it would be helpful to sit him on the toilet at those times and give him lots of activities to do. All the blowing games like bubbles, party horns and rocking backwards and forwards on the toilet encourage him to use his tummy muscles - the very same muscles that he needs to use to push poo out. Please ring the ERIC Helpline - 0845 370 8008 - if you would like further help.
My daughter is three and a half and we are having real problems. Unless we take her to the toilet every 20-30 minutes, we end up with accidents. She can wet her pants 3 times in an hour, but at other times she can last for a couple of hours without going. Does this mean she isn't ready to train, and if so, what do we do next?
All children are different and develop at different rates. ERIC's message is that potty training should be fun for both parent and child and should not be a stressful time. If sitting on the potty is fun then the child will want to continue to sit on it and when they are ready to do so potty training will be a success. When the time is right most children will happily take themselves to the potty. There is no way of hurrying this process along. This can be achieved by being relaxed - some children take longer but all children will have accidents. Try leaving the potty around as a reminder for the child to sit on it. But if your child is unable to hold wee in her bladder for an hour and a half, she is not yet ready for toilet training
My daughter is eight and still wets the bed most nights. We have tried alarms and tablets from the hospital - but have had no luck. She was dry for 18 months from two and a half, but a urine infection set her off wetting again. She has had scans and tests but no medical reason has been found. She wants to go to Brownie camp this year but won't be able to if she's still wetting ...
Your daughter has what is called secondary nocturnal enuresis - that is when bedwetting returns after a period of at least six months being dry. It is often triggered by a stressful event, which in your daughter’s case was a urinary tract infection. The treatment for secondary enuresis is the same as for primary enuresis.
It would be helpful to know why you think the alarm failed. The most common reason that parents tell us is that the children don’t wake to the alarm - but the rest of the household does. Sometimes, if the alarm is given to a child when they are not really ready or motivated to take responsibility for the alarm, then it is quite likely to be unsuccessful. In order for an alarm to be successful the child should be motivated to become dry and really wants the alarm; the child knows it is their alarm and their responsibility (with your support) and must be prepared for the hard work and waking needed for success. We know that the alarm has an overall success rate of 72% when the child has been correctly selected for this treatment.
My son will be three in March and is still in nappies. He has been diagnosed with autism and just doesn't seem to understand. I have tried potty training with no success.
Potty training can be a very complex business. For children with autism, toilet training will usually take longer. You will need to use different strategies to help him through this process. It is not uncommon for children with autism to have additional difficulties, so you may need to use pictures, signing and additional techniques as well as normal potty training strategies.
It is important that you do not delay the toilet training process due to the autism because the toilet training process will take a little longer. Please ring the ERIC helpline on from Monday to Thursday from 10am – 2pm. You will benefit from talking through strategies to deal with the problems - these are too complex to discuss on the forum.
My son will be four in April, starting school in September. He is fully potty trained with no accidents and dry by night. But he flatly refuses to go on the toilet, standing or sitting. How can I convince him to do so - I've tried trainer seats and bribery. He even uses the potty as his twin sister uses the toilet and still refuses to try to do the same. I need to get this sorted before he goes into school for his inset day in June.
Do you know of any reason why he should not like to sit on the toilet? Has he ever had a frightening experience that may have put him off? Some children find sitting on the toilet with their bottoms over that big gaping hole quite frightening. You may find it helpful to take other opportunities of sitting him on the toilet with the seat cover down, when perhaps undressing him or when you are getting ready for his bath. Another trick you can try is to get his favourite toy and let him see it sitting on the toilet quite happily. He has his sister as an excellent model and I feel sure he will sit on the toilet in his own time.
You will find it helpful to reward him for the stepping stones he takes towards this goal. You may need to try initially to reward him for sitting just for two or three seconds and just build upon this. We find that the lucky dip bag reward can be very effective – this works by allowing your child to have a dip in the bag for each small step he takes. Put small, wrapped, little things that you know he will like into the bag, also add little pieces of paper with money values which you can then transfer into pennies in a jar and also choose a picture of your family favourite activity and cut it into six small pieces and each time he pulls a piece out of the bag you stick it on a card and when the picture is complete you go for the family treat. Please don't be overly concerned - September is a fair time away and I'm sure he will make giant strides before then.
My daughter is four and has been dry since two years 9 months, but is still wet at night. She refuses to poo anywhere except in a nappy and if you try anything else she gets really upset and makes herself constipated. I have tried taking nappies away - but she then went five days without a poo. A couple off weeks ago we managed to get her to sit on the potty with a nappy on and do a poo - she did this for a week but won't now. We've tried reward charts, stickers, etc, but have had no joy.
We hear this story at ERIC so many times. It is understandable - young children have been using nappies for a poo ever since they can remember; they are very comfortable with this and change can come hard to some of them. The most important thing is that she is having a poo. At this stage it is not 'where' she is having a poo that is important. You can break the poo journey down into very small steps. You should always be pleased with poo no matter where it is, as it is very difficult for a young child to know whether you are displeased with the poo, or where she has done it. When an accident occurs, remain calm and relaxed, take you child to the toilet and put the poo into the toilet sending it home to poo land. Then say to your child: "next time you need a poo, you need to try and get poo to the toilet as quickly as possible so that poo can join his friends in poo land".
The second step is an acceptance that, for now, your child has chosen the nappy as a receptacle for the poo but you could ask her when she needs to poo, to go into the toilet. When your child is ready you may suggest sitting on the toilet with a nappy on - you will find many children make the transition in their own time when pressure is not applied.
My three year old seems to have gone backwards with her toilet training. We're fairly sure it's due to her baby brother coming home (he spent three months in the neonatal unit as he was born 11 weeks early) and now commanding lots of attention. Until three months or so ago she'd been completely dry, night and day, for at least six months apart from the very, very occasional accident. However she then started having accidents both night and day (this was about the time her brother started moving about and become more demanding.) Thankfully with a bit of patience the daytime ones have stopped again however she's wetting the bed at night at least twice a week. She stays over at her gran's every Friday night and occasionally Saturday night too but NEVER has an accident there (where she's the only child and gets all the attention). We're sure it's something psychological but any advice on how to handle it would be greatly appreciated
I think your little girl did really well to be dry at night when she was so young. So please don't think of it as going back - bedwetting (enuresis) is quite out of the child's control. We understand from research that the reason children are dry when away from home has something to do with sleep patterns.
You point out so well in your message that the new baby had considerable impact on your daughter and the way this has been expressed by her is through bedwetting. In our information about toilet training you will note that we say choose a time when you have a clear run with no major events coming up and we expressly say, for example, moving house and having a new baby are major events for anyone especially young children, so it is not surprising to ERIC that your daughter has begun bedwetting. Be reassured with praise and encouragement that she once again will become dry at night.
My two and a half year old daughter uses the potty every time she has to go, for both number ones and twos but as soon as she puts pants on she either wets herself or takes them off as she says she needs a wee even if she doesn't!
I think this may in some way be linked to the association your child makes between wearing pants and the nappy and it is all part of the process of potty training. She is doing very well and you can feel confident that she will develop an understanding soon. Try not to dwell on the wet pants and keep the fun in the potty training.
Is being four and a half and still in nappies at night considered a problem? I'm just not sure if my daughter will ever be dry through the night. Her nappies are always soaked by the morning. She still occasionally has wet knickers in the day too - any advice?
We would like to emphasise that a guide to readiness to be dry at night is when the nappy is becoming less wet. Most children will become dry at night spontaneously without any training but some children will suffer with bedwetting for a while longer and may require some interventions to help them to become dry. There is no right or wrong message about continuing to wear pull-ups - it depends upon individual circumstances and what you feel is right for you and your child. You may like to download the ERIC leaflet 'Bedwetting a guide for parents' which explains all about the reasons why bedwetting occurs and how to deal with it
We have been having serious problems with our three and a half year old and toilet training. She will go when we take her to the toilet and we have specific intervals during the day when we do that - 6.30am, 9.30am, 12.30pm, 3.30pm and 6pm before bed. She is always wet during the night in her nappy. Sometimes she goes willingly, sometimes she puts up quite a fight. Occasionally she will have an accident between times, and also if we forget to take her she will have an accident. The one thing she will not do is tell us when she needs to go, no matter what. It is driving me crazy.
Your daughter is able to hold wee in her bladder very well and is in effect toilet trained, however she has left the responsibility of the timing of her toileting to you! She has demonstrated when at nursery she can stay dry but does have the odd accident. I note she is often able to leave three hours between wees but needs prompting. It is not unusual for young children to ignore messages from both the bladder and bowel particularly when they get involved in activities.
You could try giving your daughter some responsibility to manage her own toileting. Rather than offering three-hourly prompts, how about asking your daughter to visit the toilet before meals, TV programmes or any other activity. Reward her when she remembers. Initially you may need to continue to remind her, but you will find over time the rewards will encourage to go to the toilet independently. Sometimes it can help to personalise the bathroom by doing little things like putting her name on the door, taking a favourite toy for a wee or getting nursery rhyme toilet paper to encourage her to want to go to the toilet by herself.
My four and a half year old son has been dry in the day from two years. For the last few months he has been wet when I've collected him from nursery. It is a substantial amount of wet as it wets his trousers as well, so not just a near miss, if a miss at all. I think nursery may be right in saying he's just missing when he needs to go, as today he was fidgety so I asked if he needed to go, he said no (engrossed in a game at the time). His Dad later noticed and asked him, then later again I did (probably an hour in all). When he finally went he did have some wet on his pants. I've spoken to him about it and he said he knew he wanted to go when we asked him, so I told him to go as soon as he feels he needs a wee, not wait, and that will help him not to have accidents. Am I doing the right thing and should I be doing anything else? Also, he is really upset about not being dry at night. I needed an alarm mattress as a child but our continence nurse has said it’s a bit too soon yet but he get so upset about it and says he'll never be able to do it. I think I had the mattress when I was four - would it do any harm to get him one? I think he would feel better if he knew something was happening.
It is not uncommon for children to have accidents during the day but I'm a little unsure what you mean when you say your son is 'missing'. Can I assume that he not paying particular attention to the message that he needs to wee when he is involved in play or other activities. As he is so concerned about the night time wetting I'm a little surprised that he is not more attentive during the day.
Children can have an overactive bladder - this can make them go to the toilet more frequently and urgently making it difficult for them to control and avoid accidents. If this is the case, then you need to encourage him to take a least 6 - 8 water-based drinks spread throughout the day as this will help to improve his bladder control. We would encourage you to take you son to the GP for a routine urine test and check for constipation. You may find it useful to ring the ERIC Helpline to discuss the issues in more depth on 0845 370 8008.
I would not be at all concerned about his night time wetting particularly as you yourself were late in getting dry at night. The disadvantage of using the mat alarm too early is that if it is unsuccessful then your son may not have confidence that it will help him when he gets older and more able to manage it. When a child has an alarm it should be the child's responsibility, with parents help. I think it would be fair to say most four year olds are a little too young for this responsibility.
My son is four and has been toilet trained successfully since just over three. He remains dry at night in pull-ups but when these are taken away he immediately wets the bed. I thought we had cracked it on his fourth birthday. He said he no longer wanted to wear pull-ups at night and only his pants. He seemed very excited by this and we put no pressure on him. Two weeks later, he had the smallest accident and now insists on going back into night pull-ups. It seems very much a confidence issue and I wondered how I should handle this, and instil a sense of confidence that if there is a little accident it does not matter. Incidentally - can you give me some tips on how to encourage wiping his own bottom after a poo?.
For some reason your son finds the security of having a pull-up gives him the confidence to remain dry at night. When you are feeling really strong you could try taking the pull-ups away or better still encourage him to make that decision for himself when he is ready.
The only tip I can give on wiping bottoms is that practice makes perfect, but wet wipes can help the process.
