Potty Training & Bed Wetting

Sometime blog ideas just land in my lap. Such was the case this week. A couple of week’s ago I was consulting with a couple that was cautiously thinking about a second adoption. In the course of talking with them, they also asked about their son, adopted at three, who was struggling with bed wetting. He was now six and they were still up with him more nights than not. Then last week I received a FAQ about a child adopted at 2 ½ that was still not completely potty trained day or night at age 5. And the final nudge came from reading a fun blog on potty training struggles at The Accidental Mommy. OK, I can take the hint. This week I’ll write about pee and poop, and how to get it where you want it.

Actually, this brings back such memories. I can proudly say that they are now just memories since all four of my kids do their business in the potty. (Not much to be proud of since 3 of them are teens, but hey, with teens I don’t get much to brag about, so humor me.) I actually wrote an article on bedwetting that got picked up by the Associated Press and for a while, when you googled my name you would get a bunch of stuff on bed wetting. (Again, not much to brag about, but…)

I am not one to attribute all problems to adoption, but in fact, major trauma during the time when kids are beginning to take control over their bladder and bowels (potty training sound so much better, doesn’t it) can interfere with and complicate the process. And adoption, no matter how much better it might be for the child in the long run, is a major trauma to a child. I haven’t read any studies that say that children adopted between the ages of 2 and 4 are more likely to struggle with potty training, but anecdotally, I believe this to be true. If your child is newly adopted, don’t worry about accidents or regression. This blog is not intended to talk about this situation. Best bet, is establish routines, offer unconditional love and quickly respond to your child’s needs. This blog is aimed for kids that have been in the home a while and that you believe are capable of being toilet trained.

There is no one perfect solution that will work for all children. Your situation is unique, and so is your child, but I can share a philosophy and a few tricks that might help. Daytime and nighttime wetting are usually two entirely different things, and should be handled differently. I’ll start with daytime wetting. First, if your child is younger than 3 ½ don’t worry about it. The ability to control bodily functions is a combination of physical and mental maturity, physical development, temperament, and environment, and each child will reach this milestone at a different time. If your 3 ½ year old is still having frequent daytime accidents, make sure there are no medical reasons interfering. Absent medical problems, most children are moving very steadily towards daytime control by the time they are 3 and at the latest four years old. Of course, lots of kids have an occasional slip up when they are having fun and don’t want to stop to go pee, or when they don’t want to ask for permission to leave the classroom, or when they don’t want to go poop away from home, or when they just plain forget. For those cases, simply reminding them or having a mandatory pee break usually works. One commenter at The Accidental Mommy suggested giving the child a watch and set it to beep every hour to remind him to go to the bathroom. I really liked that idea because it puts the responsibility on the child to remember to go to the bathroom. Setting it every hour seemed a bit excessive, but you get the idea.

But sometimes the failure to potty train during the day means this issue has become a power struggle between parent and child. My basic rule for power struggles is to sidestep them when possible, but when you can’t avoid them, make darn sure you win. Your kid has control over what goes in and comes out of his body, so you will lose this battle every time. If youc an’t win, then don’t let this be a battle. Daytime accidents can also be an attention getting activity. Think about it, mommy or the teacher has to stop what they are doing and give little Suzy one on one attention. At some schools they give the child a new pair of underpants, and hey, free stuff is pretty cool.

The most important step to helping your child achieve daytime control after the age of 3 ½ or so is a parental attitude shift. Going to the bathroom is your child’s problem and achievement, not yours. Absent power struggles or attention craving, most kids don’t want to pee or poop on themselves. Your role is minimal, although I strongly encourage you to simplify your life and stay close to home while you implement this new attitude.

Since it is your child’s issue, your child should handle as much of the hassle associated with accidents as possible. They should change their clothes on their own and put the wet clothes in the washing machine. If their underpants are dirty they should rinse them in the toilet. (You do need to supervise this, and if your child is one of those that likes to play in their poop, I wouldn’t let them do it.) They should clean up any puddles. Feel free to set a high standard for cleanup since there can be an odor and stain issue. The most important part of turning this responsibility over to your child is your attitude. This is not a punishment, and your attitude should not be punitive. You are simply acknowledging that your child is ultimately in charge of his daytime bathroom habits, and being in charge means taking care of the mess.

Although you can’t make your child go to the bathroom, you can give her incentives to want to avoid accidents. I give a lot of suggestions at the adoption resources page. If you are already in a power struggle with your little darling over this issue, I would wait a long while before I did any of the incentive suggestions, because your little darling might perceive these techniques as just another round in the battle. The key is to do all things in a matter of fact way, with no ulterior punishment motive.

Do not interfere with the natural consequences of failing to be potty trained. If you can’t take your child someplace because you aren’t convinced he can stay dry, then you hire a sitter, and explain that he will be able to come when he’s able to stay dry. Personally I would make sure I hired a very boring sitter. If your child can’t go to a particular pre-school or has to be in a younger class, fine. Don’t interfere or try to prevent this. It is a natural part of not being dry. Reassure your child that he will soon be able to control his pee and poop.

What to do about pull-ups during the day in a child over 4 that you believe is capable of going to the bathroom? The basic rule of thumb is that doing your business in the potty is what you do at this age. If you don’t, you are responsible for the hassle. How pull-ups fit into this strategy changes. For example, in the situation in the FAQ I received, the mother thought the child was enjoying the attention she was getting at school when she had an accident, and the child did not want to wear pull-ups. In that situation, I recommended that the mom insist on pull-ups until her daughter was dry for a week. . “We wear pull ups until we can be dry. Don’t worry, I’m sure you’ll be ready soon.” (I would also work with the school so that the child wasn’t being rewarded with attention for wetting herself.) However, in most other situations I don’t recommend pull-ups because they cut down on the hassle, and I want to maximize the hassle to encourage her that it is easier to go pee in the potty. If YOU need the child to wear pull-ups because you need to go someplace and know that an accident will cause work for you, then by all means, have your child wear them, but make them the exception to the rule.

As for nighttime wetting, I am convinced after all my research that the only logical and sanity preserving approach is to let nature take its course. Research has shown that almost all bedwetters stop on their own when their bladder has matured and sleep patterns changed. There is no research to show that the bed alarms work, and there is plenty of anecdotal evidence that they disrupt not only the child’s sleep, but the rest of the house as well.

But, once your child is 4 or so, you should not be up with him in the night to take care of a wet bed. Sleep is too important for being a happy and good parent. Your child should be taking care of herself and getting herself back to sleep in the middle of the night without waking you. In our house, we made sure we had good mattress protection (I bought the cheap ones and made sure I had an extra because we wore out quite a few), a pile of old large towels, and an extra blanket in their room. In the middle of the night if they woke up wet, they could put a few towels on the bed and go back to sleep or they could choose to sleep on the floor. (For whatever reason, most of my kids liked to sleep on the floor, so this was fine with them.) If they were prone to pee twice in the night, which most kids aren’t, I would make sure that there was plastic for them to spread under them if they chose the floor. The key is that you shouldn’t be awakened in the night to help. Let them brainstorm on what they need in the middle of the night to get themselves back to sleep. (One of my kids came up with the towel idea.)

Simplify your bedding. We used a bottom fitted sheet, a washable blanket, and no bedspread. This made clean up easier in the morning and remaking the bed easier at night. In the morning, if the bed was wet, the child was responsible for stripping the bed, wiping off the mattress pad, and putting everything in the washing machine. If I was upstairs, I might help them, but not always. Before bed, they got the bedding out of the dryer and remade the bed. I might help, but it wasn’t my job.

I don’t really know what to say about using pull-ups at night. We vacillated, which is probably not the best idea. At first we used them most of the time, but as the child got older and started staying dry more, we moved away from them. Even then, I would periodically get tired of washing bedding each day, and we would go back to them. The problem with pull-ups is they take away the negative consequence of feeling wet and uncomfortable, and might prolong bedwetting. I’m not sure that feeling wet does much to help a child stay dry at n ight, so it is entirely up to you and your child. For the most part, I’d let the child decide. Even though there is no evidence to show that it works, I would always wake my bedwetters up and take them to the bathroom before I went to sleep at 11:00 or so. I couldn’t help feeling that it would help to give them a fighting chance if we got every little bit of urine out. It didn’t work, but I still did it. Isn’t that the classic sign of stupidity—continuing to do what you know doesn’t work?!?

We never made a big deal out of bedwetting and we assured them that this was natural for some kids, and that they would eventually outgrow it when their bladder got bigger. At six, one of my kids was worried that he was still wetting the bed, so I explained it to him using two different sizes of balloons. The smaller balloon filled much faster than the larger balloon. He could understand that his bladder was like the smaller balloon. He seemed to accept his bladder was the size it was, just like his feet were the size they were.

My bedwetters always had pull-ups and a plastic bag to put the wet pull-up in for sleepovers. A friend of mine, who wet the bed until she was 13, told me that when she was almost 13, her mother told her that she could have new sheets and bed spread when she stopped wetting the bed. Apparently, that incentive helped her, because she got the bedspread within six months. I suppose that shows that sometimes a little motivation can help, but I wouldn’t try this until the child was much older.

Some experienced parents can be awfully smug, assuming that their way was the best way. I don’t think that. There is no one best way. If you are in the midst of a major power struggle with your child, don’t blame yourself. Some kids are gifted at sucking us into these struggles. It’s not too late to extricate yourself. I hope these suggestions help. If you are in the “been there, done that” crowd and actually read all the way through this blog, please share what worked for you.