Symptoms of “Potty” (Toilet) Training Problems
- Doing the pee-pee dance: your child waits until the last minute to use the restroom so that it is almost impossible for them to hold it.
- Withholding going to the bathroom: your child struggles to urinate or have a bowel movement. It may feel like they are intentionally not using the bathroom.
- Toileting accidents: your child stands and pees on the floor without realizing it. They may get up from playing and then realize that they’re wet.
- Having accidents when doing something fun: your child becomes so engaged in their play that they are unaware they need to use the bathroom and have an accident.
- Peeing out of defiance: your child pees on the carpet or poops in the closet
- Holding feces for a long time and becoming constipated: your child is holding their bowel movements for so long that you have sought help from a doctor.
- Wetting pants on purpose: your child knows how to use the restroom, you notice they will go to the bathroom in their pants intentionally
Causes of Toileting Accidents
Toilet training should begin with a child-oriented approach when a child is developmentally ready, often between 30 months and 3 to 4 years. We know both genetic and environmental influences can influence child development. When children are old enough to be potty trained have toileting accidents, take the time to consider why. Sometimes children do potty train but then experience a regression that could be related to one of the causes below.
Toilet training is a learning process. It is harder for some children than others. Children with special needs may have a harder time mastering potty training, but it can also be challenging for any child. This learning process is new and challenging. Positive reinforcement like earning prizes or special time works better than punishing, yelling, and expressing frustration. This process can also be very frustrating for many parents and teachers. As adults, you may get frustrated, and sometimes your child can tell even if you try to hide it.
When you see significant challenges or regression in potty training, the underlying problem could be sensory, perseveration, or power struggle/ need for control.
Three Questions to Ask Yourself About Your Child’s Persistent Toileting Accidents
Is my child is “wired differently” from a sensory perspective? That is, your child is less sensitive to bodily sensations, needing to go to the bathroom, the feeling of being wet, soiled or dirty and needing to bathe.
Your child seems to have less awareness of their body and when to go to the restroom. Some children’s sensory systems are developing differently, and they don’t feel the cues that one would typically feel to indicate a need to go to the restroom.
These children might not know what it feels like to “have to go pee.”
It is important to notice if your child is developmentally ready to potty train. Some children may feel the need to go to the bathroom from a young age. You may find that they go to a closet or corner to relieve themselves at 18 months old, 2 years old, 30 months. All children are different. Some children who are sensitive to being wet or soiled will let you know right away. Others may have a dirty diaper, and you have no idea. As you potty train, you may have an easier time with a child who does not want to be wet or soiled. They have sensory awareness and motivation to potty train.
Other children do not have the awareness or need to potty train. It feels inconvenient to them to stop playing. They do not realize the need to go to the bathroom or socially are not bothered by having an accident. This lack of awareness or need could be related to a broader developmental delay or a slower learning process for your child.
If you suspect it is more of a sensory need, an Occupational Therapist may be able to provide therapy for toileting.
Is my child struggling with perseveration or hyper-focus? This term means trouble shifting off a fun activity like the computer to do something less fun, like take a bathroom break.
In this case, you may find that your child has adequate control over their body but simply refuses to go because they are having so much fun. Some children may become distracted by something motivating and misjudge the time it will take to make it to the restroom, thus resulting in an accident.
Sometimes, children who have these challenges may have an inattentive profile. You may want to watch for other attention, focus, hyperactivity, and impulsivity challenges. They could be early indicators of ADHD. Other times, though, children just need practice when they struggle to shift from a fun activity to the bathroom. Going to clean up and change clothes is a much more time-consuming activity than taking a quick bathroom break. Be sure that your child is the one to put clothes in the laundry, get a clean-up wipe, get dressed again, etc. This process should not be punishing at all, just part of the routine.
If your child continues to have these accidents despite the clean-up routine, it may be helpful to get a timer or vibrating watch that will provide an additional alert that it is time to take a bathroom break. For some children, it is extremely hard to shift their attention and focus. Therefore it will help to have an additional signal to go potty.
Does my child want to be in control? Not going to the bathroom can be related to anger, defiance, or rigidity. Perhaps your child never does anything you suggest. In this case, children may restrict and withhold themselves from going to the bathroom in an effort to have control. Children cannot control very much in life, but they do ultimately control using the bathroom. You may see toileting regression from a previously potty trained or almost potty trained child.
Think about what is changing or new in your life. Is there a new sibling or added family conflict? If so, your child may be exerting control over what they can. Toileting is powerful in that a child can control it and that it does elicit strong responses from adults and family members. In this case, it will be important to give your child control in the areas you can and help manage the big emotions that your child is experiencing. Sometimes, play therapy can lead to more healthy expressions of emotions with a young child.
Make sure to talk with your child about feelings, be open and calm yourself, and reinforce the use of feeling words and expressing needs, fears, frustrations, and positive emotions.
Solutions for Toilet Training Accidents
The strategy to use depends on the reason for your child’s accidents. See our guide below based on the type of toileting issue.
- What to do about sensory toileting accidents: Work with your child to understand what going potty is all about. For example, you could review a book about understanding our bodies. Describe how digestion works, and even draw a picture together of what happens when you drink water all the way to having to go pee. Then talk about the feeling of needing to go potty. Many sensory impaired children have neurological issues that interfere with their ability to know when they have to go. Children with ASD and some with ADHD also have toileting accidents. Disorders like Cerebral Palsy and Down Syndrome may induce toileting issues. In that case, various online resources are provided below. Occupational therapy intervention may also be helpful.
- What to do about perseverating or hyper-focus toileting accidents: If your child is having so much fun that they forget to stop to use the bathroom, try these strategies. Devise a reminder system, such as a watch that vibrates on the hour to signal the need for a bathroom break. Then reward your child for trying to go to the bathroom each hour. Make this activity pleasant and positive, not punishing.When there are accidents, have wipes and tools needed to get cleaned up in the bathroom, and allow your child to do most of the clean-up (depending on appropriateness for your child’s age and ability). Cleaning up, washing hands, taking a shower, or depositing clothes in the washer can be good jobs for your child to get into the routine of doing. Again, these activities should be a part of an overall hygiene regimen, not punishment.
- What to do about control-related toileting accidents: Offering control to children in other areas can help to decrease accidents. Although this is a frustrating situation for a parent, it is very important that you do not lose your cool. Show your child that you are calm and flexible. Deliberately offer choices and be willing to negotiate on minor issues. Decide to let other rules and instructions go while you are working on this problem.Some children with emotional issues will want control within their environment. Elimination is within the child’s control.
In situations where a child has experienced trauma or a recent loss, a child may struggle with toileting. They may even smear feces or urinate on things. Children with emotional control issues require consistent support and nurturing. When you have concerns, seek help early and often.
When to Seek Help for Toileting Accidents
Should these strategies not go smoothly, first meet with the pediatrician to be sure no medical cause for accidents is present. Then seek out a professional, such as a behavioral therapist, play therapist, or psychotherapist, depending on the underlying causes for your child’s struggles. Get into a proactive routine to avoid frustration, shame, constipation, and bad habits.
Further Toileting Accident Resources
Books for Parents and Clinicians
Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.
Frank, Kim (2003). The handbook for helping kids with anxiety & stress.
Foxman, Paul (2004). The worried child: Recognizing anxiety in children and helping them heal.
Papolos, Demitri & Papolos, Janice (2002). The Bipolar Child: The definitive and reassuring guide to childhood’s most understood disorder.
Books for Kids with Anxiety
Zelinger, Laurie & Zelinger, Jordan (2014). Please explain anxiety to me.
Cook, Julia (2012). Wilma Jean and the worry machine.
Peters, Daniel B. (2013). From worrier to warrior: A guide to conquering your fears.
On-Line Resources for Toileting Problems
- Toilet training products: http://www.galaxy.com/rvw93474-41438/Toilet-Training-Made-Easy-Sinkems.htm
- More products: webehave.com
- Bedwetting solutions. THERApee: www.bedwettingtherapy.com
- Books for toilet training: http://www.parents.com/fun/entertainment/books/potty-training-books/
- Toilet training tips for children with disabilities: http://www.specialchild.com/tips06.html
- Alarms and adaptive equipment for older children bedwettinghelp.com
- or www.autismspeaks.org — look for Toileting Tool Kit.
- Toilet training for children with down syndrome: http://www.ds-health.com/train.htm
- Tips for children with autism: http://www.bbbautism.com/pdf/article_25_toilet_training.pdf
- Article from autism treatment network on toilet training https://www.autismspeaks.org/blog/2016/07/22/toilet-training-dilemma-our-6-year-old-fights-going-near-bathroom
- Article on dealing with constipation in children with autism Autism Speaks ATN/AIR-P Guide for Managing Constipation in Children
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