School age potty regression

[mattsmom]

I have a major vent here and I would appreciate your advice.

I have a 4.5 yr old that I have had since last May. He was totally potty trained when he started and only had a couple accidents in his transition to me from another daycare. After that, he did great.

Well, since the beginning of December, he has regressed so much in regards to potty training and it is getting so frustrating. His mom chalked it up to the excitement of the holidays for that month, but it has continued and gotten way worse. It is almost on a daily basis that he is peeing and pooing in his pants, at home, school (jk) and at my house.

I have tried everything from sending him constantly to the bathroom, using rewards and incentives for the few times he is doing well and trying to find out if anything is wrong and why he doesn't go to the bathroom when he needs to.

I asked mom if she would see if the doctor has advise or if there is something medically wrong and she just fluffs it off and says that they won't do anything.

Plus, when he has an accident and he is 10 ft from the washroom, I ask him why he didn't just go in, he shrugs his shoulders and says that he doesn't know. He shows no remorse or shame or anything. He is thinking this is normal now. since at school and home, they just clean him up and go on.

The question is, how long do I let this go on?

[Lee-Bee]

How was his transition into JK?

Is he stressed about school or anything at home?

Is he too scared/shy/worried to ask to go to the bathroom. What is the set up/system at school?

Something weird is going on. It's been a few months so it isn't merely a regression.

It may have started as a 'normal' regression and then he liked the responses he got so he's stuck with it, becoming a habit. But the fact it goes on is all settings seems suspicious. I can see him liking the attention/reaction he gets but ALL settings likely don't respond in the same way so I would think it would be limited to specific settings.

If you don't see any signs of anything going on (developmentally, medically) then try and put ALL negative impact on him. He changes his clothes, he gets new clothes, he washed the floor, cleans the poop off himself with no help. It will suck for you but just section him off somewhere that the impact is less on you (he has to stay on the tile bathroom floor until clean). See if that gives him less incentive. I would just caution that this is NOT appropriate for a child that has underlying disorders as it is punishing them for something that truly is out of their control. It's a perfectly fine consequence for a child that is being lazy or is just trying to be a 'pain' for kicks though!

[Van]

It sounds like it has turned into a habit, and he has to be re-trained to go to the toilet before he goes in his pants

[lemondrop]

I agree with Lee-Bee, but I would also change him into a diaper or pull-up the minute he stepped in my house. NO WAY would I put up with a child peeing and pooping all over my home.

[mattsmom]

I would just caution that this is NOT appropriate for a child that has underlying disorders as it is punishing them for something that truly is out of their control. It's a perfectly fine consequence for a child that is being lazy or is just trying to be a 'pain' for kicks though!

That's what I mean though, mom doesn't want to take him to dr to see if there is any underlying issues. She just expects me to put up with it, clean him up, oh and this is the kicker....she doesn't want me to punish him at all for it!

[Lee-Bee]

That's what I mean though, mom doesn't want to take him to dr to see if there is any underlying issues. She just expects me to put up with it, clean him up, oh and this is the kicker....she doesn't want me to punish him at all for it!

But the child isn't in mom's care. He is in your care and JK's care. Therefore there NEEDS to be a team effort.

Give her the clear expectation or terminate. If she wants NO punishment (discipline is a better term for what we are talking about) then she NEEDS to have him assessed and diagnosed with some sort of condition that clearly outlines that he is NOT in control of this.

If she is not willing to do that, then the child cleans up after himself. It's not punishment it is just the natural consequence of an older child, that has been fully toilet trained, choosing to be lazy. If I peed and pooped my pants no one at work is going to come along and clean me up. I'd be doing it myself. Therefore....I have no desire to do it! (though as a healthy adult I would be even less inclined if someone else was going to clean me up lol).

[bright sparks]

Maybe I am the exception as a mother of a boy who regressed after about 12 months of being accident-free. Do not put this kid back in diapers or pull-ups. If you aren't prepared to clean him up constantly then I absolutely understand, but give notice. My son went through at least 6 pairs of underwear A DAY in jk and sk. He wasn't bothered what people thought of him so there wasn't an incentive in the world that would make him go unless he wanted to.

We like to find out the cause of something or label a behaviour because then we have a greater chance of being able to "fix it" and solve the problem. This kid doesn't need to go to the doctors if there are no other things presenting with the regression. If the child was anxious, emotional beyond their norm or other things, then I'd say go to the doctors, but otherwise, you need to just be patient and in all likelihood terminate because it isn't manageable in group care.

My son wasn't a badly behaved child EVER. He is just a unique being who was lost in his head. No need to punish, just constantly reinforce what he should do and what he shouldn't do and try to condition him at the very least and in time he will come through it. This type of child is not always intentionally lazy it just isn't important to him. If he isn't upset by consequences now, then why do you think it's suddenly going to change now. Making this a huge negative issue multiple times a day would work within a few days for some children, but this type just doesn't care. I managed to deal with it once I let go of my expectations and realised that this was how it was and I had to just keep going until he snapped out of it. If this is stressing you out terminate. I can assure you that he cares a lot less about it than you do and while you are stressed out and frustrated, that will only make it worse.

[bright sparks]

That's what I mean though, mom doesn't want to take him to dr to see if there is any underlying issues. She just expects me to put up with it, clean him up, oh and this is the kicker....she doesn't want me to punish him at all for it!

She can expect what she likes, but ultimately it is up to you to set the tone for what is acceptable. Make a choice. She can expect it but it is down to you to make a choice and stick with it. You set the tone for her expectations based on your actions. I don't think punishment works with this type of thing either, but that is because I have experience and I tried the punishment route and it only caused more frustration for ME, and didn't make a damned bit of difference to the childs toileting.

[mattsmom]

She can expect what she likes, but ultimately it is up to you to set the tone for what is acceptable. Make a choice. She can expect it but it is down to you to make a choice and stick with it. You set the tone for her expectations based on your actions. I don't think punishment works with this type of thing either, but that is because I have experience and I tried the punishment route and it only caused more frustration for ME, and didn't make a damned bit of difference to the childs toileting.

I totally understand what you're saying,maybe it's different when it's your own child. I can deal with the odd accident, say, if we were out and he didn't get there on time or something like that. But when it's a daily/every other day thing and I'm constantly cleaning up a whole bowel movements/urine from him, it gets a bit frustrating.

It's hard because we love to go to the park after school and play, since we have been having good weather days lately. But we can't because he is always having accidents. Also, I am thinking towards the summer and when we go on all morning outings to parks/splashpads and programs farther from us. I can't have him pooping in his pants every time we go out somewhere nor am I going to bring everyone home because he can't control himself.

I just have to figure out if I'm willing to deal with this any further or terminate.

[kindredspirit]

She really needs to take him to the doctor! Sure, it could be behavioural, but incontinence can also be caused by UTIs, constipation (even if pooping regularly, there could be a mass in his rectum). And if it is behavioural, she can get professional advice.

If she refuses, and you decide to ride it out, definitely give him a bag, clothes and cleaning wipes and let him be independent. That is NOT a punishment, just a natural consequence. My 1.5yo helps wipe up if she pees through her trainers, and can put her wet trainers in the laundry basket (still needs me to clean up thoroughly, but she is only 1!).

[bright sparks]

She really needs to take him to the doctor! Sure, it could be behavioural, but incontinence can also be caused by UTIs, constipation (even if pooping regularly, there could be a mass in his rectum). And if it is behavioural, she can get professional advice.

If she refuses, and you decide to ride it out, definitely give him a bag, clothes and cleaning wipes and let him be independent. That is NOT a punishment, just a natural consequence. My 1.5yo helps wipe up if she pees through her trainers, and can put her wet trainers in the laundry basket (still needs me to clean up thoroughly, but she is only 1!).

I still don't think a visit to the doctors is necessary. Incontinence is not a common symptom of a UTI, frequent urination is a symptom which would result in more frequent accidents, but that is not incontinence. Second, of all, UTI results in smelly urine and the child would be in significant pain and have other symptoms after a lengthy period like this most commonly a fever. In terms of constipation, I don't see any mention of constipation from the OP so that is irrelevant but if there was a mass there would be other symptoms such as pain and fever. Don't get on at the parent to go to the Drs, its a waste of time and will cause more conflict between you and her. If anything, suggest she contact early years/ROCK for resources to help with toileting. Family Dr is not the best person to help with this and it is just one more person in the waiting room holding up patients who really need to see the Dr when there aren't any actual telltale signs that this child has a medical issue. Stop panicking and accept that some children fall outside of the norm but that doesn't mean there is "something wrong" that "needs to be fixed but that expectations need to be altered and a home daycare may not be the best environment for the child while going through this stage in toileting.

[kindredspirit]

I still don't think a visit to the doctors is necessary. Incontinence is not a common symptom of a UTI, frequent urination is a symptom which would result in more frequent accidents, but that is not incontinence. Second, of all, UTI results in smelly urine and the child would be in significant pain and have other symptoms after a lengthy period like this most commonly a fever. In terms of constipation, I don't see any mention of constipation from the OP so that is irrelevant but if there was a mass there would be other symptoms such as pain and fever. Don't get on at the parent to go to the Drs, its a waste of time and will cause more conflict between you and her. If anything, suggest she contact early years/ROCK for resources to help with toileting. Family Dr is not the best person to help with this and it is just one more person in the waiting room holding up patients who really need to see the Dr when there aren't any actual telltale signs that this child has a medical issue. Stop panicking and accept that some children fall outside of the norm but that doesn't mean there is "something wrong" that "needs to be fixed but that expectations need to be altered and a home daycare may not be the best environment for the child while going through this stage in toileting.

I'm a ER RN. It can be difficult to tell whether a child just isn't making it to the bathroom, or if they can't control it. UTIs can present atypically, not always smelly, not always an aggressive bacteria leading to fever, etc. If the child is incontinent of poop too, there could be underlying constipation (where stool is oozing out around a mass of impacted stool). Depending on the size, that can cause incontinence of both urine and stool. Eventually, when big enough, it would cause pain, but not fever. I've seen it on a 'just in case' X-ray.

I'm not saying there's something wrong with the child. All likelihood is that it is behavioural. But I think it is good practice to rule out any medical issue when a trained child of school age regresses for no apparent reason. If the child can't physically control it because of a medical issue, then behaviour modification approaches won't work, and that would be hard on the child too.

[Peacefulbird]

I know it is hard. Years ago I had a case almost like that. A day care provider did not potty train and the parents tried but life was in between so at 3 and a half close to four, the boy wasn't potty trained. Few caregivers rejected him because of this issue and at four years old I said "yes" I'll give a try. He started school and he had accidents.

First I was so grateful that the parents told me so I was aware of it. I just did a general development check list, then I took notes of his diet and water consumption and general activities.

And this is what I found. 1. He was overactive and needed to drink lots of water also eat a lot.

2. His fine motor skills weren't greatly developed and this happens with lots of boys. And mom was dressing him in nice tight jeans with clip and zipper.

3. Besides the water consumption he was eating to many fiber foods.

If you combine all the above it was a recipe for potty training disaster.

So. I started first. Working with mom in changing his diet. Then we started wearing old pijama bottoms. I followed with him the same routine as when I train my babies, reminding him, even when going to outdoor activities he will go to the potty before leaving the house and in the park as soon as we arrive (I have a folding potty), I encouraged him to drink small sips of water not all in one shot. I left intact his emotional integrity and respected him, he is a human being. I kept reminding him and increasing his self esteem. By the third day he was on his way to function normally. I kept following up (he even asked for his jeans back:0) I just explained those weren't the best for now but mom will get him a special ones when he is ready. And mom did she got the jeans with elastics. The teacher found a big improvement in his behaviour an he was happy.

Now, I think in your situation it is basically your choice; you can do the effort or you can not but, do not blame the.child. it is just some times they go through lot issues in their little heads or even phisically, some have small bladders, some haven't learned to listen to their body yet.

It takes a special person like us to understand and be patient isn't? Persistence is the key.

[bright sparks]

I'm a ER RN. It can be difficult to tell whether a child just isn't making it to the bathroom, or if they can't control it. UTIs can present atypically, not always smelly, not always an aggressive bacteria leading to fever, etc. If the child is incontinent of poop too, there could be underlying constipation (where stool is oozing out around a mass of impacted stool). Depending on the size, that can cause incontinence of both urine and stool. Eventually, when big enough, it would cause pain, but not fever. I've seen it on a 'just in case' X-ray.

I'm not saying there's something wrong with the child. All likelihood is that it is behavioural. But I think it is good practice to rule out any medical issue when a trained child of school age regresses for no apparent reason. If the child can't physically control it because of a medical issue, then behaviour modification approaches won't work, and that would be hard on the child too.

This regression started in December which pretty much rules out everything you have said in terms of bowel obstruction and UTI. Symptoms would not have stayed stable and consistent with either of these things for 12-16 weeks. I think an appointment with a dr would be good to talk about strategies for handling this behaviour if they were actually qualified and knowledgeable to do so, which they really aren't. Let's not encourage parents to be neurotic unnecessarily. In the first few weeks of the regression it was the time to rule out physical illness, 3-4 months in, it's common sense to understand that all indications point towards a behavioural issue. Perhaps because I have had first hand experience of this with my own child in addition to working for the NHS in the U.K. and community healthcare, I see no clear indication that there are any health issues to be concerned about. UTI and bowl obstruction would have caused excruciating pain long before the 3 & 4 month mark resulting in emergent care. No additional symptoms, why overthink this.

[kindredspirit]

This article references the kind of cases I was referring to, and offers a much more thorough explanation. Chronic, underlying medical issues that can impact continence.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2066129/

[Peacefulbird]

Can you start a journal? And start observing and write? That's what I did when I worked in centres. It is helpful to parents and also medical practicioners.

Record when usually happens the accidents and time. And what are his activities and what he eats. Record that information for about three days and you will see. Also notice how he behaves before the accidents and after.

Some times children can not express verbally what is botherig them but they do through their actions or behaviour.

If you find that his accidents are a routine then target those with reminders. If it is b.m. constipation then usually they become aggressive or unhappy. Then you can target that with a balanced diet plan, another think is at times they ignore to go to the bathroom because they are over stimulated (new toys, tv etc). If he cries constantly, tells you something is not working right.

And remember, their bodies still developing and that can also be the issue.