Is your child starting to have more accidents? Or acting as though they’ve forgotten their potty training completely? Then your child is experiencing a setback in potty training. Don’t worry you are not alone, because like you, I had the same problem with my 3 year-old son. I am sure, like me, you started searching the internet, asking your pediatrician, and care giver for some explanations and solutions but are coming up short. To save you time and extensive research, below is what I’ve found out on the topic.
Before I continue, please keep in mind that setbacks happen and are more common than you think. Do not think you made a parenting mistake, because there is no instant potty training program or technique that will potty train your child over night or over a weekend. Like weight loss, it requires continuous work, persistence, and patience for months, if not years, to completely potty train your child. As explained by Barbara J. Howard, MD, FAAP, “The point is, toilet-training setbacks happen to most children in one form or another, through such issues are rarely discussed outside the family. Toilet training is an ongoing learning process for your child, not a cut-and-dried program that is completed in a couple of weeks. You will probably find that your child’s problem is not unusual. The sooner you can ascertain its cause and provide the appropriate support, the better for your child[i].”
The first thing to consider when you are trying to ascertain the cause of your child’s setback is whether, the setback is caused by physical, emotional, social, or cognitive challenges. Once you determine the cause of the setback, then you can begin to solve the issue.
Physical Challenges
The causes of your child’s setback can be physical. They could be experiencing a urinary tract infection, constipation, or fecal soiling. If you believe you child is having one of these issues, please consult your pediatrician immediately to determine your next step. The most common symptoms as described by the American Academy of Pediatrics, which will indicate whether, your child might have one of these physical challenges, are[ii]:
Urinary Tract Infection
Fever
Pain or burning during urination.
Urgent need to urinate, or wetting of underwear or bedding by a toilet-trained child.
Vomiting, refusal to eat.
Abdominal pain.
Side or back pain.
Foul-smelling urine.
Cloudy or bloody urine.
Poor growth.
Constipation
Child resists having bowel movements.
Complains that it hurts to poop.
Strains a great deal when defecates.
Urinates more than usual yet produces dry, hard stools.
Fecal Soiling
Referred to as Encopresis in children over the age of four.
Affects 1.5 percent of young school children.
With boys outnumbering girls by a ratio of six to one.
Occurs when emotional stress, resistance to toilet training, or physical pain during bowel movements causes a child to resist having bowl movements.
This resistance can cause the muscles involved in stool ejection to stretch, and nerve sensations in the area diminish, making it more difficult for the child to feel the need to defecate.
Congenital mega-colon or Hirschsprung’s disease (a congenital condition that prevents a child from feeling the sensation of having a full bowel), ulcerative colitis, allergies, or even a diet containing too many dairy products or high-fat foods can sometimes lead to accidental soiling.
If these physical causes have been eliminated then emotional or psychological causes should be considered.
These are a few physical challenges that may be the cause for your child’s setback in potty training. If you suspect your child is having any sort of physical issue then it is always best to take your child to their pediatrician for a medical examination.
Social and Environmental Challenges
If your pediatrician has ruled out any physical challenges that may be causing your child’s setback, then you may want to consider possible environmental or social obstacles. First thing you should consider is whether, all adults who are taking part in caring for your child are on the same page. As explained by Mark L. Wolraich, MD, FAAP, “Perhaps you have no problem with the fact that your four-year old is not yet toilet-trained, while his baby-sitter resents having to change diapers. Or you may be battling a recent rash of accidents by keeping your child on a regular bathroom schedule at home, only to find that she’s wet her pants at school because she wasn’t sent to the bathroom after lunch[iii].”
This is but one example of environmental and social conflicts your child may be having, other issues you might want to consider, are[iv]:
Multiple Households
Problems can arise if a child has two separate homes, usually from the result of parent’s separation or divorce. It is very important that both parents communicate and provide a consistent routine in both households.
Travel
A change in your child’s environment when traveling can cause a setback in your child’s potty training. Though, once the child has returned to her routine or gets use to the new routine, she may have some negative learned behavior, such as withholding stool or delaying urination, which can take up to weeks or months to correct. To avoid these setbacks, it is best to keep your child’s bathroom experience as close to their experience at home when traveling.
Emotional Issues
Emotional issues that cause setbacks in potty training, are the most difficult to address, since young children are unable to express their anxiety, confusion, or fear in words. These issues result from a major change in your child’s life to cause them to regress. These changes can be a new baby in the family, a move to a new house, family conflict, a new school or routine, or any other emotionally stressful situation can cause your child to revert back to an earlier level of potty training[v]. For toilet-trained children regression does not last long if parents respond calmly and use appropriate support and communicate with their child. If you identify the problem, sympathize with your child, find a practical solution, while clarifying your expectations regarding toile use, then you will find your child will respond more quickly.
I experienced regression with my three-year-old when his brother was born. Along with his brother’s birth, we also pulled him from day care and had a house full of guest visiting to see the new baby. Once we identified the problem was not physical, then I began to take steps to help him overcome his anxiety and regression. As suggested by American Academy of Pediatrics: Guide to Toilet Training, I put him back in diapers until he demonstrated behavior that he was ready to begin his toilet training again. These signs were, letting me know he soiled himself and periodically asking to use the potty. You may also need to find another approach to your method. The potty chart was no longer working for my son, so we started awarded him with pennies and nickels every time he used the potty.
Cognitive Challenges
Sometimes your child just may not be ready to be toilet trained. Like any other development, such as walking and talking, every child develops differently. Typically, girls are more likely to potty train at an earlier age then boys. My pediatrician said not to even begin to potty train my son until he turned three. The reason being, is that boys normally do not show any interest until 36 months, while girls begin to show interest by 18 – 20 months[vi]. Other issues may be that your child does not have the motor skills to pull up and down their paints, difficulty breaking focus in time to go to the bathroom, forgetfulness, or have an active imagination where they may be afraid of the toilet or flushing[vii].
If your child is demonstrating any of these signs, then it is best to view their issue from their point-of-view. Try not to criticize your child for something they cannot help, but instead use a series of brief, thoughtful conversations that may ease the situation[viii]. If bathroom time is a way of testing boundaries, then it is important to reinstate your rules and stand firmly behind them[ix].
Potty training is, in my opinion, one of the most difficult challenges I have come across in raising my sons. But like all other stages of your child’s life, it always seems worse when you’re in the thick of it! My advice, from one parent to the next, is be patient, creative, and always remember that within six months (sometimes a year) your child will be completely potty trained and ready for the next phase of their life!
[i] Wolriach, Mark L. with Sherill Tippins. American Academy of Pediatrics: Guide to Toilet Training. Bantam Books, New York: 2003, p 111.
[ii] Wolriach 111 – 124.
[iii] Wolriach 125.
[iv] Wolriach 127 – 129.
[v] Wolriach 129 -136.
[vi] Wolriach 36 – 38.
[vii] Wolriach 137.
[viii] Wolriach 137.
[ix] Wolriach 138.