Sunday, June 1, 2014

Potty Training and Accidents in Preschoolers

How many of you parents out there dreaded and still do dread potty training? Maybe you tried the 3- Day-Potty method and it worked great, or maybe it didn't and it's 6 months later and you are back to square one.  We trained our 4 year old when she was 2.5 (read about our 3 day training here), and we lucked out in that it worked amazingly well and hasn't worn a diaper at night since.

But it doesn't always go that smooth for a lot of families.  Last week, being on our preschool parent committee, I helped interview new teachers to hire for the school.  One of the questions I asked was, "what is your philosophy on potty training, rewards and punishments?"

This question is a HUGE deal to me because I have strong feelings when it comes to potty training and shaming a child for 'not getting it.'

My first job out of college was as a preschool teacher, and I was so excited to be at an award winning school that was NAEYC accredited.  Well, my first week there, I was in the gym with our class and one of the 3 year olds had a pee pee accident on the floor.  An aide stepped in, SHAMED the child and made him go stand in the corner! I just.about.died. I marched right over to the director's office (after helping the poor child), and told her I refused to work at a school where the staff shamed a child for having an accident. She didn't seem to think it was a big deal, so I quit.  I was 22 and looking back maybe I could have made a difference if I stayed, but I was so shaken and upset about it all.

So with that being said, I felt like a blog post about potty accidents and possible causes was needed. Plus I also recently came across some medical articles about reasons children have accidents and thought I would share, since I feel so passionately about helping kids through this delicate but HUGE life milestone. (Pat Bass III, MD, MPH). Let's start with what causes accidents..

Urinary Accident Causes:

Whether your child can control their bladder or not has to do with their nervous system.  Ok, going to repeat this one because it's important.  YOUR CHILD'S ABILITY TO CONTROL THEIR BLADDER HAS TO DO WITH THEIR NERVOUS SYSTEM.  As the nervous system matures, the child's brain is able to get messages that her bladder is filling up.  It's a developmental milestone and nervous systems mature differently for all children, kind of like learning how to walk. Some may get it earlier than others.  There are also other medical causes like hormones, fluid retention (see below).

By age 5, 90% of children are able to get through the day and night without having an accident.  By age 10 it's about 5%.  So yes, there are still some 10 year olds out there that will be wetting the bed.  I have some family members that had this problem growing up and it was hard on them, especially when they had sleepovers, but thankfully they have special Pull-Ups now for big kids to help.

Other causes of daytime accidents:
  • Overactive Bladder:  Sometimes a child can hold the bladder so much that they exercise the muscle and it makes the bladder stronger, which isn't good for the urinary system.  The bladder can become so strong that it overpowers the muscles around the urethra and it can't hold back urine so they have an accident.
  • UTI: More common in girls, UTI's can also cause an overactive bladder

    Night Bedwetting:
    Getting through the night without an accident can take a little longer to master than daytime incontinence.  It's more common for children to wet the bed after age 5 than it is for them to have accidents during the day.  Here's what could be happening if your child is experiencing bedwetting:
    • It's hereditary:  If both parents experienced bedwetting, a child has an 80 percent chance of having problems staying dry at night.
    • Deep sleeper: Nighttime incontinence is also related to a child being a deep sleeper.
    • A smaller bladder: Your child’s bladder may simply be smaller than other children her age, which makes it easier for the bladder to become full and spill over.
    • Fluid retention: Children who wet the bed tend to retain more fluid than other children. Our bodies retain fluid for our organs, such as our heart. But when you lie down, your heart doesn’t need to work as hard and your body gets rid of the extra fluid. Children who are more active during the day retain more fluid than children who aren’t as active.
    • The internal alarm is still developing: We all have an internal alarm that wakes us when our bladder needs to be emptied. The alarm becomes stronger as the child gets older.
    • Hormones aren’t lowering urine levels:  Antidiuretic hormone is released at night to slow down the production of urine, but some children may not be producing enough of the hormone to stay dry while they sleep.
    • Anxiety: Anxiety and stressful events, such as a new baby sibling, can cause a child to take a longer time to potty train at night or cause a child who’s already potty trained to start having bladder problems.
    • Sleep apnea: If she’s having trouble breathing at night due to inflammation or an enlargement of her tonsils or adenoids, it could be causing nighttime incontinence. Often, treating the sleep apnea can also help keep her dry.

    Other Causes:

    Dr. Hodges, MD is a specialist that also states that a child that has daytime and night time accidents can be caused by constipation.  In most cases the cause is chronic holding of pee, poop or both. He believes that constipation issues are often the cause of pee pee accidents.  Holding pee thickens and irritates the bladder, causing spontaneous, forceful contractions like hiccups. Holding poop stretches the colon, which presses against the bladder and irritates the nerves feeding it. When you treat constipation aggressively, wetting episodes almost always cease.

    Dr. Hodges believes that constipation in children often goes unrecognized, even in children with grapefruit-sized poop masses lodged in their rectums.
    One of his patients was a 3.5 year old girl who was having "excessive" potty accidents; her previous doctor had missed a giant mass of stool in her rectum that made it impossible for her to stay dry. After she became his patient, he found her mass on an X-ray.

    Most kids with masses like hers poop DAILY (softer poop oozes around the hard mass), so no one is the wiser! Many doctors don't look for clogged rectums when patients present with accidents and bedwetting.  The answer is fueling your child with fiber rich foods and less processed, chicken nuggets and mac n cheese (I know, easier said than done.)  Since mine are the pickiest eaters on the planet and refuse all vegetables, I have them taking Juice Plus chewables and I signed up to sell it since it helps curb the cost :) You can read more about it here. Sorry, just had to throw in a plug there.  But it is my saving grace because without it, my kids would be more sick and definitely not be getting enough fiber.

    Also, here are a few books to help get your child to eat more fiber rich foods:

    Hope this helps some of you out there struggling with potty training your kids!  Hang in there, and if you need assistance with accidents and potty training, definitely talk to your doctor about options.


    1. This really helps shed some light on causes, as I had no idea about hormones and nervous system maturation. Thanks for posting!