My question is in regards to a soon to be four year old boy who was fully potty trained for well over a year during the day but has reversed and is now wetting himself several times a day.
There are no stress related or medical issues known and I am stumped. I have tried different approaches to help him gain control of this issue but they have not seemed to help him. We have used a sticker chart, ignored it, time outs, timers, praise, treats, etc. but nothing seems to work.
When he is asked "Why?" his reply is simply "Because I didn't go to the bathroom."
I feel like I am out of options and welcome some new suggestions.
Halifax, Nova Scotia
Poor little guy. Reading your post I went through a couple of issues in my mind and what I kept coming back to is an issue of power. Perhaps this is one thing the little guy can control?
Have you tried not making a big deal about it and said a simple 'oops!' and casually changed him? I wonder if the drama of wetting one's self were removed if the behaviour might change.
Sounds to me like you are doing a great job working through this with him. He is lucky to have you!
I would like to offer an alternative perspective to
the wetting issue you are describing. You said you “have tried different
approaches to help him gain control of this issue” but I have to wonder
if he is perhaps already in full control of the issue, and is choosing
(subconsciously or otherwise) to wet himself as an exercise in exerting
himself in one of the few avenues where a 4 year old truly does have
I will assume, given you have tried several strategies to address this, that a medical issue has already been ruled out by a doctor. So if, as you say, you have already attempted all of the tried and true methods to address the wetting issue, then you may want to take a step back from the issue of wetting itself, and take a critical look at his day from a perspective of autonomy and control. If he is in fact wetting as a statement of autonomy, then looking at incorporating more socially appropriate avenues to exert autonomy may meet the need that he is otherwise addressing through his wetting.
I would recommend taking a critical look at how the adult caregivers interact with the young person;
- Are the regular interactions collaborative or
- Are there enough choices offered over different areas of their life, or are the choices not meaningful to the young person or too limited in scope?
- Are schedules and routines followed willingly, or are they enforced?
- Are expectations discussed and mutually agreed upon, or are rules “handed down”?
- Do caregivers often allow the young person to lead the activity, make up the rules of the game, and guide the interaction, or is structure and rule adherence the paramount consideration?
- To sum all of the above, does the child have a voice, and is it heard and respected?
If the wetting is a statement (intended or not) of autonomy and control of self, then exploring other avenues in the life space where autonomy can be exercised may result in a decrease in the behaviour. If it hasn’t already become clear, this approach is not simply a treatment to discontinue once the wetting has stopped. Giving young people autonomy and the power of self-determination is a lifelong gift, and can only be given when caregivers tailor their approach with this end in mind.
Thank you for the stimulating question,
St. John’s, NL
We like to think we are in control of our kids but when it comes to food, we cannot force it in, and we cannot control when it comes back out! My advice is don't make a big deal out of it. Be aware of your own response and ask yourself 'Who is this a problem for, me or him?' If the answer is you, then you need to back off a bit. Meet him where he is at, and revert to training pants. He is still very young. In time he will make the transition.
I have a 5 & 3 year old that are currently going through the same issue. My wife and I are now using visual reminders as my oldest is autistic so he relates to these visuals very well, as does my 3 year old. Also having reminders on the hour using the visuals has decreased the wetting. I noticed wetting was at its worst when boys were so focused on something such as as playing a game or watching a TV programme. Recently we are also using social stories that we type up and read to the kids. These involve a written plan with visuals for the day ahead that incorporates a holistic approach to the day. Just keep encouraging and things will get better.
Hope this helps.
Is he in school yet or will he be starting school? How long has he been completely toileted before this started?
It’s not uncommon for some kids (particularly boys) to go back and forth on potty training until age 4. At age 4 and typically around the time they start kindergarten or nursery school the issues clear up all on their own, probably due to "peer pressure". Until there is another 'reason' for him not to pee in his pants, then he will continue to do so. The reward of social acceptance will outweigh a sticker or hot wheels car.
Is this your child or a child you're working with? Is he living with his biological parents or has he been removed? A child who has been removed from the home (at any age) can develop behaviors later on that are related to the removal however at the time there may be nothing the current caregivers can relate as stressful in the environment.
Motivations behind why any behavior occurs:
Medical (you've indicated this is not it)
Access to a tangible (the child that has a melt down to try and get you to buy a chocolate bar in the grocery store)
Escape (I don't want to do my homework so I will hide it, I don't want to listen to the teacher so I will scream at her until she kicks me out)
Sensory (It feels good/I like this better than that)
You will have to determine yourself why the child is wetting himself (if I had to guess it’s a combination of Escape and Sensory. "I don't want to use the toilet right now because what I'm doing is so much better", but there is an online questionnaire that you can fill out to determine a little bit better. Its called the MAS (Motivation Assessment Scale). By determining the motivation for a behavior you can better develop a method of intervention.
I've found asking a young child why they did a behavior that is not accepted typically leads to future lying, because the answer they give you for whatever their motivation was is usually scorned and looked down on. (Example: Asking why a kid hit another kid, there's no answer here that would be 'ok' and would encourage the child to be honest in the future. Usually you will start to get 'I dunno' and a shoulder shrug). So be aware of that when asking children why they did what they did.
First of all kudos to the suggestion to make sure medical causes are ruled out, and in general to the compassionate tone to the responses.
A few more:
*Make sure his pants are easy for him to use. ( Don't roll your eyes heavenward, in my experience with the same problem, a different kind of pants stopped it)
I'd see this as more of a need for direct nurturing and attention than a control issue although of course that could definitely be involved as well. Lucky him that there is kindness and gentleness shown in the changing process.
I'd think a 4 year old in placement would be quite anxious and missing any attachment figures he had. Perhaps the crux of it. So the more caring and attention he gets the better. Offer it to him as much as you can.
Make sure there are no hidden sources of anxiety - bullying and teasing from others, especially older children ? Ensure that he is protected from such.
Absolutely NO time outs, points, that kind of thing. That only exacerbates any underlying feelings that might be contributing.
A few 'preschool teacher' type suggestions:
- A routine. Preschoolers respond to routines, set
times for having the 'activities of daily living'. Snack time, bathroom
time, nap time, etc. Periodically and matter-of-factly asking him if
he'd like to go to use the bathroom. Accepting his response.
- Activities. My experience with 4 years olds in group care is that they are the youngest in a group of primarily older children and that the activities are not really suitable for 4 year olds. Of course that may or may not be the case here. But I'd certainly look at his daily experience.
So something to take a look at:
Are there lots of play opportunity with all kinds of materials ? Good opportunity for play contributes to a sense of mastery - and control if that indeed is an issue. and allows self- expression. May give some useful insights.
Water play may help ( fill up a sink or tub and let the youngster play in it with funnels, egg beaters, floating toys, etc. Clay play. Painting and coloring. Block play. Outdoors play.
If there's a lot of TV watching and technological play, try to reduce it.
Playmates. Are there others in his age group ? If so encourage them to play together.
Karen Vander Ven