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  1. #11
    Euphoric ! bright sparks's Avatar
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    Quote Originally Posted by kindredspirit View Post
    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.

  2. #12
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    Quote Originally Posted by bright sparks View Post
    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.

  3. #13
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    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.

  4. #14
    Euphoric ! bright sparks's Avatar
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    Quote Originally Posted by kindredspirit View Post
    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.

  5. #15
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    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/

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    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.

  7. #17
    For how long? I think you can take it to the present day. But, there is a very big But. We have to try to work together, without screaming or pointing, to try to push the baby into it. To make him aware of the need for his own actions. Perhaps it is necessary to do it purposefully in front of all, that he would learn from the experience of other children.

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